Surgical Treatment of Basal Joint Arthritis of the Thumb


Surgical Treatment of Basal Joint Arthritis of the Thumb


Introduction



Patient Selection




  • Painful Eaton stage II, III, or IV basal joint arthritis


  • Symptoms that persist despite nonsurgical management such as splints, NSAIDs, cortisone injections, activity modifications, or therapy programs

Diagnostic Imaging




  • Radiographs useful for preoperative planning, assessment


  • Radiographic staging does not correlate well with symptoms

Procedure


Room Setup/Patient Positioning




  • Most commonly, general anesthesia or regional anesthesia is used


  • Supine position; hand on table/arm board


  • Apply well-­padded tourniquet around upper arm

Surgical Technique


Abductor Pollicis Longus Suspensionplasty


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Figure 1Illustrations demonstrate the surgical technique for abductor pollicis longus (APL) suspensionplasty. A, Creation of a bone tunnel in the thumb metacarpal. The bone tunnel is carefully created to connect hole 2, which is located in the articular center of the metacarpal base, and hole 1, which is located at the dorsal surface of the proximal metacarpal metaphysis 1 cm distal to the articular surface. B, After division of the APL at the proximal musculotendinous junction, the free end of the APL tendon is passed through the bone tunnel from hole 1 to hole 2. C, A bone tunnel is created from palmar (3) to dorsal (4) in the index metacarpal at the metaphyseal-­diaphyseal junction. D, The APL tendon is passed through both bone tunnels at the thumb and index metacarpal (from 1 through 2 and from 3 through 4), emerging dorsally from the index metacarpal tunnel with a weave through the extensor carpi radialis brevis (ECRB) tendon to anchor the ligament reconstruction and tension the tendon transfer. I = thumb metacarpal; II = index finger metacarpal; III = long finger metacarpal.

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Figure 2Intraoperative photograph shows assessment of the ligamentous reconstruction in APL suspensionplasty. The APL has been passed through the second bone tunnel, which is a palmar-­to-­dorsal transverse bone tunnel at the metaphyseal-­diaphyseal junction of the proximal index metacarpal. The tendon is being tensioned by the clamp on the upper left. By applying this tension, the thumb is suspended into a position that maintains the space that the trapezium had once occupied and the overall thumb ray length is maintained.

May 13, 2023 | Posted by in Uncategorized | Comments Off on Surgical Treatment of Basal Joint Arthritis of the Thumb

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