Huber Abductorplasty for Thenar Atrophy: Revisiting an Overlooked Adult Indication.

Background: Restoration of thumb abduction is essential for functional pinch and grasp in individuals with thenar atrophy. The abductor digiti minimi (Huber) transfer for reconstruction of thumb abduction is rarely used in adults. This study evaluates postoperative functional outcomes in a series of 4 adult patients undergoing Huber abductorplasty and contextualizes the results using published benchmarks. Methods: Four adults (aged 20-39 y; 2 men, 2 women) with clinically diagnosed thenar atrophy underwent Huber abductorplasty. Etiologies included iatrogenic recurrent motor branch injury, traumatic median nerve laceration, and severe neurogenic thoracic outlet syndrome. Follow-up ranged from 3 to 16 months. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, pain ratings, thumb range of motion, palmar abduction, and strength measures (3-jaw pinch, lateral pinch, tip pinch, and gross grasp). Outcomes were reported descriptively and compared with the contralateral hand when available and with published normative data. Results: At final follow-up, DASH scores were lower in 3 of 4 patients (mean final DASH score 42.5); 1 patient demonstrated persistent disability (DASH 75). Pain resolved by 2 months in 3 patients. Three-jaw pinch strength ranged from 4.5% to 47.3% of normative values, lateral pinch from 26.5% to 70.8%, and gross grasp from 28.8% to 77.3%. One patient demonstrated persistent functional deficits. Conclusions: Huber abductorplasty can provide meaningful functional recovery and restore thenar contour in carefully selected adults with thenar atrophy. This technique remains a viable reconstructive option and warrants reconsideration alongside tendon-based opponensplasty procedures in adults.