Opposition is the movement that brings the thumb across the palm to meet the fingers, and it is what makes a human hand so capable. When median nerve palsy takes it away, opponensplasty rebuilds it using a working tendon.
Opponensplasty restores the thumb movement lost when median nerve palsy paralyses the muscles at the base of the thumb. A working tendon is rerouted so it pulls the thumb across the palm towards the fingers. This is reconstruction of a movement, not a repair of the nerve, and feeling in the fingers is unchanged.
Grip depends on the thumb meeting the fingers. That meeting requires the thumb to rotate and swing across the palm, a movement called opposition, driven mostly by small muscles at the base of the thumb that run under the median nerve. Should that nerve fail, the muscles waste, the bulge at the base of the thumb flattens and the thumb lies alongside the index finger instead of facing it.
Patients notice the loss in ordinary tasks. Buttons, coins, keys and small tools all need a thumb that can come round to meet a fingertip. Holding a glass becomes a matter of trapping it against the palm, which is clumsy and insecure.
Opponensplasty solves this by borrowing. A tendon still working under another nerve is detached, redirected across the palm and attached near the base of the thumb, so its pull now swings the thumb into opposition. Nothing is done to the median nerve itself, which is why numbness in the thumb and index finger remains after the operation.
Opponensplasty suits people whose thumb joints move freely but whose thumb muscles will not recover their nerve supply.
Passive movement of the thumb is checked, the web space measured and donor tendons tested. A stiff web must be treated first, or the new pull will not work.
A regional block numbs the arm, with sedation if you prefer. Short incisions are placed at the donor site, in the palm and beside the base of the thumb.
The chosen tendon is detached from its usual insertion and drawn out through the palm incision, keeping its muscle and nerve supply completely intact.
A tunnel is created so the tendon pulls from the correct direction, then it is fixed near the base of the thumb at a tension giving opposition without stiffness.
Wounds are closed and a splint holds the thumb across the palm to protect the join. Therapy dates are arranged before you leave.
The hand rests elevated in the splint, and simple medication controls discomfort. Thumb movement is not attempted at this stage.
Sutures are checked and dressings changed. Splinting continues while the therapist explains the retraining that follows.
Support eases and active practice begins. Learning to bring the thumb across using a different muscle takes conscious effort at first.
Pinch and grip usually feel much more secure. Control keeps improving as the new movement becomes automatic in daily use.
Most patients regain a thumb that meets the fingers well enough for daily tasks, which is a considerable change from a thumb lying flat beside the hand. Pinch strength does not usually match the other side, because one transferred tendon replaces several small muscles. Numbness in the thumb and index finger remains, as the nerve has not been treated. Outcome depends on thumb suppleness before surgery and on retraining afterwards.
The operation is well established, though a few specific problems can occur and should be discussed first.
Protecting the join comes first, and teaching the thumb its new movement comes next.
It does not. A working tendon is rerouted to replace the lost movement, while the nerve is left exactly as it was.
Feeling and movement come from different parts of the nerve. Restoring the movement does not restore the sensation.
One transferred tendon stands in for several small muscles, so pinch improves usefully but rarely reaches its original power.
Learning to use a muscle for a new task is most of the work. Without retraining, the transfer is rarely used properly.
Thumb reconstruction at Elegance Clinic in Surat begins with a careful look at how supple the thumb is, since that determines what a transfer can deliver.
What opponensplasty costs depends on which donor tendon is chosen, whether the web space needs releasing at the same time and how long the operation takes. Splints and the retraining programme afterwards are part of the treatment and are included in what you are told. A written estimate is prepared after assessment, listing surgery, anaesthesia, day care charges and the review visits planned. Where the palsy followed an injury at work, employer or insurance cover may apply.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →The total depends on which donor tendon is used, whether the thumb web needs releasing as well and how long theatre time runs. Splints and therapy also count. A written estimate is prepared once your assessment is complete.
It is a well established reconstructive procedure, usually carried out under a block with the arm numb. Infection, adhesions in the palm and a transfer needing adjustment are the recognised concerns, and all are explained before consent.
A splint holds the thumb for several weeks while the join heals, then retraining begins. Most people use the thumb for daily tasks within a few months, and control continues to improve well beyond that.
Pinch usually becomes reliable enough for coins, buttons, keys and light tools. Matching the other hand is not the expectation, since one tendon takes the place of several small thumb muscles.
Not through this operation. Only movement is reconstructed, so numbness in the thumb and index finger continues. That skin still needs protecting from hot surfaces and sharp edges you cannot feel.
Once the thumb muscles have shown no recovery over an adequate period and while the thumb still moves freely when pushed across by the other hand. Stiffness developing in the web space makes the operation harder.
Thumb movement is tested passively, the web space checked and donor tendon strength graded. What the transfer will change, and what it will not, is explained plainly, along with a written estimate before deciding.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
