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Australian Family Physician Aug 2010Injury to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint (MCPJ) is a common injury, especially in skiers. It is often misdiagnosed, which can... (Review)
Review
BACKGROUND
Injury to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint (MCPJ) is a common injury, especially in skiers. It is often misdiagnosed, which can lead to chronic instability.
OBJECTIVE
This article reviews the current literature on UCL injury of the thumb and describes the clinical assessment and management.
DISCUSSION
The UCL of the thumb is often injured as a result of forced abduction of the thumb, with or without extension. The injury can be identified by pain, swelling and haematoma along the ulnar border of the first MCPJ as well as pain and laxity on valgus stress testing. Proper examination involves placing a valgus stress on the thumb and measuring instability. Initial investigation should involve a plain X-ray, supplemented by ultrasound or magnetic resonance imaging, where appropriate. Treatment can be conservative or involve surgical management depending on the severity of the injury.
Topics: Collateral Ligaments; Diagnostic Imaging; Hand Injuries; Humans; Metacarpophalangeal Joint; Physical Examination; Physical Therapy Modalities; Radiography; Skiing; Splints; Thumb; Ultrasonography
PubMed: 20877752
DOI: No ID Found -
The Yale Journal of Biology and Medicine 1977Congenital absence or traumatic amputation of the thumb is a major disability profoundly disturbing the function of the hand, as the thumb represents an estimated 50% of...
Congenital absence or traumatic amputation of the thumb is a major disability profoundly disturbing the function of the hand, as the thumb represents an estimated 50% of total hand function. The methods for thumb reconstruction utilizing the index finger were developed some twenty years ago, and progress has been made in the last several years with emphasis on intrinsic muscle reconstruction as emphasized by Buck-Gramcko. The method, technique and anatomy of index pollicization is discussed, and representative cases presented for congenital absence of the thumb and for traumatic amputation of the thumb.
Topics: Adult; Hand; Hand Deformities, Acquired; Humans; Infant; Orthopedics; Thumb
PubMed: 899040
DOI: No ID Found -
Clinics in Orthopedic Surgery Mar 2012Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand... (Review)
Review
Within the Oberg, Manske, Tonkin (OMT) classification, thumb duplications are a failure of formation and/or differentiation affecting the radial-ulnar axis of the hand plate. The Wassel description of seven types of thumb duplication provides a good structure from which an approach to management is based. The aim of surgical reconstruction is to obtain a stable, mobile thumb of adequate size and appropriate shape. The most common form of reconstruction is removal of the lesser digit and reconstruction of the dominant digit. Surgical techniques address the problems of deviation, instability and lack of size. The disadvantages of the Bilhaut-Cloquet procedure, these being joint stiffness and a nail ridge, may be lesser concerns when reconstruction of one digit will not create a satisfactory thumb of adequate mobility, stability, alignment and size. Complicated problems of triphalangism, triplication, ulnar dimelia and the rare circumstance in which neither of the duplicated thumbs may be adequately reconstructed present specific challenges which demand alternative techniques.
Topics: Hand Deformities, Congenital; Humans; Orthopedic Procedures; Patient Care Planning; Plastic Surgery Procedures; Thumb
PubMed: 22379552
DOI: 10.4055/cios.2012.4.1.1 -
Medicine Aug 2022This study compared emergency surgery with elective surgery for thumb reconstruction to explore the advantages, safety, and clinical value of emergency reconstruction.... (Randomized Controlled Trial)
Randomized Controlled Trial
This study compared emergency surgery with elective surgery for thumb reconstruction to explore the advantages, safety, and clinical value of emergency reconstruction. By comparing the advantages and disadvantages of thumb reconstruction in emergency surgery and elective surgery, it provides data support for optimizing the treatment process and methods. In this study, 22 patients who underwent thumb reconstruction in Rizhao people's Hospital from January 2018 to December 2020 were randomly divided into emergency operation group and elective operation group. The differences in operation period, hospitalization time, postoperative complications, hand function score, and satisfaction score between the 2 groups were analyzed. The operation period and hospitalization time of patients in the emergency surgery group were significantly lower than those in the elective surgery group, with statistical significance (P < .05). There was no significant difference in postoperative complications between the 2 groups (P > .05). After 3 months of rehabilitation training, the 2-point discrimination, functional score, and satisfaction score of the reconstructed thumb in the emergency surgery group were higher than those in the elective surgery group, and the difference was statistically significant (P < .05). Emergency reconstruction of the thumb can reduce operation time and hospitalization time, reduce operation costs, and obtain a more ideal appearance and function.
Topics: Amputation, Traumatic; Free Tissue Flaps; Humans; Postoperative Complications; Plastic Surgery Procedures; Thumb; Toes
PubMed: 36042674
DOI: 10.1097/MD.0000000000030196 -
International Journal of Molecular... Oct 2023Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local... (Review)
Review
Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.
Topics: Humans; Thumb; Prospective Studies; Quality of Life; Arthritis; Pain; Platelet-Rich Plasma
PubMed: 37834357
DOI: 10.3390/ijms241914909 -
BMJ Case Reports Sep 2020
Topics: Diagnosis, Differential; Female; Fingers; Hand Dermatoses; Hematoma; Humans; Medical Illustration; Middle Aged; Syndrome; Thumb
PubMed: 32900755
DOI: 10.1136/bcr-2020-238156 -
The Journal of Hand Surgery, European... Jan 2019Triphalangeal thumb is a rare congenital anomaly in which the thumb has three phalanges. Clinical presentation of triphalangeal thumb can vary considerably and can be...
Triphalangeal thumb is a rare congenital anomaly in which the thumb has three phalanges. Clinical presentation of triphalangeal thumb can vary considerably and can be present in both hands or unilateral. The thumb can be long with a finger-like appearance. The presence of clinodactyly depends on the shape of the extra phalanx varying from wedge-shaped to rectangular. Various joints, ligaments, muscles, and tendons of the first ray can be hypoplastic or absent, with varying degrees of stiffness or instability. The aim of surgical treatment is to reconstruct or correct the anatomic anomalies to obtain greater function and a more acceptable appearance. In our series, operations varied from removal of the delta phalanx with ligament reconstruction to multiple osteotomies and rebalancing of soft tissues. Results in these often complex cases can be rewarding if the surgeon has sufficient knowledge of the underlying anatomic differences. This review summarizes our current concepts of presentation and management of the triphalangeal thumb.
Topics: Age Factors; Hand Deformities, Congenital; Humans; Muscle, Skeletal; Orthopedic Procedures; Postoperative Care; Thumb
PubMed: 30223699
DOI: 10.1177/1753193418797922 -
Orthopaedics & Traumatology, Surgery &... Feb 2017Congenital thumb anomalies are common and have a major impact given the specific functional role of the thumb. They may occur alone or as part of a multiple congenital... (Review)
Review
Congenital thumb anomalies are common and have a major impact given the specific functional role of the thumb. They may occur alone or as part of a multiple congenital anomaly syndrome. The primary goal of surgical management is to improve or restore pincer grip. In patients with 'congenital' trigger thumb, the A1 pulley must be released if the interphalangeal joint remains in fixed flexion. Thumb duplication is generally managed by reconstruction of the thumb from the predominant (ulnar-based) digit; the accessory (radial-based) digit is excised after collection of its tissue components needed for the reconstruction programme. Thumb aplasia requires pollicisation of the index finger by island flap transfer of the second ray to give it the shape, position, and function of a thumb. Among patterns of digital hypoplasia, some require reconstruction of the existing thumb and others excision of the rudimentary thumb followed by pollicisation. In patients with aplasia of multiple hand digits, a toe transfer may be considered when there is no natural tendency to develop digital prehension at the hand.
Topics: Child; Child Health Services; Hand Deformities, Congenital; Humans; Osteotomy; Plastic Surgery Procedures; Thumb
PubMed: 27940039
DOI: 10.1016/j.otsr.2016.04.016 -
Hand (New York, N.Y.) Jul 2022Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals...
BACKGROUND
Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery.
METHODS
This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question, categorized with the International Classification of Functioning, Disability and Health coding system, and compared to self-reports of pain and function. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0 = not motivated). Factors characterizing patients highly motivated for surgery (NRS ≥ 8) were explored with multivariate regression analyses.
RESULTS
The mean age of the participants was 63 years (SD = 7.6), and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use, but these were not reflected in self-reports of pain and function. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with reporting more activity limitations (odds ratio [OR] = 4.00, = .008), living alone (OR = 3.18, = .007), and a young age (OR = 0.94, = .002).
CONCLUSIONS
Decisions on CMCJ OA surgery should be based on assessment and discussion of patients' life situation, hand pain, activity limitations for, and goals and motivation for surgery. According to the european league against rheumatism (EULAR) recommendations, previously received conservative and pharmacological treatment should also be evaluated.
Topics: Cross-Sectional Studies; Female; Goals; Humans; Male; Middle Aged; Motivation; Osteoarthritis; Pain; Thumb
PubMed: 32988234
DOI: 10.1177/1558944720940063 -
Hand Clinics Aug 2016Thumb hypoplasia is a component of radial longitudinal deficiency. The severity of hypoplasia can range from a slightly smaller thumb to a complete absence. Types II and... (Review)
Review
Thumb hypoplasia is a component of radial longitudinal deficiency. The severity of hypoplasia can range from a slightly smaller thumb to a complete absence. Types II and IIIA hypoplastic thumbs are candidates for reconstruction to improve function, stability, and strength. There are 2 commonly used tendon transfers that can augment thumb opposition strength: the Huber abductor digiti minimi muscle transfer and the flexor digitorum superficialis opposition transfer. Both transfers use ulnar-sided structures to augment the thenar musculature. The Huber opposition transfer increases thenar bulk, but does not provide additional tissue for metacarpophalangeal stability.
Topics: Hand Deformities, Congenital; Humans; Muscle, Skeletal; Tendon Transfer; Thumb
PubMed: 27387085
DOI: 10.1016/j.hcl.2016.03.012