When the median nerve is injured either secondary to a chronic severe case of carpal tunnel syndrome, or after a median nerve laceration, sensation will be absent in the thumb, index, long, and half of the ring finger. This deficit can be disabling, but visual queueing with activities can help to compensate for the absence of feeling.

The greatest functional deficit of low median nerve palsy--that caused by an injury to the nerve at the level of the wrist, lies with paralysis of the thumb thenar muscles. This causes the thumb to be held in supination and makes prehension nearly impossible because the thumb cannot be brought out of the plane of the palm--in preparation for grasp.

A number of options exist for restoring opposition, that is, the combination of pronation and palmar abduction. These opponens transfers all have a direction of pull from the ulnar side of the palm, and result in optimal postioning. They do not augment pinch strength, however, which is provided by intrinsic muscles in the hand innervated by the ulnar nerve.

After surgery, the hand and thumb are held in a cast for 4 weeks, followed by a splint for four additional weeks. Therapy for retraining is necessary for 6-8 weeks. Ultimately, opponens transfers are among the most successful in hand surgery--and you will be pleased with the outcomes following such surgery for median nerve palsy.

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