Tendon Suspension Arthoplasty

This woman noted progressive pain over the base of her thumb with pinching and gripping activities.  She had tried splints and cortisone injections but the pain began to significantly interfere with her daily activities. For that reason surgery was offered. The clinical picture and corresponding x-ray reveal the basilar thumb CMC joint arthritis (blue circle) and the resulting subluxation (green arrow).  On the clinical picture you also see thumb MCP joint hyperextension (blue arrow) which is a secondary deformity caused by the CMC joint subluxation.

To treat her basilar thumb arthritis, a tendon suspension arthroplasty was performed. The trapezium was removed and a tendon graft was brought through a bone tunnel in the base of the thumb metacarpal (blue arrow) to stabilize the Joint.  The remainder of the tendon graft filled the space previously occupied by the trapezium (green arrow).  Also, in order to correct the MCP joint hyperextension, and in that way protect the basilar thumb reconstruction, a fusion of her painful and hyperextended MCP joint was performed.  She was placed in a cast for 4 weeks and then began therapy.  Deformities were corrected and she gained full painless motion