Usefulness and complications associated with thenar and standard portals during arthroscopic surgery of thumb carpometacarpal joint

Tsujii, Masaya; Iida, R.; Satonaka, Haruhiko; Sudo, Akihiro

doi:10.1016/j.otsr.2015.04.009

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…5 A more user-friendly portal, the thenar portal, was proposed for improving the view and better performance of the procedures in the CMC joint. 2,[4][5][6][7] The portal seems to be safe because only mild complication was reported (transient scar tenderness). 7 However, the periportal anatomy has not been well elucidated, and the published data delineating the relationships between the MBMN and its terminal branches and the thenar portal were seldom found.…”

Section: Discussionmentioning

confidence: 98%

“…2,[4][5][6][7] The portal seems to be safe because only mild complication was reported (transient scar tenderness). 7 However, the periportal anatomy has not been well elucidated, and the published data delineating the relationships between the MBMN and its terminal branches and the thenar portal were seldom found. Walsh et al 5 reported that MBMN was an average of 23 mm from this portal, however, which point of the MBMN to the portal measured was not described.…”

Section: Discussionmentioning

confidence: 98%

“…Only mild complication of transient scar tenderness with the thenar portal of CMC arthroscopy was reported. 7 There were several possible reasons for few injury of the nerve. First, it was the terminal divisions, not the main trunk of MBMN, that could be most at risk of iatrogenic injury.…”

Section: Discussionmentioning

confidence: 99%

“…However, the most lateral joint capsule or joint surface can be difficult to visualize arthroscopically. 4 A thenar portal was reported for better visualization and performance of the procedures in this joint, [4][5][6][7] but the anatomical study has been not performed for vital structures including the terminal branch of motor branch of median nerve (MBMN) around the thenar portal, although Walsh et al reported the distance between origin of motor branch and thenar portal. 5 What is more, though there are a large number of studies dealing with the morphological variations of MBMN, there are few studies that consider the localization of the distal course of this branch.…”

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confidence: 99%

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The Safety of the Thenar Portal: An Anatomical Study of the Thumb Carpometacarpal Arthroscopy

Pan

Hung

2016

Jnl Wrist Surg

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To define the localization of the distal course of the motor branches of median nerve (MBMN) and its arborization and its quantitative relationships to the thenar portal of the carpometacarpal (CMC) joint in the hope of evaluating the safety of this portal. In 16 embalmed cadaveric upper extremities, the localization of the course of the MBMN and its arborization were defined. In 14 fresh-frozen cadaver upper extremities, the CMC arthroscopic portals, 1-U, 1-R, and a thenar portal, were established, after which the limbs were dissected. Measurements were taken from the portals to the superficial radial nerve, radial artery, and the MBMN. The distal course of the MBMN and its terminal branches were all located in the proximal third of the thenar muscles, where the thenar portal was introduced. The mean distances between vital structures and each traditional portal (1-R or 1-U) were consistent with the previously published studies. Both the superficial and the profound branches of MBMN were very close to the thenar portal, and the distance between these two main terminal branches and the thenar portal was 1.2 mm (range: 0-6.2; standard deviation [SD] = 2) and 2.2 mm (range: 0-7; SD = 2.1), respectively. Five (35.7%) of the 14 fresh-frozen specimens indicated the superficial branch lay directly over the portal. One hand (7.1%) had the profound branch crossed over the thenar portal. Four hands (28.5%) indicated both the superficial and profound branches directly overlay the thenar portal. The superficial palmar branch of the radial artery was found in six hands, and in four of them, it crossed over the thenar portal. The distal course of the MBMN and its terminal branches were all located in the proximal third of the thenar muscles, where the thenar portal was introduced. The thenar portal could improve the view of the CMC joint of the thumb and provide better performance of procedures in this joint. We should bear in mind that the arborization of the MBMN was mostly located in the proximal third of the thenar muscle, and any operation in this area should be performed with great caution.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Safety of the Thenar Portal: An Anatomical Study of the Thumb Carpometacarpal Arthroscopy

Pan

Hung

2016

Jnl Wrist Surg

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“…This rate could be reduced by using the thenar approach 35,36 to the TM joint, which appears to be less risky than the conventional approach. [37][38][39] In addition, it would be interesting to compare our technique with other techniques, such as suspensionplasty, with or without the addition of adipose stem cells.…”

Section: Discussionmentioning

confidence: 99%

Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs

et al. 2022

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Purpose There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results We found a significant improvement in pain (p = 0.005) and grip strength (p = 0.0021) as well as an improvement in pinch strength (p = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 (p = 0.002) and 3 (p = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful.Level of evidence: This is a Level IV study.

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Basal joint arthroscopy indications in first CMC joint arthritis

Fontès

2021

Hand Surgery and Rehabilitation

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Usefulness and complications associated with thenar and standard portals during arthroscopic surgery of thumb carpometacarpal joint

Abstract: IV.

Cited by 8 publications

References 16 publications

The Safety of the Thenar Portal: An Anatomical Study of the Thumb Carpometacarpal Arthroscopy

The Safety of the Thenar Portal: An Anatomical Study of the Thumb Carpometacarpal Arthroscopy

Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs

Basal joint arthroscopy indications in first CMC joint arthritis

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