The Camitz transfer and its modifications: a review

Rymer, Ben; Thomas, Peter

doi:10.1177/1753193415625605

Cited by 29 publications

(42 citation statements)

References 16 publications

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“…Carpal tunnel syndrome (CTS) is a disease that causes weakness of the thumb’s muscle because of thenar atrophy, resulting in opposition impairment [ 11 , 14 – 16 ]. Hence, the extent of improvement in pronation was often used as one of the evaluation items of the opponensplasty method which is aimed to regain the opposition function equivalent to that of healthy subjects [ 13 , 17 – 21 ]. Nevertheless, in these reports, nail tip angle, spatial angle, or Kapandji score were used in the substitution evaluation method for the measurement of the pronation angle.…”

Section: Introductionmentioning

confidence: 99%

A new method of measuring the thumb pronation and palmar abduction angles during opposition movement using a three-axis gyroscope

et al. 2018

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BackgroundThumb opposition is vital for hand function and involves pronation and palmar abduction. The improvement of pronation is often used as one of the evaluation items of the opponensplasty method for severe carpal tunnel syndrome. However, most of the studies used substitution evaluation methods for measurement of the pronation angle. Thus, there is still no appropriate method for measuring thumb pronation angle accurately in carpal tunnel syndrome patients.In recent reports, a wearable gyroscope was used to evaluate upper extremity motions and it can be possibly used for accurate measurement of the thumb pronation angle along the three-dimensionally moving bone axis.Thus, we investigated the reliability of measuring thumb pronation using a gyroscope and evaluated whether this method can be used to detect opposition impairment.MethodsThe participants were volunteers with unaffected upper limbs (32 hands) and patients with carpal tunnel syndrome (27 hands). The pronation and palmar abduction angles during opposition movements were measured using a three-axis gyroscope that included a three-axis accelerometer. The gyroscope was fixed onto the first metacarpal bone and the thumb phalanx.ResultsThe pronation and palmar abduction angles of the metacarpal bone and the palmar abduction angles of the phalanx significantly decreased in the carpal tunnel syndrome group. The pronation angle of the metacarpal bone during opposition movement peaked later than the palmar abduction angle in all hands.ConclusionsWe were able to measure the thumb pronation and palmar abduction angles using the three-axis gyroscope, and this tool was able to detect impairments of thumb opposition due to carpal tunnel syndrome. This could be a tool for measuring thumb and finger angles and for detecting impairments caused by various diseases.

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Section: Introductionmentioning

confidence: 99%

A new method of measuring the thumb pronation and palmar abduction angles during opposition movement using a three-axis gyroscope

et al. 2018

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“…In thenar paralysis, restoration of function can be achieved by several surgical approaches involving PL tendon transfer to the insertion site of the abductor pollicis brevis to restore thumb abduction function (Camitz Opponensplasty) (Camitz, ; Rymer and Thomas, ). A modified approach to Camitz opponensplasty in treatment of severe carpal tunnel syndrome mobilizes the PL tendon through the radial or ulnar portion of the incised flexor retinaculum for use as a pulley for better approximation of pure opposition movements (Foucher et al ; Kato et al ; Littler and Li, ; Macdougal, ; Park et al ; Terrono et al ).…”

Section: Discussionmentioning

confidence: 99%

“…Through surgical PL tendon transfer approaches, restoration of functional palmar movements can be achieved allowing patients to perform activities of daily living such as writing and the ability to pick up fine objects (Foucher et al ; Gilbert et al ). Kaplan () considered the PL as synergist in thumb opposition and described its insertion into the abductor pollicis brevis as a consistent feature, which may explain its effectiveness in restoring functional thumb movements through surgical tendon transfer (Foucher et al ; Rymer and Thomas, ).…”

Section: Introductionmentioning

confidence: 99%

Revisiting the functional anatomy of the palmaris longus as a thenar synergist

2017

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Surgical studies describe the palmaris longus (PL) as a synergist in thumb abduction, which may facilitate its use in restoring thumb function using opponensplasty. However, beyond morphological descriptions and isometric thenar abduction strength measures, the evidence supporting the PL as a thenar synergist in-vivo is limited. The purpose here was to determine whether the PL provides synergistic contributions to thenar musculature by: (1) recording PL muscle activity using indwelling electromyography (EMG) during thumb movements; and (2) quantifying changes in PL muscle architecture using ultrasonography. In 10 healthy males, PL muscle activity was recorded during maximal thenar muscle contractions (abduction, flexion, opposition, adduction, and extension) with the wrist secured in a neutral position. The PL EMG was normalized to its maximal EMG recorded during isometric wrist flexion. Dynamic changes in PL muscle thickness (M ) were determined during abduction and adduction using ultrasound imaging. The results indicate that the PL is activated during thenar movements with greatest relative PL EMG recorded during thenar abduction (46%), flexion (35%) and opposition (37%). Compared to rest, PL M significantly increased (21%) during maximal thenar abduction. With direct measures in vivo, this study supports morphological and surgical observations indicating the PL acts as an extrinsic hand muscle in enhancing thenar muscle actions. Knowledge of the synergistic relationship between the PL and thenar musculature may allow for further development of surgical opponensplasty approaches using the abductor pollicis brevis and PL as a functional digastric unit. Clin. Anat. 31:760-770, 2018. © 2017 Wiley Periodicals, Inc.

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“…Thenar muscle atrophy, especially abductor pollicis brevis (APB) atrophy, is frequently observed in patients with long-standing severe carpal tunnel syndrome (CTS). [1][2][3][4][5][6][7][8][9][10][11][12] Moreover, most advanced CTS patients with thenar muscle atrophy have severe disorder of thumb opposition and difficulty with activities of daily living. [1][2][3][4][5][6][7][8][9][10][11][12] Thumb opposition is essential in providing motion and strength for both pinch and grasp, and, therefore, it is important to restore it for these CTS patients.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] Moreover, most advanced CTS patients with thenar muscle atrophy have severe disorder of thumb opposition and difficulty with activities of daily living. [1][2][3][4][5][6][7][8][9][10][11][12] Thumb opposition is essential in providing motion and strength for both pinch and grasp, and, therefore, it is important to restore it for these CTS patients. [1][2][3][4][5][6][7][8][9][10][11][12] Opponensplasty is a standard and effective procedure that improves thumb opposition to achieve fine finger movement.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive modified Camitz opponensplasty for severe carpal tunnel syndrome

Nanno

Kodera

Tomori

et al. 2018

J Orthop Surg (Hong Kong)

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Purpose: We aimed to compare the clinical results and the complications between the minimally invasive modified Camitz opponensplasty and the conventional Camitz opponensplasty for severe carpal tunnel syndrome (CTS), and to evaluate the efficacy of the modified technique for CTS. Methods: Twenty-eight hands in 24 patients with severe CTS who had disorder of the thumb opposition with thenar muscle atrophy (group 1) were treated by minimally invasive modified Camitz opponensplasty, passing the transferred palmaris longus (PL) tendon under the abductor pollicis brevis (APB) fascia using only palm and thumb incision, and no incision to either wrist crease or forearm. Ten hands in 10 patients (group 2) were treated by the conventional Camitz opponensplasty. Clinical evaluation was made by comparing the results before and after surgery for the angle of the thumb palmar abduction, pinch power, and grip strength. Results: All clinical findings significantly improved after surgery compared with before surgery in all patients. In group 1, there were no complications including transferred tendon bowstring, painful wrist scar, or injury to the palmar cutaneous branch of the median nerve in all hands. Conversely, patients in group 2 had four painful wrist scars and nine bowstrings of the transferred tendon. Conclusions: Several complications have been considered to attribute to the long incision and an extensive dissection crossing the wrist crease from the palm to the wrist in the conventional Camitz procedure. The current modified Camitz opponensplasty by minimally invasive incision without straddling the wrist crease is a simple and effective procedure that can decrease the risk of painful scar around the wrist crease in severe CTS patients with disorder of thumb opposition. Additionally, this technique, by passing the transferred PL tendon under the APB fascia, is useful in restoring the thumb opposition immediately, and in preventing the bowstringing of the transferred tendon.

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The Camitz transfer and its modifications: a review

Abstract: IV.

Cited by 29 publications

References 16 publications

A new method of measuring the thumb pronation and palmar abduction angles during opposition movement using a three-axis gyroscope

A new method of measuring the thumb pronation and palmar abduction angles during opposition movement using a three-axis gyroscope

Revisiting the functional anatomy of the palmaris longus as a thenar synergist

Minimally invasive modified Camitz opponensplasty for severe carpal tunnel syndrome

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