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9 Cards in this Set

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Burton-Pellegrini CMC arthroplasty
Trapezium is excised
FCR is % proximally & tenolysed to its distal insertion. A drill hole is placed in the palmar 1/3 of the artiular surface of the 1st metacarpal.
FCR is passed through the drill hole, with the FCR sutured to the dorsal periosteum at the site of the APL insertion. The remaining FCR is rolled into an 'anchovy' and positioned in the trapezial defect.
Anchovy CMC athroplasty
Trapezium excised, the Palmaris Longus is harvested and rolled into an 'anchovy'.
The 'anchovy' is interpositioned in the space vacated by the trapezium.
The APL is usually imbricated to increase stability at the CMC level.
The 1st DC is typically released to avoid irritation secondary to the sutured APL.
Weilby-Kleinman CMC arthroplasty
THe dynamic stability for the CMC joint is created by utilizing 50% of the FCR (lengthwise) to fill the space of the trapezium.
The APL is woven to form a sling to support the 1st metacarpal.
Zancolli CMC arthroplasty
Trapezium excised, a slip of APL is routed through the drill holes in the 1st MP & sutured to the FCR.
10-14 days PO
Bulky compressive removed
Following suture removal, pt fit with SA cast/wrist & thumb static splint w/ IP free. The thumb is positioned midway between palmar & Rad Abd. (Apply light compressive dressing prior to fabricating splint).
***NOTE: Thumb must not be positioned in radial abduction. This would risk stetching out the reconstruction.
4 wks PO
A & Self PROM are initiated: thumb & wrist=6-8x/day for 10 minute sessions. Exercises should emphasize:
-Palm/Rad Abd
-Thumb circumduction, flexion, extension
- Wr. flexion/extension
-Wr. RD/UD

CMC joint should be supported during Self passive exercises.

Splint is worn b/t HEP & noc for protection of surgery & for comfort.
Scar management is initiated (if patient had been in a cast for 4 weeks).
Desense along site to decrease hypersensitivity.
6 weeks PO
Unrestricted PROM (continue to support CMC joint).
If needed, add dynamic flexion splinting for MP & IP joint thumb. Any dynamic splint must be form fitting & provide max support of CMC joint.

Continue with wr/th static splint b/t exercise sessions & at night.

Persistent & dense scars may benefit from US. US can enhance vasoelasticity of the soft tissues (increase mobility).
8 wk PO
GENTLE strenghening may be initiated b/t 6-8 wks. if edema &/or pain are present, delay strengthening until 8 weeks.

Static splint may be DC'd. Pt's with repetitve heavy lifting/pinching Ax's may be more comfortable in a short opponens splint. (Depending on need, either thermoplastic/pre-fab can be used).

Persistent hypersensitivity along the surgical site typically responds well to high rate, conventional TENS worn continuously until the pain dissipates. (Fludio may help with sensitivity).
10-12 wks PO
Patient may resume normal use of their hand in daily Ax. Patient education is important. The basic guidelines outlined in conservative management of CMC arthritis should be reviewed once again. Simple suggestions such as non-skid pads to remove jar lids, etc should be reinforced.