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. 2011 May;44(2):308-16.
doi: 10.4103/0970-0358.85352.

Trapezio-metacarpal arthritis: The price of an opposable thumb!

Tolga Turker  1 , Sunil Thirkannad
Affiliations

Trapezio-metacarpal arthritis: The price of an opposable thumb!

Tolga Turker et al. Indian J Plast Surg. 2011 May.

Abstract

Trapezio-metacarpal arthritis is the most common arthritic problem of the hand for which patients seek surgical treatment. The current article reviews the etio-pathogenesis, epidemiology, classification and management of this widespread problem. The anatomy and unique biomechanics of this joint are also reviewed. In addition, the article provides a detailed description of our preferred method of trapezio-metacarpal arthroplasty.

Keywords: Arthritis; Arthroplasty; Trapezio-metacarpal joint.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Polyaxial mobility of digits, especially the thumb, enables us to grasp objects of differing shapes and sizes
Figure 2
Figure 2
The trapezio-metacarpal joint is best described as a “twisted saddle”. A good way to understand this is by using the analogy of a car driving on a twisted and curved road
Figure 3
Figure 3
The centre of rotation of twisted and curved road
Figure 4
Figure 4
The centre of rotation of the trapezio-metacarpal joint lies at its volar ulnar corner
Figure 5
Figure 5
The imaginary “controlling tether” for a car as it swerves along the twisted and curved road
Figure 6
Figure 6
The beak ligament is the controlling tether for the first metacarpal and serves as the pivot point for circumduction of the thumb
Figure 7
Figure 7
The characteristic appearance of severe trapezio-metacarpal arthritis includes an adducted first metacarpal with compensatory hyperextension at the metacarpophalangeal joint
Figure 8
Figure 8
Robert's view in which the hand is hyperpronated and placed on the X-ray cassette while the X-ray beam is directed in an anterio-posterior manner across the trapezio-metacarpal joint
Figure 9
Figure 9
Path of force transmission in a normal thumb
Figure 10
Figure 10
Path of force transmission after trapeziectomy
Figure 11
Figure 11
Chevron shaped incision over the dorso-radial aspect of the trapezio-metacarpal joint
Figure 12
Figure 12
The path taken by the second loop of wire which is passed down the flexor carpi radialis sheath in a proximal to distal direction so as to emerge at the thumb wound
Figure 13
Figure 13
The direction in which the distally based flexor carpi radialis graft is passed. This creates a suspensory ligament between the second and first metacarpals
Figure 14
Figure 14
The final appearance of the arthroplasty after the free end of the FCR tendon has been looped around the remaining intact portion
See this image and copyright information in PMC

References

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