Treatment of Subsesamoid Arthritis of the Metacarpophalangeal Joint of the Thumb: Volar Plate Reinforcing Technique after Sesamoid Excision

Jong-Pil Kim; Hyun-Yul Yoo; Byoung Kwon Min

doi:10.4055/jkoa.2009.44.2.240

Journal List > J Korean Orthop Assoc > v.44(2) > 1012895

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Yoo, and Min: Treatment of Subsesamoid Arthritis of the Metacarpophalangeal Joint of the Thumb: Volar Plate Reinforcing Technique after Sesamoid Excision

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(2): 240-248.

Published online: 30 April 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.2.240

Treatment of Subsesamoid Arthritis of the Metacarpophalangeal Joint of the Thumb: Volar Plate Reinforcing Technique after Sesamoid Excision

Jong-Pil Kim, M.D., Hyun-Yul Yoo, M.D., Byoung Kwon Min, M.D.

Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea.

Address reprint requests to Jong-Pil Kim, M.D., Ph.D. Department of Orthopedic Surgery, Dankook University College of Medicine, 359 Manghyangro, Dongnam-gu, Cheonan 330-715, Korea. Tel: +82.41-550-3919, Fax: +82.41-550-3094, kimjp@dankook.ac.kr

Abstract

Purpose

To report the clinical outcomes of a volar plate reinforcing technique with free tendon grafts after sesamoid excision for the surgical treatment of subsesamoid arthritis of the metacarpophalangeal (MCP) joint of the thumb.

Materials and Methods

Eleven consecutive patients that underwent sesamoid excision and volar plate reinforcement using a palmaris longus free tendon graft were enrolled. There were 7 males and 4 females, with an average age of 46 (range, 30-56 years). Post-traumatic arthritis after a hyperextension injury of the thumb was present in 9 patients. Two patients had idiopathic arthritis. All patients were evaluated by objective and subjective criteria, the mean follow-up duration was 19 months (range, 12-35 months).

Results

The results were satisfactory overall (3 excellent, 7 good, 1 poor). The mean grip strength and pinch strength significantly improved from 63.0% and 51.3%, respectively, preoperatively, to 84.9% and 88.9%, postoperatively. The mean range of motion for the MCP joint was -5.9/50.9 degrees. The mean DASH and MHQ scores showed significant improvement compared to the preoperative scores.

Conclusion

The early clinical results suggest that the described technique is a safe and effective option for subsesamoid arthritis of the MCP joint of the thumb.

Keywords: Thumb, Metacarpophalageal joint, Subsesamoid arthritis, Sesamoid excision, Volar plate reinforcing technique

Figures and Tables

Fig. 1

A lateral radiograph shows that the space between the metacarpal and sesamoid is narrowed with sclerosis (arrow).

Fig. 2

Arthroscopic examination shows a sesamoid with osteophyte formation and cartilage denuding, indicating sub-sesamoid arthritis (arrow head).

Fig. 3

Surgical approach. A inverted trapezoid skin incision, centered over the MCP joint of the thumb, is extended proximally into the palm within a skin crease over the distal portion of the thenar eminence.

Fig. 4

A photograph of excised both sesamoid bones shows that grossly degenerative changes developed in the radial sesamoid (asterisk).

Fig. 5

(A) A intraoperative photograph shows that two limbs of graft (arrow head) have been placed in each side of the flexor pollicis longus tendon (asterisk) and secured. (B) Schematic diagram of volar plate reinforcement with a free tendon graft of the MCP joint of the thumb.

Fig. 6

Photographs at final follow-up. (A) Postoperative active extension of the MCP joint of the thumb was to 0°. (B) Pinch strength was 90% of the value on the unoperated side.

Table 1

Demographics of Patients

Table 2

Grading the Results

Total scores: 0-7 points, poor; 8-13 points, fair; 14-17 points, good; 18-20 points, excellent; ADLs, activities of daily living. Modified from Glickel et al.4)

Table 3

Clinical Results

Table 4

Pre- and Postoperative Mean Disabilities of the Arm, Shoulder and Hand (DASH) Scores^*

^*The DASH is based on a score of 0 to 100. A lower score indicates less disability.

Table 5

Pre- and Postoperative Mean Michigan Hand Outcomes Questionnaire (MHQ) Scores^*

^*All MHQ scale scores are based on a scale of 0 to 100. For all of the scores except pain, higher scores indicate better hand performance. For the pain scale, lower scores indicated less pain.

References

1. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998. 23:575–587.

2. Eiken O. Palmaris longus-tenodesis for hyperextension of the thumb metacarpophalangeal joint. Scand J Plast Reconstr Surg. 1981. 15:149–152.

3. Glickel SZ. Peimer CA, editor. Metacarphophalangeal and interphalangeal joint injuries and instabilities. Surgery of the hand and upper extremity. 1996. v. 1-2. New York: McGraw-Hill;1043–1068.

4. Glickel SZ, Malerich M, Pearce SM, Littler JW. Ligament replacement for chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg Am. 1993. 18:930–941.

5. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996. 29:602–608.

6. Kessler I. A simplified technique to correct hyperextension deformity of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am. 1979. 61:903–905.

7. Masson JA, Golimbu CN, Grossman JA. MR imaging of the metacarpophalangeal joints. Magn Reson Imaging Clin N Am. 1995. 3:313–325.

8. Mohler LR, Trumble TE. Disorders of the thumb sesamoids. Hand Clin. 2001. 17:291–301.

9. Parks BJ, Hamlin C. Chronic sesamoiditis of the thumb: pathomechanics and treatment. J Hand Surg Am. 1986. 11:237–240.

10. Posner MA, Langa V, Ambrose L. Intrinsic muscle advancement to treat chronic palmar instability of the metacarpophalangeal joint of the thumb. J Hand Surg Am. 1988. 13:110–115.

11. Rozmaryn LM, Wei N. Metacarpophalangeal arthroscopy. Arthroscopy. 1999. 15:333–337.

12. Schuurman AH, Bos KE. Treatment of volar instability of the metacarpophalangeal joint of the thumb by volar capsulodesis. J Hand Surg Br. 1993. 18:346–349.

13. Seybold EA, Warhold LG. Impingement of the flexor pollicis longus tendon by an enlarged radial sesamoid causing trigger thumb: a case report. J Hand Surg Am. 1996. 21:619–620.

14. Trumble TE, Watson HK. Posttraumatic sesamoid arthritis of the metacarpophalangeal joint of the thumb. J Hand Surg Am. 1985. 10:94–100.

15. Zancolli EA. Claw-hand caused by paralysis of the intrinsic muscles: a simple surgical procedure for its correction. J Bone Joint Surg Am. 1957. 39:1076–1080.

TOOLS

Similar articles