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In man and some of the apes, the thumb has the function of a contra
finger. This function is made possible by a great freedom of
movement of the first metacarpal and a highly developed and
differentiated thumb musculature. The grasp function of the hand is
dependent on the oppositional capacity and adductive power of the
thumb, and is severely limited by a paralysis or dysfunction of the
intrinsic thumb muscles. Whereas loss of the function of the
adductor pollicis can be partially compensated for by the adductive
action of the extensor pollicis longus, in paralysis or dysfunction
of the radial thenar muscles compensation can only be provided by
surgery. Since 1918, many methods of tendon transfer have been
described for the restoration of thumb opposition, all of which
bring about an improvement of the grasp function, albeit to
different degrees. These methods vary in the selection of the
motor, the direction of pull of the tendon, the use of a fulcrum,
and the mode of insertion. The highly effective method of Bunnell
(1938) is often used as the standard procedure. With this method,
the flexor superficialis tendon of the ring finger is looped around
the tendon of the flexor carpi ulnaris and passed subcutaneously
across the thenar eminence, after which it is fixed on the thumb at
the level of the metacarpo-phalangeal joint."
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