Smith transfer of extensor carpi radialis brevis tendon. A, Usual incisions (A and B) for detaching and withdrawing extensor carpi radialis brevis, channeling tendon graft through second interspace (C), and attaching graft to tendon of adductor pollicis (D). B, Extensor carpi radialis brevis is transected distally and withdrawn proximal to dorsal retinacular ligament (“sheath”). C, Tendon graft (palmaris longus or plantaris) is passed deep to adductor pollicis and between second and third metacarpals. D, Tendon graft is sutured to adductor tendon. E, Proximal end of tendon graft is passed subcutaneously to proximal incision. F, Tendon graft sutured proximally to extensor carpi radialis brevis with thumb adducted and wrist at 0 degrees of extension. Extensor carpi radialis brevis is at resting length. Graft is made slightly longer if thenars are paralyzed.