A Simplified Modification of the Henderson Extensor Carpi Ulnaris Opposition Transfer


      There are several potential donor muscle–tendon units for a thumb opposition transfer. The extensor carpi ulnaris (ECU) is useful when the more usual donor units are not available. The technique and results of a simplified ECU opposition transfer elongated with a free tendon graft are described.


      Ten ECU opposition transfers were performed using this modification of Henderson technique in 5 adults after complex trauma, 3 adults with median and ulnar nerve palsies, and 2 children with congenital hand differences.


      Seven patients achieved a Kapandji opposition score of 6 to the distal phalanx of the small finger, and 3 patients achieved a Kapandji score of 5 to the distal phalanx of the ring finger. None of the patients required a secondary tenolysis or developed a radial deviation imbalance of their wrist.


      This modification of the Henderson technique using ECU elongated with a free tendon graft and inserted directly and only into the abductor pollicis brevis tendon is an effective method of restoring opposition to the thumb, especially when other conventional donor muscle–tendon units are not available.

      Type of study/level of evidence

      Therapeutic V.

      Key words

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        • Kirklin J.W.
        • Thomas Jr., C.G.
        Opponents transplant; an analysis of the methods employed and results obtained in 75 cases.
        Surg Gynecol Obstet. 1948; 86: 213-223
        • Burkhalter W.
        • Christensen R.C.
        • Brown P.
        Extensor indicis proprius opponensplasty.
        J Bone Joint Surg Am. 1973; 55: 725-732
        • Schneider L.H.
        Opponensplasty using the extensor digiti minimi.
        J Bone Joint Surg Am. 1969; 51: 1297-1302
        • Cawrse N.H.
        • Sammut D.
        A modification in technique of abductor digiti minimi (Huber) opponensplasty.
        J Hand Surg Br. 2003; 28: 233-237
        • Baek G.H.
        • Jung J.M.
        • Yoo W.J.
        • Chung M.S.
        Transfer of extensor carpi radialis longus or brevis for opponensplasty.
        J Hand Surg Br. 1999; 24: 50-53
        • Phalen G.S.
        • Miller R.C.
        The transfer of wrist extensor muscles to restore or reinforce flexion power of the fingers and opposition of the thumb.
        J Bone Joint Surg Am. 1947; 29: 993-997
        • Kessler I.
        Transfer of extensor carpi ulnaris to tendon of extensor pollicis brevis for opponensplasty.
        J Bone Joint Surg Am. 1969; 51: 1303-1308
        • Wood V.E.
        • Adams J.
        Complications of opponensplasty with transfer of extensor carpi ulnaris to extensor pollicis brevis.
        J Hand Surg Am. 1984; 9: 699-704
        • Henderson E.D.
        Transfer of wrist extensors and brachioradialis to restore opposition of the thumb.
        J Bone Joint Surg Am. 1962; 44A: 513-522
        • Kapandji A.
        Clinical test of apposition and counter-apposition of the thumb. Article in French.
        Ann Chir Main. 1986; 5: 67-73
        • Cooney W.P.
        • Linscheid R.L.
        • An K.N.
        Opposition of the thumb: an anatomic and biomechanical study of tendon transfers.
        J Hand Surg Am. 1984; 9: 777-786