Injured Thumb Research Articles

Long-term follow-up of primary flexor pollicis longus tenorrhaphies

This study retrospectively analyzes primary flexor pollicis longus repairs. Ninety-four patients were identified and had extensive chart review. Thirty patients returned for follow-up (mean of 6.8 years) interview, range of motion, and strength testing. At follow-up, interphalangeal active range of motion, metacarpophalangeal active range of motion, and carpometacarpal active range of motion was 68 degrees, 48 degrees, and 46 degrees, respectively. Comparisons between active range of motion for the injured and noninjured hands revealed percentage differences of 71, 82, and 96% for the interphalangeal, metacarpophalangeal, and carpometacarpal joints. The percentage differences between active range of motion and passive range of motion for the injured metacarpophalangeal and interphalangeal joints were 71% and 75%. Injured thumbs had averages of 6.7, 7.0, 5.4, and 30.6 kg for the key, chuck, thumb-index pinches and JAMAR grip mean. The percentage differences of injured to uninjured hands in these tests were 91%, 84%, 92%, and 92%. Factors that appear to have a consistently negative effect on outcome include mechanism of injury and associated damage. Factors that did not uniformly affect outcome included zone of injury, age, sex, and postoperative splinting.

Functional splinting versus plaster cast for ruptures of the ulnar collateral ligament of the thumb: A prospective randomized study of 63 cases

In a prospective randomized study that included 63 consecutive thumbs with injuries of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb, plaster cast immobilization was compared with functional treatment with a splint. The splint allowed flexion and extension of the MCP joint, but prevented ulnar and radial deviation of the thumb. The study included both operated on and nonoperated on cases where surgery was performed only when the torn ligament was regarded as displaced. Of 40 thumbs treated nonsurgically, 21 were treated with a cast and 19 with a splint. Of 23 thumbs treated surgically, 10 were immobilized postoperatively in a plaster cast and 13 were treated with the splint. At the follow-up examination after 15 (11-41) months, there was no difference between the treatment groups as regards stability, range of motion, strength of the injured thumb, and length of sick leave. However, the patients considered the splint more comfortable than plaster cast immobilization. We conclude that immobilization of the thumb after a ligamentous injury with a movable splint is strongly preferred by the patients and that the functional results of this technique are equal to plaster cast immobilization after both surgical and nonsurgical treatment.

Locking of the metacarpophalangeal joint of the thumb.

We clinically examined the hands of twenty-three patients and experimented with amputation specimens to clarify the characteristic features and pathomechanism of locking of the metacarpophalangeal joint of the thumb. In all of the patients the locking had resulted from forced hyperextension of the thumb. Every injured thumb showed a mild hyperextension deformity of the metacarpophalangeal joint, with the joint having become fixed. Manual reduction was successful in seven patients, but the other sixteen required open reduction, during which we found that the proximal palmar ligament was ruptured transversely with its distal part riding over the volar prominence of the radial condyle of the metacarpal together with the accessory collateral ligament. These dislocated parts of the ligament formed a constricting bundle on the distal joint surface of the condyle that prevented closed reduction. The locking was released by cutting the constricted ligament bundle. Our description of this mechanism is supported by the experimental evidence that we obtained from examining the amputation specimens.

Restoration of sensibility to the injured thumb

Restoration of sensibility to the injured thumb

Restoration of Sensibility to the Injured Thumb

SummaryTwo almost identical thumb injuries with total loss of tactile sensation are presented. In one, sensibility was restored by a hetero-digital neurovascular island flap; in the other by a radial nerve flap.A brief review of the relevant literature is given.Our thanks to Mrs. J.D. Marriott for typing the manuscript.

Radial-innervated cross-finger flap from index to provide sensory pulp to injured thumb.

Radial-innervated cross-finger flap from index to provide sensory pulp to injured thumb.