Thumb Carpometacarpal Arthroplasty with Ligament Reconstruction and Tendon Interposition Using Flexor Carpi Radialis Tendon and a Tenodesis Screw

Description

This video outlines a surgical technique for performing thumb CMC arthroplasty using the flexor carpi radialis (FCR) tendon and a tenodesis screw in cases of later stage basilar thumb arthritis. It follows the case of a 60-year-old right-handed man experiencing chronic thumb pain, previously unresponsive to conservative treatments such as bracing and anti-inflammatory drugs. The detailed surgical procedure begins with a careful incision and retraction of nerves, followed by joint capsule incision and trapezium resection, emphasizing the importance of FCR tendon preservation. The surgical steps include tendon harvest through incisions at the wrist, the creation of a tunnel in the metacarpal for the tendon graft, and subsequent tendon loop and fixation using a tenodesis screw to maintain joint alignment and stability. Post-operative care includes splinting, gradual transition to occupational therapy, and expectations for full recovery, with assessments showing improved function and pain relief three months after surgery. The video concludes with an acknowledgment of the absence of consensus on the superior technique for trapeziectomy, while emphasizing the potential advantages of using a tenodesis screw to prevent complications often associated with silicone implants.

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