Post-traumatic instability of the trapeziometacarpal joint of the thumb

Abstract

In 28 patients with a solitary diagnosis of instability of the trapeziometacarpal joint because of a rupture of the anterior oblique ligament, reconstruction was carried out using a slip of the tendon of flexor carpi radialis. We were able to review 26 patients. The results after a follow-up of four years seven months showed that most (87%) had significant relief from pain and symptoms. Seventeen were graded as good to excellent. The mean grip strength recovered to 86% of the contralateral side. Most patients (81%) felt that they had subjective improvement and would have undergone the operation again. A lesser functional result was seen in those who developed a flexion deformity because of overtightening of the reconstruction. Increased awareness of this lesion can lead to an early and clear diagnosis so that the patient may be advised adequately. We describe a specific, diagnostic, clinical test which we have used consistently and successfully.

Clinical Results of 40 Consecutive Basal Thumb Prostheses and No CRPS Type I After Vitamin C Prophylaxis~!2009-10-04~!2009-12-30~!2010-02-17~!

“…The overall complication rate for trapeziometacarpal surgery is high and one of the possible complications is CRPS (variable incidence of 8 to 19 %) [17, 21]. Torrededia et al .…”

“…different procedures for surgical intervention in basal joint arthritis of the thumb are extensively described resulting in different outcomes and complication rates [7]. What we can learn from this and the experience from others is that the complication rate for basal joint surgery of the thumb is high for all of these different procedures [4, 6, 17]. Normally the infection rate is low.…”

“…reported even an incidence as high as 19% of CRPS-I in a special patient category with post-traumatic instability of the trapeziometacarpal joint [17]. …”

Primary repair of capsuloligamentous structures of trapeziometacarpal joint: A preliminary study

“…1 In another test, Takwale et al described a two step clinical provocative test in which the thumb is first abducted in a palmar direction and pronated while in the next step gradual abduction and supination of the retropulsed thumb is done reproducing symptoms of instability. 17 In addition to clinical examination and radiographs, Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography can help in reaching to the precise diagnosis. Connell et al studied trapezio-metacarpal joint ligamentous injuries using conventional MRI and recommended coronal and axial imaging with fat suppression and a coronal STIR sequence to look for the integrity of stabilizing ligaments.…”

Modified Eaton-Littler’s Reconstruction for Traumatic Dislocation of the Carpometacarpal Joint of the Thumb—A Case Report and Review of Literature

“…Diagnosis of instability due rupture of the anterior oblique ligament is difficult. History and specific clinical tests are important in making a diagnosis [12]. Eaton and Littler have described a technique of ligament reconstruction of the CMC joint using a slip of flexor carpi radialis tendon [2].…”