reconstruction

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Interferes with pinch grip and grasp and thumb is ineffective as a post

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

Epidemiology

Middle age men

Steroids / Growth Hormone

Aetiology

Usually occurs in gym

Bench Press

Clinical

Significant bruising in the acute phase

In chronic setting, ask patient to adduct against hip / resistance

Epidemiology

Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness

Younger patient on steroids / growth hormone

Occasionally occurs in young athlete with excessive contracture

Aetiology

Often preceded by quadriceps tendinosis

Indication

1.  Acute < 3/52

- single bundle

2.  Chronic

- double bundle

Technique Single Bundle

Set up

- knee at 90 degrees on bolster

- x-ray getting lateral of knee

Anatomy

6th compartment

- fibro-osseous tunnel overlying 1.5 cm to 2.0 cm of distal ulna

- held tight by the extensor carpi ulnaris tendon sheath

- the extensor retinaculum passes around the ulna to insert on the palmar aspect of the carpus

- extensor retinaculum is a separate structure from the ECU tendon sheath

Mechanism

Forced supination, palmar flexion, and ulnar deviation

Types

Dorsal

- most common

Volar

Causes

1.  Acute traumatic peripheral tear TFCC with DRUJ dislocation

- usually major trauma

- dorsal or volar

2A.  Distal radial fracture

Definition

Stenosing tenosynovitis of the first dorsal compartment of wrist

Epidemiology

Most are middle aged women

Aetiology

Repetitive thumb movements

- abduction & extension

- combined with RD & UD movements

Any mechanical irritation

- foreign body

- prominent bony surface

- restricted fascial compartment

Definition

Volar Intercalated Segmental Instability

- secondary to injury to the lunate-triquetral ligament

Epidemiology

Less common

Aetiology

Caused by fall on outstretched extended wrist

- hypothenar eminence strikes ground first 

- isolated LT ligament injury

Can be part of perilunate dislocation

- SL heals

- residual LT laxity

Epidemiology

Usually occurs in young people

- often previous history of tendonitis ± steroid injections

Location

Usually at level of inferior pole of patella

- less common at tibial tubercle

- mid-substance ruptures rare

Clinical

Severe pain

Palpable defect

Extensor deficit / unable to SLR

Xray

Patella alta / high riding patella