4.0 of 79 Ratings
A 64-year-old right–hand-dominant woman has been experiencing radial-sided right wrist pain, particularly with opening jars and pinching. On exam she has tenderness directly over her thenar eminence and swelling distally along her FCR tendon. She has worn a splint on-and-off over the past year, has had multiple cortisone injections, and has modified her activity, all of which helped initially. She wants to move forward with surgical intervention. Given her history, physical exam, and radiographs shows in Figures A and B, what surgical procedure would best alleviate her symptoms AND reduce the need for a secondary procedure?
Scaphotrapeziotrapezoidal (STT) arthrodesis
Open scaphoid distal pole resection
Open scaphoid distal pole resection with silicone interpositional spacer
Arthroscopic scaphoid distal pole resection
First carpometacarpal joint (CMCJ) arthrodesis
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A 76-year-old female has been seen in your office on multiple occasions. She has persistent pain and discomfort when pinching with her left thumb. In addition, she has a 20-degree extension deformity of her ipsilateral MCPJ. She has received injections and has attempted nighttime splinting for 3 months. Due to recalcitrant symptoms, she elects for surgical management. You discuss with her the risks and benefits of various surgical options. In addition to MCPJ stabilization, you discuss treatment options for her CMCJ. Specifically, with regard to the benefit of ligament reconstruction and tendon interposition (LRTI) as compared to trapeziectomy, you council her that:
LRTI offers improved pain relief
LRTI offers improved range of motion
LRTI offers decreased symptomatic metacarpal subsidence
LRTI offers improved subjective patient-centered outcome scores
No benefit of LRTI over trapeziectomy
A 57-year-old woman presents to clinic with left thumb pain. She reports difficulty with pinching and grasping. Physical examination is remarkable for a painful CMC grind test. A radiograph of her left hand is shown in Figure A. All of the following are possible sequelae of her disease EXCEPT:
Thumb metacarpal adduction deformity
Thumb interphalangeal (IP) joint flexion deformity
Thumb carpometacarpal (CMC) joint extension deformity
Thumb metacarpophalangeal (MCP) joint hyperextension deformity
Thumb metacarpal palmar flexion deformity
A 55-year-old female patient presents with pain along the thumb ray and increasing deformity of her right hand. Key pinch causes her pain. The appearance of her hand is seen in Figure A. Range of motion of her thumb is seen in Figure B. What is the most likely cause of her deformity?
Type II hypoplastic thumb
Median nerve neuropathy
Lupus thumb deformity
Extensor tendon rupture
Osteoarthritis of the trapeziometacarpal joint
A 68-year-old female office assistant reports left thumb pain that has progressively worsened over the past 2 years. She is left hand dominant and reports difficulty with opening jars and holding a coffee cup. On examination of the left hand she has a positive thumb carpometacarpal grind test and has a fixed deformity at the thumb metacarpalphalangeal joint. Figure A demonstrates the left hand grasping an object and Figure B shows a radiograph of the left thumb. What is the most appropriate next step in treatment?
Carpometacarpal joint fusion and metacarpophalangeal joint volar capsulodesis
Carpometacarpal joint resection arthroplasty and metacarpophalangeal joint volar capsulodesis
Carpometacarpal joint resection arthroplasty and metacarpophalangeal joint fusion
Carpometacarpal joint resection arthroplasty and temporary metacarpophalangeal joint percutaneous pin fixation
Carpometacarpal joint fusion and metacarpophalangeal joint fusion
A 60-year-old man has chronic pain at the base of this thumb and weakness on attempted thumb pinch. A radiograph is shown in Figure A. Which injection would likely most offer the greatest degree of symptomatic improvement?
All of the above are equally effective
All of the above are detrimental
A 56-year-old right hand dominant male presents to your office complaining of right thumb pain worsened with pincer grip and using his mobile phone. He is a writer, and is having difficulty holding his pen. Radiographs from this visit are shown in Figure A. Compared with trapeziectomy alone, which of the following treatment options is likely to result in superior pain relief and improvement of key-pinch strength?
Trapeziometacarpal corticosteroid injection followed by aggressive occupational therapy
Trapeziectomy with interpositional palmaris longus arthroplasty
Trapeziectomy, interpositional arthroplasty, and palmar oblique ligament reconstruction using flexor carpi radialis autograft
Partial trapeziectomy with capsular interpositional arthroplasty
None of the above