Indications Thumb metacarpophalangeal (MCP) joint fusion is indicated in patients with symptomatic arthritis or instability. Clinical examination Patients may complain of pain, swelling, stiffness, or decreased grip strength. Patients with carpometacarpal joint destruction often have compensatory hyperextension of the thumb…
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Indications Distal interphalangeal (DIP) joint arthrodesis is indicated in patients with intractable pain or instability after failure of nonoperative management. Many patients with DIP arthritis present with mucous cysts. Cyst excision may correct a nail deformity, skin changes, or a…
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Indications Implant arthroplasty is indicated for patients with severe pain, deformity, and loss of motion in the proximal interphalangeal (PIP) joint who have failed nonoperative treatment (splinting, antiinflammatory medication, steroid injection, and/or hand therapy). Silicone implants may be used in…
Indications Metacarpophalangeal (MCP) arthroplasty is indicated in patients with chronic pain, deformity, or functional loss. Arthrodesis is poorly tolerated at the MCP level because the arc of motion starts at this joint. Implant arthroplasty is the preferred surgical treatment for…
Indications The boutonniere deformity is characterized by flexion at the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. Boutonniere deformities are caused by pathology at the dorsal PIP joint. Disruption of the central slip of the…
Indications The swan-neck deformity is characterized by proximal interphalangeal (PIP) joint hyperextension and distal interphalangeal (DIP) joint flexion. Swan-neck posturing is a result of tendon imbalance; the root cause can be at the wrist or at the metacarpophalangeal (MCP), PIP,…
Indications The extensor carpi ulnaris (ECU) tendon is stabilized within the ulnar groove by a fibro-osseus subsheath lying deep to the extensor retinaculum ( Fig. 38.1 ). Injury to the subsheath results in volar subluxation of the tendon around the…
Indications In rheumatoid arthritis patients, tendon rupture is a result of synovitis or attrition over a deformed bone. Common bony pathologies include caput ulnae syndrome (dorsal prominence of the ulna head leading to extensor tendon rupture; Fig. 37.1 ) and…