Treatment of game-keeper's thumb by a new operation

[Metacarpophalangeal joint injuries and sequelae]

Injuries of the metacarpophalangeal joints of the thumb and fingers are of a bony or ligamentous nature. They can heal without subsequent problems if correctly diagnosed and treated but incorrect or absent diagnostics and therapy can result in chronic instability, dislocation, fusion as well as subsequent arthritis and functional limitations. They can lead to substantial impairment of the gripping function. Fractures with inclusion of joints and with fragments sufficiently large for refixation are as a rule treated operatively just as differences in torsion and instability. Persisting instabilities are secondarily stabilized by ligamentoplasty and arthritis of the metacarpophalangeal joint of the thumb is treated by fusion. For metacarpophalangeal joints of the fingers the main concern is preserving motion. Established salvage operations for arthritis include denervation, resection arthroplasty and systematic arthrolysis for impairment of the joint and contractures with intact joint surfaces. Even in chronic conditions, with appropriate treatment good functional results for metacarpophalangeal joints of the thumb and fingers can be achieved. This article presents the current pathophysiological principles and concepts for diagnostics and therapy of acute and chronic injuries of the metacarpophalangeal joints of fingers and thumbs.

Pollex valgus: orthopaedic management for ulnar instability of the metacarpophalangeal joint of the thumb

This article describes pollex valgus, the condition of ulnar instability of the thumb's rnetacarpophalangeal joint, relevant to the field of physical therapy. Following a discussion of the normal anatomy and biomechanics of the metacarpophalangeal joint and its component structures, the joint capsule, ulnar collateral ligament, accessory ulnar collateral ligament, volar plate, and adductor aponeurosis, the author details pollex valgus pathology. Emphasis is given to mechanisms of injury and the specific lesions, including ligament sprain and rupture, avulsion, joint locking, and the Kaplan and Stener lesions. Orthopaedic management of pollex valgus is presented in terms of evaluation, via the case history and clinical examination, and treatment, by tape strapping and surgical repair. The author concludes with mention of active exercise and joint mobilization for the rehabilitation of pollex valgus lesions. J Orthop Sports Phys Ther 1986;6(6):334-342.

Chronic posttraumatic radial instability of the thumb metacarpophalangeal joint

Radial collateral ligament injuries accounted for 35% of 26 patients undergoing surgery for lateral instability of the thumb metacarpophalangeal joint in a 3-year period. Nine patients with chronic radial instability presented with significant disability but with a symptom complex distinct from the weak pinch and grasp of chronic ulnar instability. Functional and clinical stability was obtained in these patients with a surgical procedure that consisted of repair of the callateral ligament at the site of injury, distal advancement of the abductor pollicis brevis tendon, and repair of the abductor aponeurosis.