The thumb-in-palm (TIP) deformity in adults with upper motor neuron syndrome results
from an imbalance of extrinsic and intrinsic muscular forces. Traditionally, the thumb
is adducted against the index ray, and flexed to varying degrees at the metacarpophalangeal
and interphalangeal joints. However, not all TIP deformities result from the same
underlying imbalances. The severity of the deformity ranges over a spectrum dependent
upon the involved muscle groups and underlying spasticity, myostatic contracture,
and/or joint contractures. Surgical procedures for correcting a TIP deformity can
be classified broadly as procedures used for functional, present volitional motor
control, versus nonfunctional, absent motor control. Techniques include tenotomies,
tenodeses, tendon lengthenings, tendon transfers, tendon reroutings, neurectomies,
and joint releases. A focused physical examination is key in developing a patient-specific
treatment algorithm.
Key words
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Article info
Publication history
Published online: September 01, 2022
Accepted:
July 13,
2022
Received:
May 27,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2023 by the American Society for Surgery of the Hand. All rights reserved.
