The role of arthroscopy in trapeziometacarpal arthritis - ncbi - nih
The role of arthroscopy in trapeziometacarpal arthritis - ncbi - nih
Prospective outcomes of Stage III thumb carpometacarpal arthritis treated . The use of a dorsal-distal portal in trapeziometacarpal arthroscopy.

Because of osteolysis in three patients/four hands, the use of Gore-Tex ] published his experience with arthroscopic débridement and synovectomy of the TM joint in 23 patients with Eaton Stage I and II OA as compared to a control group of 21 patients treated with nonoperative measures. The patient is positioned supine on the operating table with the arm extended on a hand table. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. Further considerations for trapeziectomy with ligament reconstruction and tendon interposition Although trapeziectomy with LRTI is considered to be the standard for surgical care of TMC arthritis, Kirchberger. A trocar placed through the D-2 portal passed through the first dorsal interosseous muscle and penetrated the DIML, entering the joint either through or between the UCL and POL (Fig.

Arthroscopic techniques for evaluating and treating TM disease surfaced in 1994 [ ]. Note how the trapezium is devoid of all cartilage. A line drawing of the standard portal placement illustrates the location of the 1-R, l-U, and D-2 portals. The total thumb ROM decreased by 20%, but all patients could oppose to the fifth finger. Careful wound spread technique is needed to prevent iatrogenic injury to the surrounding superficial radial nerve branches.

A 22-gauge needle is inserted 1 cm distal to this juncture and angled in a proximal, radial, and palmar direction, hugging the thumb metacarpal while viewing from either the 1-R or 1-U portal. The posterior oblique ligament (POL) is an intracapsular ligament originating from a fan-shaped base on the dorsoulnar side of the trapezium immediately ulnar to the dorsoradial ligament (DRL) and can be seen tangentially from the modified radial portal (Fig. Another recently studied modification of trapeziectomy with LRTI involves the use of the entire width of the flexor carpi radialis (FCR), in contrast with the original Burton-Pellegrini technique suggesting the use of half the thickness of the FCR. A knowledge of the intracapsular anatomy is crucial to these techniques. The ulnar recess can be visualized from the thenar portal and complements the ulnar tubercle, the tapered prominence of the ulnar aspect of the trapezium. They measured the distances of the surrounding neurovascular structures to three portals in a cadaver study of seven limbs. Tools are also needed to monitor outcomes after surgical treatment, and Tandara. Intraoperative fluoroscopy is employed to assess the adequacy of bone resection and for locating the portals as needed. Prospective outcomes of Stage III thumb carpometacarpal arthritis treated with arthroscopic hemitrapeziectomy and thermal capsular modification without interposition. The DIML is an extracapsular ligament that originates from the dorsoradial aspect of the index metacarpal radial to the extensor carpi radialis longus insertion.

Current trends in the management of trapeziometacarpal arthritis
The keyword trapeziometacarpal arthritis was utilized to query the . Grip strength , relieve pain, and strengthen the dorsal ligament complex. Muscoli dorso trapeziometacarpal arthritis Trapeziometacarpal joint arthritis - ncbi - nih Keywords: Trapeziometacarpal arthritis, Thumb carpometacarpal arthritis, . The removal of a dorsal bone wedge results in thumb extension .

Bony changes, such as the finding of osteophytes on the trapezial side of the joint, indicate an advanced case of TMC arthritis and are likely to cause mechanical issues and reduced function. This yielded 15 articles, six of which were either case reports or nonarthroscopic articles and were excluded. Bilateral arthroscopic tendon interposition arthroplasty of the thumb carpometacarpal joint in a patient with Ehlers-Danlos syndrome: a case report. It runs obliquely to insert into the dorsoulnar aspect and palmoulnar tubercle of the first metacarpal base. The relevant landmarks are outlined, including the proximal and dorsal edge of the thumb metacarpal base, the tendons of the APL and the EPL, and the radial artery in the snuff box.

A review by Slutsky concluded that careful wound spread technique, fluoroscopy, and cadaver training are important for successfully arthroscopy, but it is unclear whether arthroscopy as an adjunctive technique for resection arthroplasty provides better outcomes compared to more standard open techniques. The thumb is immobilized in abduction by cast or splint for 4 weeks for all of these procedures. The plane of the 1-U portal, which is just posterior and ulnar to the EPB, passes between or through the DRL and POL. Pegoli L, Parolo C, Ogawa T, Toh S, Pajardi G. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint.

Questions regarding the use of temporary K-wire fixation or thermal shrinkage or the need for a natural or synthetic interposition substance cannot be answered at this time owing to the absence of adequate published information. In an anatomic study of six cadaver arms, the SRN was located a mean of 6. The authors also identified the dorsal ligament complex, including the dorsoradial ligament and posterior oblique ligament, as the most important for stabilizing thumb opposition and preventing metacarpal subluxation, while the anterior oblique ligament was found to be less important for TMC stability. There is still a paucity of literature on TM arthroscopy. An arthroscopic burr inserted through the 1-R portal is used to resect the medial osteophyte. The main indication for surgery is basilar thumb pain that is unresponsive to nonoperative treatment. A small skin incision is made, followed by wound spread technique with tenotomy scissors. The FDMA runs within the deep fascia overlying the first dorsal interosseous muscle, parallel to the radial side of the index metacarpal. The 1-R and 1-U portals are established as described. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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