Executive Editor: Chris Colton

Authors: Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Thumb

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Glossary

Dorsal to MCP joint
This approach is indicated for intraarticular, or periarticular, fractures of the metacarpophalangeal (MCP) joint of the thumb. enlarge

Indications

This approach is indicated for intraarticular, or periarticular, fractures of the metacarpophalangeal (MCP) joint of the thumb.
It is also used for arthrodesis of the MCP joint.


A straight, or gently curved, skin incision can be used. enlarge

Skin incision

A straight, or gently curved, skin incision can be used.
Start the incision 2 cm proximal to the MCP joint, extending it to approximately 2 cm distal to the MCP joint.
Identify and protect the dorsal divisions of the dorsal sensory branch of the radial nerve, and the dorsal veins.


Elevate the skin and fine subcutaneous tissue as a single layer, by blunt dissection, and expose the tendons of extensor ... enlarge

Exposure of the extensors

Elevate the skin and fine subcutaneous tissue as a single layer, by blunt dissection, and expose the tendons of extensor pollicis longus (EPL) and extensor pollicis brevis (EPB).


Incise between the EPL and the EPB tendons. enlarge

Splitting of the tendon

Incise between the EPL and the EPB tendons.


Be careful not to detach the insertion of the EPB from the base of the proximal phalanx. enlarge

Be careful not to detach the insertion of the EPB from the base of the proximal phalanx.


Take care not to detach the collateral ligaments. enlarge

Capsulotomy

After separating the extensor tendons, the joint capsule is exposed. A longitudinal capsulotomy is performed to enter the joint.
Take care not to detach the collateral ligaments.


Flex the thumb in order to expose the MCP joint fully. enlarge

Exposure of the joint

Flex the thumb in order to expose the MCP joint fully.


Repair the capsulotomy with fine, interrupted mattress sutures. The separated tendons of EPL and EPB are approximated with ... enlarge

Wound closure

Repair the capsulotomy with fine, interrupted mattress sutures. The separated tendons of EPL and EPB are approximated with sutures.

v1.0 2008-11-08