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Huber Abductorplasty for Adults with Thenar Atrophy
Yesmeen M. Elgabori, BA, Alejandro J. Friedman, MA; Steven M. Koehler, M.D.
Montefiore Medical Center, Bronx, NY
Introduction: Restoration of thumb abduction is essential for day-to-day functional pinch and grasp in individuals with thenar atrophy. The Huber muscle transfer uses the abductor digiti minimi (ADM, or Huber transfer) to reconstruct abduction of the thumb, though this technique is rarely utilized in adult patients. This study analyzes longitudinal outcomes in four adult patients undergoing a Huber transfer and compares results to published benchmarks.
Materials and Methods: Four patients (ages 39, 38, 32, and 20; 2 men and 2 women) with clinically diagnosed thenar atrophy underwent Huber abductorplasty. One case involved the left hand and three involved the right. Patients were followed over periods ranging from 3 (patient 2) to 16 months postoperatively (patient 3). Outcomes included DASH scores, pain ratings, thumb ROM, palmar abduction, and opposition strength metrics (3-jaw, lateral, tip pinch, and gross grasp). These were compared to the non-surgical hand when available, as well as reported age-matched normal ranges.
Results: DASH scores decreased in three of four patients (mean final DASH = 42.5), with Patient 2 maintaining a high score (75). Patient 1 showed the greatest relative strength improvement (+62.5% in 3-jaw and +54.5% in lateral pinch), while Patient 4 had a 116% increase in gross grasp. At final follow-up, Patient 3 achieved 84% of non-surgical hand strength in gross grasp. However, Patient 2's surgical hand achieved only 10.8% and 39.8% of non-surgical strength in 3-jaw and lateral pinch, respectively. Pain resolved entirely in three patients by month 2. Functional recovery in most patients approached or exceeded previously reported benchmarks for ADM transfers, though one case showed persistent deficits consistent with literature-reported revision rates (yet, no revision was performed).
Conclusions: While rarely used in adults, Huber abductorplasty provides functional improvement in adult patients with thenar atrophy. Adults demonstrate clinically meaningful gains in strength and patient-reported outcomes. Inter-patient variability highlights the importance of individualized surgical planning, rehabilitation, and longitudinal follow-up. These findings suggest that Huber transfers are a viable technique in adults.
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