Extensor indicis opponensplasty: a modified evaluation system



Extensor indicis opponensplasty is the gold standard treatment for the restoration of opposition in individuals with median nerve injuries, and it has excellent outcomes. Most authors have used the Sundraraj and Mani scoring system, which considered a thumb reaching any fingertip as a good or excellent outcome. To refine the technique for extensor indicis opponensplasty, we propose an informative yet simple system to describe outcomes.


This study included 13 patients who underwent extensor indicis opponensplasty for median nerve injuries, with four isolated and nine combined. Six patients had triple insertions, and seven had single/double insertions. The patients were evaluated using the Sundraraj and Mani system and our proposed system for the primary outcome. Secondary outcomes included return to productivity and complications.


We demonstrated that 92% of the patients achieved excellent results according to the Sundraraj and Mani system. We achieved pulp to little pulp (5A) in seven patients, tip to little pulp (5B) in two patients, pulp to ring pulp (4A) in one patient, tip to ring pulp (4B) in one patient, pulp to middle finger pulp (3A) in one patient, and fair opposition (1) in one patient. A 5A score was achieved in five patients with triple insertion.


The new system proposed in this study better facilitates the comparison of technical variations of opponensplasty.

Level of evidence:Level IV, therapeutic study.

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Correspondence to Omar Mohamed Nouh.

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The authors did not receive any funding for the completion of this work.

Declaration of conflicting interests

Omar Mohamed Nouh, Shaimaa Mostafa Gad, Youssif Ahmed Khashaba, Ashraf Abolfotooh Khalil, Ashraf El-Sebaie Mohamed, and Mostafa Ahmed Abo Elsoud declare that they have no conflicts of interest.

Ethical committee approval

Ethical committee approval was obtained.

Informed consent

Informed consent was obtained from all patients who were part of the study. The study included one minor, and informed consent was obtained from his parents. The consent form included details regarding the preoperative measures, the operative procedure, and the postoperative outcomes, including potential complications. Patients or their legal guardian (one patient) also consented to enrolment in the study and the publication of the results.

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Nouh, O.M., Gad, S.M., Khashaba, Y.A. et al. Extensor indicis opponensplasty: a modified evaluation system. Eur J Plast Surg 42, 473–480 (2019). https://doi.org/10.1007/s00238-019-1505-9

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  • Extensor Indicis
  • Tendon transfer
  • Opponensplasty
  • Median nerve injury
  • Evaluation