Surgical Technique: Hemi-Extensor Carpi Radialis Brevis Tenodesis for Stabilizing the Midcarpal Joint in Ehlers-Danlos Syndrome

Krijgh, David D.; Harley, Oliver J.H.; Hovius, Steven E.R.; Coert, J. Henk; Walbeehm, Erik T.

doi:10.1016/j.jhsa.2014.07.031

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Recently, a surgical technique was described using also a (hemi) ECRB to correct a recurrent MCI in the hypermobility type of Ehlers-Danlos syndrome. 7 This technique leaves the insertion of the tendon intact, requires both a dorsal as well as a volar approach, and Fig. 2a, b (a) Cadaver specimen and (b) artist impression in which the transposition of the ECRB is depicted.…”

Section: Discussionmentioning

confidence: 99%

A New Technique for the Treatment of Midcarpal Instability

Ritt

Groot

2015

Jnl Wrist Surg

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Extensor carpi radialis brevis (ECRB) transfer to the hamate bone is a novel procedure that offers a new surgical treatment option for select patients with midcarpal instability (MCI) who do not respond to conservative treatment. We present our early experience with this procedure. In total, 12 patients (13 wrists) were reviewed with a follow-up duration ranging from 1 to 6 years. Complications and changes in active range of motion (AROM) were noted. Patient related outcome was measured using the Patient Rated Wrist/Hand Evaluation (PRWHE) questionnaire, amongst others. Two patients failed to show a positive response to the surgery. ECRB transfer to the ulnar side of the wrist is a new procedure that offers a potential option for the surgical treatment of MCI in select patients; however, further biomechanical and clinical studies are required. The level of evidence for this study is IV (therapeutic).

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Section: Discussionmentioning

confidence: 99%

A New Technique for the Treatment of Midcarpal Instability

Ritt

Groot

2015

Jnl Wrist Surg

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“…Krijgh et al treated five Ehlers-Danlos syndrome patients with MCI with a catchup clunk by looping a strip of ECRB tendon around the lunocapitate joint. 50 The authors felt that capsular procedures would loosen in these patients, and carpal arthrodesis would strain the capsule of adjacent joints. Three were successful in reducing pain and instability which led to less reliance on orthotics on short-term followup.…”

Section: Soft-tissue Stabilizationmentioning

confidence: 99%

Demystifying Palmar Midcarpal Instability

2020

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Palmar midcarpal instability is an uncommon condition diagnosed clinically with a painful pathognomonic clunk on terminal ulnar deviation of the wrist. Various causes have been described, but congenital laxity of the carpal ligaments is thought to be a key contributor. Treatment commences with conservative measures. This includes proprioceptive training based on more recent concepts on the sensorimotor function of the wrist. When these measures plateau, surgery is considered. The lack of high-level evidence and consensus on its cause continue to hamper our understanding and knowledge of this condition. The purpose of this review is to examine the current evidence to conceptualize this mysterious, yet infrequent phenomenon, and to provide an algorithm on its management.

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“…Patients with abnormal collagen, VISI deformity or failure of a soft tissue reconstruction are more likely to benefit from a bone procedure such as midcarpal fusion, proximal row carpectomy or radiolunate arthrodesis. However, Krijgh et al (2014) did present six wrists in five patients with Ehlers-Danlos syndrome, which they were able to stabilize in the short term (1 to 3 year follow-up) using a soft tissue tenodesis (part of ECRB), which was passed around both the volar and dorsal aspects of the luno-capitate articulation. Midcarpal fusions are usually successful in stabilizing the wrist, but at the considerable price of the loss of the dart throwing axis.…”

Section: Treatmentmentioning

confidence: 99%

Midcarpal instability

Hargreaves

2015

J Hand Surg Eur Vol

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Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

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Surgical Technique: Hemi-Extensor Carpi Radialis Brevis Tenodesis for Stabilizing the Midcarpal Joint in Ehlers-Danlos Syndrome

Cited by 6 publications

References 8 publications

A New Technique for the Treatment of Midcarpal Instability

A New Technique for the Treatment of Midcarpal Instability

Demystifying Palmar Midcarpal Instability

Midcarpal instability

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