Matthew M Tomaino MD MBA

University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA Arthrodesis of the distal interphalangeal (DIP) joint is a common procedure to treat the painful, unstable distal joint in the osteoarthritic and rheumatoid patient. Less common indications include chronic mallet deformity, missed flexor digitorum profundus avulsions, and distal middle phalangeal fracture nonunion. In most cases, successful fusion improves digital function. Morbidity to the extent that...

Abductor pollicis longus suspensionplasty surgical technique

A 6-cm curvilinear incision is made from 2 finger breadths proximal to the radial styloid process, to 1 cm distal to the base of the meta-carpal (Fig. 2A). The radial artery is exposed and retracted, as are branches of the radial sensory nerve. The first extensor compartment retinacu-lum is released, as would be performed for De-Quervain's disease, leaving the volar attachment intact. At the myotendinous junction of the APL, the ulnarmost slip of APL is released, and freed to the level of its...

Technique of proximal interphalangeal joint arthroplasty

Different surgical approaches have been used for the various PIPJ prosthetic devices, including dorsal, lateral, and palmar approaches 8 . Because important structures must be negotiated with all these approaches, postoperative difficulties may occur. With the dorsal approach, the central slip is vulnerable and with the lateral approach, the collateral ligaments are at risk. The volar plate and the flexor tendon sheath are at risk with the volar or anterior approach. Linscheid and Fig. 4. The...

Treatment of degenerative arthrosis

Metacarpal Boss

Degenerative changes, not related to fracture or dislocation, typically affect the second and third CMC joints, and result in dorsal hypertro-phic osteophyte formation. Patients present complaining of a tender prominence over the interval between the two joints. The pain may result strictly from direct pressure or may be related to use and overuse of the digits, sometimes associated with extensor tendon subluxation over the dorsal prominence (Fig. 7). The prominence is firm and nonmobile,...

Radiofrequency effects on collagen

Orthopedic surgeons have benefited from the use of radiofrequency in a variety of procedures during the past decade. It is only now that we are realizing that there may be some detrimental effects, and it is important to look at this technology more critically. Nevertheless, as with any new technique, judicious use of this technology may allow for stabilization of the joint capsule in a variety of clinical scenarios. Shoulder instability has been treated by a variety of authors using...

Indications

Laxity of the CMC joint of the thumb may be a manifestation of generalized ligament laxity, result as the sequela of trauma, or be a manifestation of metabolic disease such as Ehlers-Danlos syndrome. It is seen most commonly as one manifestation of generalized ligament laxity, particularly in young women in the third to fourth decades of life. They typically also have hyperextension of the elbows, knees, and finger metacar-pophalangeal MP joints. The symptoms are exacerbated by activity, but...

Surgical technique

Forearm Incision

The basal joint of the thumb is exposed through a modified Wagner incision. There is a longitudinal component parallel to the long axis of the thumb metacarpal located in the interval between the glabrous palmar and nonglabrous dorsal skin. The incision is continued transversely in the wrist crease to just ulnar to the FCR tendon Fig. 1 . There is invariably a branch of the dorsal sensory branch of the radial nerve crossing the operative field that should be mobilized and protected throughout...