Issues
Extremely difficult
- goals of rehab must be realistic
- limited number of donors
- static procedures more prominent
- fusions, tenodesis and capsulodeses must be used
Goals
1. Thumb Opposition
EIP to APB and EPL
- via pulley around Pisiform and FCR
- alternative is Palmaris longus or ADM
2. Thumb Adduction
BR / ECRB + PL graft to P1
- via base of MC III as Adductor
3. Thumb to index tip pinch
APL slip with free graft to 1st dorsal interosseous
+/- Arthrodesis thumb MP
4. Thumb to LF tip pinch
EDM to deep transverse lig
EDC to little must work
5. Power Flexion of fingers
ECRL to all 4 fingers
Technique
- using 4 tail graft to lateral sheath or A2 pulley via lumbrical path
Alternative
- free gracilis graft
- into FDP
- insert vascularized ulna graft to power
6. Sensation median nerve
Superficial radial nerve translocation