News Category: Hand

In the past, joint replacements for the fingers have been made of metal or silicone. But problems with these materials has led to the development of a pyrolytic carbon (pyrocarbon) implant. One of the designers of this implant is Dr. Robert D. Beckenbaugh from the Mayo Clinic in Rochester, Minnesota.

In this article, Dr. Beckenbaugh and Dr. Rizzo present the pros and cons of this new implant. Step-by-step surgical technique is outlined for use of the pyrocarbon implant in the proximal interphalangeal (PIP) joint.

The PIP joints are the middle joints of the fingers. Color photos of the main steps in the surgery are included. A video of the procedure is available on-line. Standard guidelines for therapy after surgery are also included.

Pyrocarbon implants can be used for osteoarthritis, rheumatoid arthritis, instability, and stiffness or deformity of the fingers. There are some conditions which prevent the use of this type of implant. For example, patients with infection or tendons that can’t be repaired are not good candidates for pyrocarbon PIP joint replacement.

During the operation, the bone and joint is prepared for an implant. A trial implant is put in place to get the best fit and alignment. Surgeons use fluoroscopy to make sure everything fits properly. Fluoroscopy is a type of X-ray imaging that allows the surgeon to see inside the body while doing the operation.

Once the size and placement of the trial implant are correct, then the final implant is inserted. The soft tissues cut open in order to do the surgery are repaired. The skin is closed with sutures. A padded dressing and plaster splint are applied to the finger.

The authors provide a table of guidelines for rehab from day four through the first three months. Splinting, exercises, and activities are discussed. A summary of tips and pitfalls for the surgeon to watch out for is also included.

Rheumatoid arthritis (RA) is a systemic disease (affects the entire body) but has its greatest effect on the joints. The hands are often involved causing painful deformities of the thumbs and fingers.

In this article, Dr. T. D. Rozental reviews four stages of rheumatoid disease of the hand and thumb. Treatment is discussed, including nonsurgical and surgical options. Photos of thumb deformities, X-rays, and results of treatment are presented.

The four stages of RA are: 1) synovitis or inflammation of the joint lining for less than six months, 2) synovitis present more than six months, 3) thumb and hand deformities develop, and 4) arthritis mutilans (loss and collapse of bone).

Conservative care is recommended for stage 1 and 2 disease. This includes medication, steroid injections, and splinting. Sometimes it takes a period of trial and error to find the drug or the right combination of medications that works best for each patient.

A physical or occupational hand therapist is part of the team from the beginning. Patients are taught how to protect their joints. Splints may be used to maintain joint alignment and prevent loss of motion or deformity. Inflamed joints need the right mix of rest and exercise. The therapist helps the patient find the best program of exercise for the entire body.

Surgery is more likely for stages 3 and 4. Repair of tendon rupture and restoration of function are two goals of surgical treatment. Six types of tendon and joint deformity common with RA are boutonnière deformity (two types), swan-neck deformity, joint contractures (joint gets stuck and can’t move), joint instability, and arthritis mutilans.

The author describes repair techniques for each of these problems. If the bone is intact but the joint is destroyed, a joint replacement called arthroplasty may be advised. Patients with advanced disease and major bone destruction may require joint fusion called arthrodesis.

Fractures, arthritis, nerve injuries, and tumors are just a few of the problems hand surgeons treat. In this review article, Dr. P. C. Amadio from the Mayo Clinic reports on the latest news in hand surgery.

Fractures of the scaphoid bone in the wrist that don’t heal may be helped by vascularized bone grafts. These bone grafts have their own blood supply to help keep them alive longer while the body builds its own bone around them. Pins work better than screws to hold the graft in place.

The best treatment for radial wrist fractures is still unclear. Internal fixation with pins, plates, or screws for fractures has fewer complications but no difference in terms of final results. A newer treatment for distal radial fractures using volar locking plates allows earlier wrist movement. Studies are underway comparing this treatment to other treatment options.

Bone fusion called arthrodesis for severe wrist arthritis is usually done with wires, staples, or screws. A newer method may not pan out. Circular plates used to fuse the wrist have a much higher nonunion rate (26 per cent compared to three per cent for other methods of fixation).

Joint replacement using silicone versus the newer prolytic carbon is also under investigation. More work is needed to improve the results of these operations.

Ruptured or torn tendons are repaired using sutures. Newer methods using tissue-engineering methods may speed healing. Rehab is essential to good results from this procedure.

Retraining the hand or a finger after nerve injury can be challenging. The patient must use the injured area and avoid using uninjured areas. Recent results from Sweden show that applying a topical numbing cream on the normal skin can help improve perception of touch, pressure, and feeling in the injured area.

The authors offer similar updates on carpal tunnel syndrome, cosmetic surgery, and bone tumors. More shoulder and elbow surgeries have also been reported. Microsurgery with the aid of improved technology has made it possible to attach fingers traumatically amputated.

In this study, blood flow and vibratory sense were measured in three groups. Group one was adults ages 18 to 65 years old with chronic upper limb pain disorder (ULPD).

Group two were slightly older with carpal tunnel syndrome (CTS). Group two had wrist and hand pain, numbness, or loss of some sensation in the wrist, hand, and fingers. Group three were normal, healthy adults matched by age and sex.

Measurements of perception and discrimination thresholds for vibration were done before and after a five-minute typing stress test. Threshold vibration was tested over the soft tissues of the forearm, palm, and back of the hand.

The authors found no difference in blood flow or volume among the three groups. There was no difference in vibration thresholds before and after the keyboard use. The major finding was that vibratory sense was changed in both arms and hands for ULPD and CTS on both sides. This was true even when only one limb was affected by the condition.

The authors suggest the changes occur in the central nervous system (spinal cord to brain pathway), rather than in the peripheral nervous system (spinal nerve to spinal cord) pathway.

It appears that widespread elevation of vibratory threshold occurs with chronic pain because of changes in the central processing of pain messages. There may not be any real changes in the nerves to the arms and hands. The problem is global, not local.

When diagnosing carpal tunnel syndrome (CTS) doctors rely on patient report of symptoms. Electrodiagnostic tests such as nerve conduction velocity (NCV) can also help identify problems with nerve transmission. Pressure on the nerve or nerve entrapment often changes NCV.

In this study, researchers compare patient report of symptoms against the results of electrodiagnostic tests. They expected to see a difference in scores for patients with psychologic problems. Patients who were not depressed and did not catastrophize their symptoms were expected to have more true nerve changes seen on NCV.

They found that symptoms of CTS such as pain, weakness, and numbness are separate measures from the results of electrodiagnotic tests. It’s better to use both types of testing when diagnosing CTS.

Normally CTS affects small sized nerve fibers. Electrodiagnostic tests are more likely to show changes in large nerve fibers and might not show changes in the small nerve fibers. Early symptoms of CTS are usually worse in the beginning when electrodiagnostic testing isn’t as likely to show any changes.

Over time, the symptoms may get better when true changes would show up on testing. But the patient feels better and testing isn’t done. The authors suggest this pattern of worse-to-better might happen because the patient gets used to the pain and doesn’t notice it as much. Or perhaps the symptoms just burn out and go away.

Whatever the explanation, the results of this study showed that there isn’t a direct link between electrodiagnostic findings and patient symptoms and function. To get a true and accurate picture of what’s going on, the physician must rely on both patient report and testing.

Carpal tunnel release (CTR) has become a very common surgical procedure for carpal tunnel syndrome. Symptoms of hand and wrist pain, numbness, and weakness are relieved by this operation.

In the past, CTR has been done by open incision. More recently, endoscopic release (ER) has been introduced. ER is done percutaneously. This means a long, thin instrument (endoscope) is inserted through the skin with a very small incision. A tiny camera on the end of the scope shows on a TV screen what the camera can see inside the wrist.

Many studies have been done to compare the results of open CTR and ER. It does not appear that one method is better than the other. Long-term results seem to be equal. In this study, patients with carpal tunnel syndrome were divided into two groups. In Group one the ulnar bursa was saved. In Group two the ulnar bursa was divided.

The ulnar bursa is inside the carpal tunnel. It is the lining of the finger flexor tendons and lines the carpal tunnel. The surgeons thought that preserving the lining between the carpal tunnel and the incision might prevent scar tissue from forming and speed up healing. All surgeries were done using the open method.

Results were measured and compared for the two groups using grip strength, scar pain, and hand function. Symptoms such as hand temperature, appearance, and work ability were also considered.

The authors report no difference in grip strength, scar pain, and self-reported function between the two groups. There were significantly more wound infections in Group two (ulnar bursa divided). They also found that Group two patients had better grip strength after surgery when no tourniquet around the arm had been used during the operation.

The results of this study show that preserving the ulnar bursa within the carpal tunnel is not necessary. It does not improve results and limits the surgeon’s ability to see the median nerve. Although rare, tumors or other serious causes of carpal tunnel syndrome might be missed if the ulnar bursa is not divided.

Sometimes young children between the ages of one and four develop a trigger thumb. With trigger thumb, the tip of the thumb is stuck in a flexed position. The thumb snaps or locks in this bent position. The exact cause of the problem is unknown. It is not congenital (present at birth).

In this study, a special splint was used to reduce the thumb. This means the joint was moved into an extended position and held there. The child wore the splint all day for six to 12 weeks. A special night splint was worn after that to keep the trigger thumb from coming back.

The children were rated afterwards as cured, improved, or unimproved. Cured was defined as full motion with no snapping. Improved was full motion with only one snapping episode each week. No change with snapping and persistent thumb flexion was labelled unimproved.

Results were compared for children with splints and children who were treated by observed only (no splints or other treatment). Two-thirds of the splinted group were cured or improved. Less than one-fourth of the observed group were cured or improved. Younger children were more likely to be cured or improved in both groups.

The children who did not improve went on to have surgery to release the tendon. All were cured. Delaying surgery by using splinting first did not affect the results of surgery.

The authors suggest trying splinting for children with trigger thumb. Surgery is not urgent and can be easily postponed.

Injury to the hand resulting in a flexion contracture can lead to many problems. This is especially true when the middle joint of the finger is involved. This joint is called the proximal interphalangeal joint or PIP. The PIP can get stuck in a flexed position called a flexion contracture.

In this article, two hand surgeons offer a review of the best treatment for this condition. It’s an important joint because it makes movement of the fingertip possible. Without full PIP extension, it is difficult to make a fist, grasp large objects, shake hands with someone, or pull on a pair of gloves.

Early treatment is needed to help prevent a permanent loss of finger extension. Conservative care with “buddy taping,” (taping the injured finger to a healthy finger) and splinting are common treatment options.

Physical therapy to restore motion early is advised. Immobilization in a cast or splint should be limited to less than three weeks. The finger should be splinted in a straight (extended) position. This will help prevent other contractures from developing.

A finger cast can be used but must be changed often. As the finger regains motion, a new cast is applied to straighten the PIP even more. Splints with springs or rubber bands called dynamic splints are an even better choice. Dynamic splinting allows both active and passive joint motion and can be removed for good hygiene.

The authors conclude it is much easier to prevent PIP flexion contractures than to successfully treat them. Splinting may take months to gain success and only with the patient’s cooperation.

Surgery shouldn’t be considered until conservative care has been tried for six months or more. Which operative technique to use for best results remains unclear. Many reports show a poor outcome after surgery for this problem. In a small number of cases, fusion of the joint or amputation of the finger is the only option.

In this review, surgeons from the Illinois Bone and Joint Institute compare treatment results of carpal tunnel syndrome. Two two different surgical methods were used.

In both operations, a band of tissue across the wrist called the transverse carpal ligament is cut and released. The goal is to take pressure off the median nerve as it goes under the ligament and through a group of wrist bones called the carpal tunnel.

The first operation open carpal tunnel release (OCTS) is done with an incision over the carpal tunnel area. In the second procedure, the same ligament is released endoscopically. This operation is called an endoscopic carpal tunnel release (ECTR). A special tool is used to slip under the skin and release the ligament without an open incision.

All information on the results of these two methods was gathered from 68 articles published between 1966 and 2001. Researchers looked for any mention of complications with either operation. Problems such as nerve, tendon, or artery injuries were included.

Analysis showed no difference in the number of complications between the ECTR and the OCTR approaches. There wasn’t enough evidence to support using the ECTR over the OCTR.

Surgeons use the ECTR because patients have less pain and a faster recovery. Those who continue to use the standard OCTR do so to avoid the possible serious complications of ECTR.

This review makes it clear that the number of complications with carpal tunnel release is low with either method of release. The choice between ECTR and OCTR may be a personal preference between the patient and surgeon.

Loss of blood supply to a bone with subsequent death of the bone is called avascular necrosis. When it affects the lunate bone of the wrist, it’s called Kienböck’s disease. The most common risk factors for this condition are trauma, steroids, smoking, and alcoholism.

Dr. Jeffrey Budoff from Baylor College of Medicine (Texas) presents this case report of a 50-year old woman with both Kienböck’s and Preiser’s diseases of the right wrist. Preiser’s disease is a condition of osteonecrosis of the carpal scaphoid, another bone in the wrist.

The patient presented with decreased motion and constant pain. Both symptoms interfered with daily activities. Her past medical history included taking steroids 11 years ago for viral pneumonia, asthma, and a kidney cyst. She reported smoking two packs of cigarettes a day. There was no known trauma to the wrist or hand.

The patient tried a course of conservative care without change in her symptoms. Surgery was planned to retain some motion of the wrist. Instead of fusing the wrist, the surgeon removed the first row of carpal (wrist) bones. A flap of soft tissue was used to fill in the gap.

Results were good. The patient reported at least a 50 per cent decrease in her pain and an increase in wrist motion. At the follow-up three years after the surgery, she had functional wrist motion. Her main symptom was soreness with activities but reported it was “tolerable.”

The purpose of this case report was to alert surgeons that patients can have more than one carpal bone affected by osteonecrosis. This can happen without the usual risk factors. In this case, a delay of 11 years after steroid use or unrecognized trauma was probably the cause of both Kienböck’s and Preiser’s disease of the wrist.

Hand surgeons from the University of North Carolina offer insight and ideas about flexor tendon repair. Despite improved surgical methods, problems after repair of tendon lacerations persist. The most common problems are scarring and joint contracture (loss of motion).

The authors say that understanding the basic science behind tendon healing is the first step toward improving results from hand surgery. They review the tendon anatomy in detail and review what’s needed for tendon healing.

The first week after a tendon injury, the body brings in healing cells to clean away any damaged or dead tissue. From weeks one to three new blood supply helps form new tissue. Then in the final (weeks three through eight), the new fibers line up along the tendon. It’s during this last remodeling phase that scar tissue called adhesions form between the tendon and its outer covering called the tendon sheath.

Motion, tension, and nutrition are the keys to tendon healing without adhesions. Tendon gliding is helped by the use of splints. Combining wrist and hand motion also helps improve overall tendon gliding inside the tendon sheath while producing low force on the repair site. Other ways to prevent scarring include careful surgical technique during tendon repair.

Scarless healing is the wave of the future. Scientists are looking into the use of polymer gels applied to the tendon after repair to limit adhesions. Growth factors used to enhance healing and inhibit scar formation are also being studied.

Problems can occur after tendon repair. The tendon may rupture, especially during the first 18 days if the patient does too much. Triggering can occur if the tendon repair is too tight or if scarring at the repair site catches as the tendon tries to glide. The authors review a wide range of other problems that can occur and the best known treatment for each one. Pulley failure and bowstringing, quadriga, swan-neck deformity, and lumbrical plus deformity are discussed.

In this study results of steroid injection for carpal tunnel syndrome (CTS) were measured using a patient survey. Researchers measured change in symptoms using a tool called the Symptom Severity Scale (SSS). The goal was to see how well the SSS works for measuring change after steroid injection treatment for CTS.

Patients with CTS who were going to be treated with steroid injection filled out a survey of questions before and after treatment. Questions were included about pain, other symptoms, and function.

The minimal clinically important difference (MCID) was calculated. The MCID is defined as “the smallest change in the score that is important.” The MCID represents a change that can be seen or measured. The patient sees this change as positive or beneficial. The physician uses the MCID to guide further treatment.

According to this study, the SSS does show sensitivity or responsiveness to change in clinical symptoms for patients with CTS treated by steroid injection. If the MCID was 1.0 or more and the patient was better, then no further treatment was needed. If the patient still had symptoms and the MCID was less than 1.0, then further testing and/or treatment was required.

The authors say further studies are needed to see if the MCID changes when improvement occurs after splinting or surgery instead of steroid injection. It would also be good to see if the MCID gets worse by the same amount (1.0), does this signal a significant decline or deterioration of the client?

Patients with Dupuytren’s disease are often have surgery to release tight fascia, the connective tissue in the hand. The operation has changed over the years. In this study surgeons compare the short-term results of a limited fasciectomy (LF) to a percutaneous needle fasciotomy (PNF).

Dupuytren’s is an abnormal thickening of the fascia in the palm of the hand. Shortening of this tissue causes “bands” or “cords” that pull the fingers into the palm. Without surgery to release the tissue, the fingers will get stuck in a flexed or bent position in the palm. The fingers can no longer be straightened or extended all the way. This is called a flexion contracture.

Limited fasciectomy is a partial removal of the fascia. The procedure is usually done under a general anesthesia. Only the diseased fascia is taken out. Fasciotomy cuts the bands to relieve tension or pressure. The surgeon uses small incisions in the palm to do this while the patient is awake but the hand is numb.

Two groups of patients with Dupuytren’s were treated either with LF or PNF. Results were measured at one and six weeks after the operation. Motion, recovery of function, and patient satisfaction were used as measures of outcome. Complication rate was also compared. Flexion contracture was a sign of failure. The severity of the contracture was measured by the total passive extension deficit (TPED). This is a measure of how much the finger(s) could be straightened by someone else or by using the other hand.

There were no complications after PNF but five percent with the LF. Patient satisfaction was about the same in both groups although the PNF group had less discomfort and better function at the end of both one and six weeks. They were able to use the hand in one week. The main measure of success (TPED) was better in the LF group.

The overall results of this study show that LF is better than PNF. The authors recommend using the PNF method of surgery for mild to moderate cases of Dupuytren’s when quick recovery is the goal. The patients in this study will be followed long-term (five years) and final results reported in the future.

Hand surgeons from Penn State College of Medicine no longer use titanium joint replacements for thumb osteoarthritis (OA). Based on the results of this study, they say the early failure rate of 20 percent is too high. The alternate surgery ligament reconstruction tendon interposition (LTRI) is more successful.

The authors say the patients who had successful titanium implants still had a weak pinch two years later. They comment that the titanium implant did not function as promised by the designers. Implant design, materials, and guidelines all contributed to a failed experience.

The biggest problem was movement of the implant. It either settled deeper into the bone or shifted to the side. Other patients reported continued discomfort or pain and swelling anytime they used the thumb. Failed cases ended up with an LTRI.

Titanium implants may still be used with low demand (inactive) patients who have good bone density. Even so, this group of hand surgeons has stopped using them for painful and disabling thumb OA. They use LTRI (soft tissue reconstruction) instead.

Piano players (pianists) are often subject to overuse syndromes of the hand and arm. The problem tends to occur when they increase their practice time. Musical pieces with trills, octaves, arpeggios, and broken octaves are special problems. These skills require fast and forceful finger movements.

In this study, researchers look at the span of pianists’ hands. They wanted to see if pianists with larger hands have fewer problems. A digital keyboard and video-based system was used to track motion in three dimensions (3-D). Of particular interest was the distance between the thumb and small finger when the hand was fully open (abducted).

Professional and amateur pianists were included. Pianists were compared based on hand span size (large versus small). The results showed that players with smaller hands must open the fingers wider (abduct more) than large-handed players. Small-handed pianists may be at increased risk of de Quervain’s tenosynovitis, a common problem among pianists.

de Quervain’s is a painful condition affecting the inside of the wrist and forearm just above the thumb. The lining around two tendons in that area get inflamed from overuse. The tendons don’t glide smoothly.

The use of computer technology to measure stress and strain on the wrist, hands, and fingers of pianists may help reduce or prevent de Quervain’s in pianists. Difference in hand size is one issue. Differences in motion may be another key feature for future study.

This is part two of a 1997 study of 21 patients with traumatic wrist fractures. Fracture occurred at the end of the radius (forearm bone) where it attaches to the wrist. The break crossed into the surface of the joint. This is called an intra-articular fracture of the distal radius.

In the first study, results of operative treatment were reported after seven years. In this study, 16 of the original 21 patients were examined 15 years after surgery. The results are compared with the seven year follow-up.

All patients were treated with open surgery and internal fixation. Fixation refers to the metal plates or wires used to hold the bones together during healing. In the first study, patients had good function but X-rays showed joint degeneration called joint arthrosis. There were arthritic changes but no inflammation and the joint space was narrowed.

After 15 years the arthrosis was worse but function was still the same. No one had lost any range of motion or strength despite degenerative changes in the joint.

The authors conclude arthrosis is linked with joint displacement after intra-articular wrist fractures. Function may be affected eventually but was not evident after 15 years. Restoring the joint as much as possible after this type of fracture is still advised.

In this review article doctors from the University of Cincinnati College of Medicine discuss two kinds of common finger injuries. The first type is a Mallet (or baseball) finger, which refers to the shape of the fingertip after the extensor tendon is ruptured.

Jersey finger is the opposite injury with rupture or avulsion of the flexor tendon. This type of injury occurs most often when a football player grabs another player’s jersey with the tip of his finger while the other team member pulls away. The force of the action hyperextends the tip of the finger while the rest of the finger is bent. Both injuries affect the tip or distal phalanx of the finger.

Anatomy, type of injury, diagnosis, and treatment are the main review points for each injury. Different ways to divide the finger deformities into groups are also presented. These are called classification schemes.

Treatment is based on the classification. For example, most Type I injuries (partial rupture of the tendon) can be treated without surgery. A finger splint is used to hold the digit in place until healing occurs. Type II (full tendon rupture) and III (rupture with bone chip attached) require surgery to repair the soft tissue damage.

Specific surgical techniques with and without pins are discussed. The placement of pins depends on the type of injury. The use of internal sutures, tension banding, screws, and wires is also reviewed. Sometimes fusion or a tendon transfer is needed.

Complications after surgery are common, often resulting in long-term disability. Infection, pin failure, and nail and joint deformity are reported in up to half of all cases.

The authors point out the best treatment is nonoperative to avoid the many complications and problems after surgery. They suggest that only patients with fractures or joint dislocations that can’t be repaired with splinting should be treated surgically.

Ganglion cysts are benign masses often filled with fluid. They can grow large enough to press on nerves and get tangled in tendons causing painful symptoms. Nerve involvement can cause numbness and tingling. Ganglia are common in the wrist where the bones of the forearm meet the first row of wrist (carpal) bones.

In this case report, a 29-year old woman was diagnosed with a ganglion cyst of the carpometacarpal joint. Only two other cases have been reported. This is where the second row of carpal bones meets the first row of finger (metacarpal) bones. The diagnosis was made using MRIs and confirmed during surgery to remove it.

Surgery isn’t always needed for ganglia. The location of this ganglion was such that it pushed against the median nerve in the carpal tunnel causing carpal tunnel syndrome. Symptoms of median nerve compression are called median neuropathy.

Removing the entire cyst and its attachments took care of the patient’s symptoms and made sure it didn’t come back. The patient was still symptom-free at the one-year follow-up visit.

Wanted for arthritic pain sufferers: pain relief. Added stability and strength would be a bonus. In this article hand surgeons report on the use of APL suspensionplasty to treat arthritic pain at the base of the thumb (carpometacarpal joint). Pain relief without weakness was the favorable outcome for most of the patients.

Pain at the carpometacarpal (CMC) joint can be very disabling. Weak pinch and grip limits daily activities. Many operations have been tried for this problem. Ligament repair and tendon transfer are the most common.

Suspensionplasty is the use of the abductor pollicis longus (APL) tendon as a sling. First, the arthritic bone at the base of the thumb (trapezium) is removed. Then the APL is taken from its attachment to the CMC and threaded through two tunnels. One tunnel goes through the bone of the index finger. The other goes through the thumb. The APL is stitched to another tendon to hold it in place. The overall effect is to stop the deforming force of the APL on the CMC joint.

Everyone was followed for at least one year. Grip and key-pinch strength was measured before and after surgery. Range of motion and pain levels were also recorded. X-rays were taken before and after as well. Two-thirds of the patients were pain free after surgery. Pinching and gripping activities were much easier. Two patients still had some weakness when opening jars and using keys.

The authors show how suspensionplasty is an effective surgical treatment for painful arthritis of the thumb. Short-term results in this small study showed improved thumb stability and function. Pain relief at last!

Radial collateral ligament (RCL) tears of the thumb are uncommon enough that the best treatment remains unknown. The authors of this study report the results of treatment for grade III RCL injuries in 26 patients. Surgical repair versus reconstruction was compared too.

Mild or moderate RCL tears rated as a I or II can be treated successfully with a cast or splint. Some doctors recommend using cast immobilization even for Grade III (complete) tears. Others believe complete tears must be repaired wit surgery.

In this study 26 patients were divided into two groups. One group had a repair of the thumb early on while the injury was still acute. The second group had reconstruction surgery much later — usually years later.

Results were measured and compared using joint motion, grip and pinch strength, and joint stability. Patients in both groups had excellent or good results. Everyone reported being satisfied with the results.

The authors conclude it’s best to repair grade III RCL injuries when they happen. Reconstruction months to years later should also be done. Repair or reconstruction should be done to prevent an unstable or arthritic thumb from developing.