| |
synonyms:
Thumb RCL Injury ICD-10
A- initial encounter
D- subsequent encounter
S- sequela
Thumb RCL Injury ICD-9
- 842.12 (Sprains and strains of metacarpophalangeal joint of hand)
Thumb RCL Injury Etiology / Epidemiology / Natural History
- 1/10 as common as UCL injury
- caused by extension and adduction injuries
Thumb RCL Injury Anatomy
Thumb RCL Injury Clinical Evaluation
- tenderness at ligament origin and insertion
- pain exacerbated by torsional motions such as turning doorknobs or with axial compression such as pushing in buttons on car doors.
- 30 degrees increased laxity in extension and 30 degrees flexion to ulnar deviation as compared to uninjured side = complete rupture.
- Partial injuries will have firm end-point
Thumb RCL Injury Xray / Diagnositc Tests
- PA, lateral and oblique views. Generally normal; occasionally proximal phalanx may be deviated ulnarly; may have avulsion fragment. Palmar subluxation is common
Thumb RCL Injury Classification / Treatment
- Partial tear (have firm end point on exam) = thumb spica cast 4-6 wks
- Complete tears = operative repair
Thumb RCL Technique
- “lazy S” incision
- dorsal branch of radial sensory nerve gently retracted
- abductor aponeurosis incised longitudinally exposing ligament and joint
- inspect for intraarticular patholoty
- tear isoloated
- mibsubstance tear=repair with 4-0 ethibond, incorporate part of palmar plate with deepest suture
- bony avulsions repaired with pull-out suture(monofilament passed with Keith needles) over button, or Mitek mini-anchors; +/- k-wire fixation of joint
- close abductor aponeurosis with 4-0 pds, skin 5-0 chromic
Thumb RCL Injury Associated Injuries / Differential Diagnosis
Thumb RCL Injury Complications
- instablity (more common with non-operative treatment)
- limitation of motion
- hypestesia
- infection
Thumb RCL Injury Follow-up Care
- thumb-spica cast for 4-6 wks
- customized thermoplastic “thumb cone” splint. ROM exercises
- two weeks after cast start full AROM
- 3 wks out of cast start strengthening, wean out of splint.
Thumb RCL Injury Review References
- Durham JW, J Hand Surg 18;232:1993
|
