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The most commonly performed surgeries for reconstructive pinch are:

  • Key-Pinch Grip – Brachioradialis to Extensor Carpi Radialis Longus, Flexor Pollicis Longus split tenodesis. The IP joint of the thumb may need to be stabilized to prevent excessive IP flexion.
  • Key-Pinch Grip with or without Hook Grip – Brachioradialis to Flexor Pollicis Longus with or without Flexor Digitorum Profundus tenodesis or Brachioradialis to Extensor Carpi Radialis Longus.
  • Key-Pinch Grip and Hook Grip – Brachioradialis or Pronator Teres to Flexor Pollicis Longus and Brachioradialist or Extensor Carpi Radialis Longus to Flexor Digitorum Profundus

Additional procedures to increase thumb pinch and thumb opposition may also be completed.

Table 13: Reconstructive Surgery Pinch Studies

Summary Table 14: Pinch Studies


There is level 4 evidence (from two case series studies; House et al., 1992; Waters et al., 1985) that metacarpal fusion can increase pinch strength as well as improve the over all ability to complete daily living tasks.

There is level 4 evidence (from one pre-post study; McCarthy et al., 1997) that the addition of intrinsic balancing procedures to extrinsic hand reconstruction can improve pinch strength and the ability to perform daily living tasks compared to extrinsic hand reconstruction alone.

  • Increasing pinch strength and the ability to execute daily living tasks is achieveable through a variety of surgical interventions such as metacarpal fusion or stabilization.