Transfer of the Extensor Digiti Quinti to Restore Pinch in Ulnar Palsy of the Hand

¹ From the Trauma Service, Department of Surgery, State University of New York, Downstate Medical Center and the Kings County Hospital; and the Hand Service, Department of Surgery, The Brookdale Hospital Center, Brooklyn

A procedure which has been used since 1969 for the restoration of a pinch mechanism in ulnar palsy is described. The two slips of the extensor digiti quinti are transferred across the dorsum of the hand and attached, one to the insertion of the adductor pollicis and the other to the insertion of the first dorsal interosseus muscle.

The indications for the procedure are motor paralysis of the ulnar nerve with an inadequate and unstable pinch mechanism—when previous repair of the ulnar nerve has resulted in the return of sensation without return of motor function, when repair of the motor portion of the ulnar nerve is not technically feasible, when the paralysis of the ulnar nerve has been present for eighteen months or more, when the injury to the nerve is above the elbow, and possibly when the ulnar nerve is destroyed by some neurological disease, or when rheumatoid arthritis has caused wasting of the intrinsic muscles and an unstable pinch mechanism without involvement of the ulnar nerve.

In the six patients who had this procedure, satisfactory function was restored. The advantages of this operation over previously described "adductor transfers" are discussed.

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