Nonsurgical treatment can be considered in partial tears of the UCL, which usually involve an isolated rupture of the proper collateral portion of the ligament. But thanks to a new procedure used to fix his torn ulnar collateral ligament, his recovery could . Rozmaryn LM, Wei N. Metacarpophalangeal arthroscopy. Repair of the thumb ulnar collateral ligament with suture tape augmentation. When this ligament is torn or damaged, it can lead to pain, elbow instability and loss of function. If you continue to use this site we will assume that you are happy with it. 10.5 As this is a midsubstance tear of the UCL, repair is achieved with a 3.0 PDS mattress suture. In addition, the ulnar nerve may be irritated as a result of the elbow injury. Once muscles and other tissues are moved out of the way, your surgeon can assess the damage. (OBQ10.213) CPT code 24346 is defined as: "Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)." A total of 187 patients (188 elbows) were identified. Is the radial collateral ligament medial or lateral? Thumb Ulnar Collateral Ligament Repair Post-Operative Protocol Days 0- until first Post-Op Apt. Regenerative . 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Current newsletters added each quarter. After 48 hours you may shower. The ligament helps keep the outer side of your knee joint stable. Black And White Aesthetic StickersPrintable, Mississippi State Women's Basketball Roster 2019, Esthetician For African American Skin Near Me, Aaliyah: The Princess Of R&B Full Movie Putlockers, Crystal Fairy & The Magical Cactus Watch Online, High School Wrestling Weight Classes 2020, University Of Miami Supplemental Essays 2021, TCU Horned Frogs Women's BasketballBasketball Team, Logical Connectives In Discrete Mathematics, Drawing On The Right Side Of The Brain Starter Kit, Presentacin gua para PYMES ante los ODS en CAEB, Innovation Strategies reconocida como Great Place to Work. 10.2 A curvilinear incision is made over the UCL, making sure the incision is marked sufficiently volar to access the UCL. The joint is stabilized by the UCL and radial collateral ligament (RCL), the volar plate, and the dorsal capsule. Injury to this ligament is also known as Gamekeepers Thumb, because Scottish gamekeepers used to commonly have this type of injury as a result of their jobs; and more commonly today as Skiers Thumb, because it occurs so often in downhill skiing accidents. What is the application of a cascade control system. 2016;4(3)(suppl3):2325967116S00071. If there is a midsubstance UCL rupture, a direct repair can be performed; however, in some cases Mitek mini anchor repair is warranted. CPT code 24346 is defined as, "Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)". The most common ones are the docking technique and the figure-eight technique. The .gov means its official. Is the ulnar collateral ligament medial or lateral? Epub 2017 Jul 19. NPI Look-Up Tool (National Provider Identifier), The official publication for Level I HCPCS (CPT-4 codes) for hospital providers, Also specific Level II HCPCS codes for hospitals, physicians and other health professionals, Fully searchable through Find-A-Code's Comprehensive Search, Codes mentioned in articles are linked to Code Information pages, Code Information page link back to related articles. Arthrex has developed the Thumb Metacarpophalangeal (MCP) Joint Ulnar Collateral Ligament (UCL) Repair using either a 2.5 mm PushLock Knotless Suture Anchor, a Micro/Mini BioComposite SutureTak , a Micro/Mini FT Corkscrew or FASTak anchors. The UCL originates at the posterior distal aspect of the medial epicondyle and inserts into the base of the coronoid process. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Patient had an unstable MCP joint and elected to have surgery to repair left thumb ulnar collateral ligament. The 7th character must always be the 7th position of a code. : Keep post-operative dressing clean, dry, and in place Keep hand elevated above the level of your heart May use hand for very light activities of daily living, such as eating, writing, typing, getting dressed, and brushing teeth Day 7-14: Introduction: Report RCL or LCL tears with 24343 (for repair) or 24344 (for reconstruction). Fig. or Under Arthroscopy: 29834 Arthroscopy, elbow, surgical; with removal of loose body or foreign body. The study evaluated 20 elbows of male college students. Repair, Revision, and/or Reconstruction Procedures on the Hand and Fingers. Both Bone (Radius and Ulna) Forearm Fracture ORIF. 107, Fig. No charge. The https:// ensures that you are connecting to the Typically follow up appointments are scheduled in two-week intervals following surgery, so we can monitor your recovery. Full extension of MCPJ with a valgus stress test assesses the accessory collateral ligament. Epub 2014 Oct 22. 10.12 Terminal branch of SBRN identified and protected. Physical therapy at this stage focuses on gradually increasing your range of motion in the elbow. 2017 Aug;9(2):95-97. doi: 10.1055/s-0037-1604292. The soft tissue was pulled proximally and pinched into the bed of origin. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. Stability, range of motion, pinch grip, and radiographs were evaluated at least 16 months after surgery. Ulnar collateral ligament (UCL) tears of the thumb are common injuries. Use a muscle-splitting approach through the flexor pronator mass. Fig. Most thumb sprains involve the ulnar collateral ligament, which is located on the inside of the knuckle joint. . PCL is primary restraint to radial deviation with MCPJ in flexion, ACL provides restraint to radial deviation with MCPJ in extension, PCL is primary restraint to radial deviation with MCPJ in extension, ACL provides restraint to radial deviation with MCPJ in extension, ACL is primary restraint to ulnar deviation with MCPJ in flexion, PCL provides restraint to ulnar deviation with MCPJ in extension, ACL is primary restraint to radial deviation with MCPJ in flexion, PCL provides restraint to radial deviation with MCPJ in extension, PCL is primary restraint to ulnar deviation with MCPJ in flexion, ACL provides restraint to radial deviation with MCPJ in extension, Shoulder360 The Comprehensive Shoulder Course 2023, Type in at least one full word to see suggestions list, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Thumb UCL Injury: Case of the Week - Shaan Patel, MD, 2019 Orthopaedic Summit Evolving Techniques, Thumb Radial Lateral Ligament Injury Debate: Time For The Operating Room- He Is Out For The Next 4 Weeks - Brian D. Adams, MD. The goal of the surgery is to stabilize the elbow, reduce or eliminate pain and restore stability and range of motion. The most common symptoms associated with UCL injuries are swollen, painful joint, and weakness to thumb especially with gripping or pinching, as well as bruising. Find more COVID-19 testing locations on Maryland.gov. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. You may see bruise-like discolorations on the skin around the joint. Reliability of . PMC We use cookies to ensure that we give you the best experience on our website. If the tear is diagnosed early a repair will be possible. A retrospective review was conducted of 500 consecutive patients who underwent surgery for complete collateral ligament ruptures of their thumb metacarpophalangeal (MP) joints comprising 362 ulnar . Sekiya I, Kobayashi M, Taneda Y, Matsui N. Arthroscopy of the proximal interphalangeal and metacarpophalangeal joints in rheumatoid hands. Surgical Technique Videos | Presenter: Damon Adamany, MD, Surgical Technique Videos | Presenter: Steven S. Shin, MD, Video Series | Presenter: Christopher Adams, MD. 239424005 - Repair of ulnar collateral ligament of metacarpophalangeal joint of thumb - SNOMED CT Authors Anthony F De Giacomo 1 , Steven S Shin. Background:The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. 2 Stage Tendon Grafts Lecture. A UCL reconstruction surgery involves harvesting a tendon from your own body, or from a donor, and attaching it to act as a new UCL. Augmenting the repair with an Internal Brace ligament augmentation results in a strong construct that allows for early motion and limited postoperative immobilization. A standard S-shaped incision over the dorsal ulnar aspect of the thumb is used. 104, Fig. 2022 Mar;10(3):267-271. doi: 10.22038/ABJS.2021.52295.2583. Results: FOIA 10.8 After the final repair, the thumb is showing no laxity on valgus stress test. Martin A. Posner. He has had persistent thumb pain with gripping since the fall. Walters BL, Cain EL, Emblom BA, Frantz JT, Dugas JR. Ulnar collateral ligament repair with InternalBrace augmentation: a novel UCL repair technique in the young adolescent. Article. 10.4 Once the adductor aponeurosis is opened, access to UCL can be achieved. Ulnar Collateral Ligament Low Level Laser ICD 10 Procedure Coding System Wikipedia June 24th, 2018 - The ICD 10 Procedure Coding System ICD 10 PCS is an international system of medical classification used for procedural coding The Centers for Medicare and Medicaid Services the agency Fig. Eventually hand therapy is . Discover how to save hours each week. Only 2 patients complained of a lumpy swelling at the ulnar aspect of the MCP joint, one of which was tender. A jersey finger refers to a rupture of the flexor tendon, which is the tendon that bends the fingertip down. 1012, Fig. He immediately knew something was wrong. Jeffrey R. Dugas, MD, (Birmingham, AL) discusses ulnar collateral ligament (UCL) repair for young overhead athletes who present with acute tearsfrom either the proximal or distal end of the ligamentnot associated with attritional or degenerative disease. For an avulsion fracture of the UCL, one must assess the size of the bony fragment. Thumb Collateral Ligament Injuries, most commonly ulnar collateral (UCL), are athletic injuries that lead to a decrease in effective thumb pinch and grasp. eCollection 2022 Jan. J Hand Microsurg. Tommy John Surgery is typically an outpatient procedure. Sutures will remain in place for 10-14 days. The UCL is located on the inner side of the elbow, which is also where the ulnar nerve passes around the elbow joint. This code (841.1) pertains to the elbow and forearm/wrist area. The technical term for a torn ligament in the thumb is an ulnar collateral ligament injury of the thumb. shaka wear graphic tees is candy digital publicly traded ellen lawson wife of ted lawson cpt code for scapholunate ligament repair 25 Feb/23 (No Ratings Yet) A tear to the UCL results in the MCP (metacarpophalangeal) joint of the thumb becoming very unstable and painful. Trigger thumb, right thumb M65.312 Trigger thumb, left thumb M65.321 . MRI of the elbow (T1 weighted) showing an unimpaired radial collateral ligament and extensor tendon.Radial collateral ligament of elbow joint. Is the radial collateral ligament and extensor tendon? 1019. 10.17 Mitek mini anchor fitted into bone and 2.0 Ticron used to pass through UCL as a half-modified Kessler suture. CPT code 24346 is defined as: "Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)." A total of 187 patients (188 elbows) were identified. 2008 May-Jun;33(5):760-70. doi: 10.1016/j.jhsa.2008.01.037. She has extensive background in CPT/HCPCS and ICD-9-CM coding and has completed comprehensive ICD-10-CM and PCS training. Innovacin Circular. 1018, Fig. Get timely coding industry updates, webinar notices, product discounts and special offers. It may also weaken your ability to grasp objects between your thumb and index finger. In the appropriate patient, the InternalBrace ligament augmentation repair allows for a more aggressive rehab protocol and earlier return to competition as compared to a conventional Tommy John reconstruction.1, 1. Previous reports show an incidence of collateral ligament injuries as high as 86% of the injuries to the thumb. For a metacarpophalangeal joint ulnar collateral ligament sprain, you would use code 842.12. When the ulnar collateral ligament of the thumb is injured, the MCP joint becomes painful and swollen, and the thumb feels weak when you pinch or grasp. Cancel anytime. Is radial collateral ligament extra articular? Arthroscopy 2002;18:292-297. This study aimed to clarify what selective contraction of the forearm muscles makes FPMs harder relative to UCL. 2021 Jun 9;3(5):278-281. doi: 10.1016/j.jhsg.2021.05.007. Lateral collateral ligament complex On the lateral side of the elbow joint, the LCL complex is comprised of three primary structures: the radial collateral ligament proper (RCL), the annular ligament (AL), and the lateral ulnar collateral ligament (LUCL) (Fig. Address : 823 129th Infantry Drive,Suite 103, Joliet, IL 60435. UCL injuries comprises of 86% of all athletic thumb injuries, acute injuries are common in many contact and non-contact sports, chronic injuries due to attenuation of the ligament under repeated stress, radially-directed force causing hyper-abduction moment, i.e. Your doctor may put you in a hinged brace that can be locked at a certain angle when you are not exercising. Where am I? Its important to continue an aggressive strengthening and stretching program during and after return to your sport. Ligament / Volar Plate CPT Codes Late effect of dislocation (nonspecific) (905.6) Repair lateral collateral ligament, elbow, with local tissue (24343) Repair lateral collateral ligament, elbow, with tendon graft, including graft harvest (24344) Repair medial collateral ligament, elbow, with local tissue (24345) The primary role of the MCPJ of the thumb is flexion and extension. During the surgery, which of the following structures may block your reduction? Call Now: (855) 558-4263 (817) 382-6789 . By the end of the first month, you may be able to fully extend your elbow and eventually stop wearing the brace. Ulnar collateral ligament (UCL) tears of the thumb are common injuries. Radial collateral ligament injuries of the thumb. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. MeSH You must log in or register to reply here. ICD9 Codes Polydactyly, fingers or thumb (755.01) Polydactyly, fingers, Triphalangealism (755.01) Accessory carpal bones (755.56) CPT Codes Reconstruction of supernumerary digit, soft tissue and bone (26587) Debridement; skin, full thickness (11041) Debridement; skin, and subcutaneous tissue (11042) It routinely takes nine months to one year (or longer) for an athlete to return to competition. At final follow-up, radiographs showed no implant complications, no osteoarthritic changes in MCP joints, and stress testing showed that all patients had normal stability in the treated thumb when compared with the untreated thumb. Ex: 1000F Category III Codes What are the collateral ligaments of the fingers? diagnosis made by history and physical exam (thumb MCP radial-ulnar stress exam) and confirmed with MRI studies. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 10 Thumb MCP Joint Ulnar Collateral Ligament Repair, Hand Trauma: Illustrated Surgical Guide of Core Procedures. If the tear is diagnosed later a ligament reconstruction might be . 6. To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. Careers. $3,095 . Fig. The previously placed anchor and FiberTape suture span the repaired ligament and a second 3.5 mm PEEK SwiveLock anchor is placed after appropriate tensioning. On the 3rd image, attenuated midsubstance radial collateral ligament (RCL) fibers are present (red arrowhead). This yielded 655 results of 647 unique patients. When a right elbow lateral collateral ligament repair with both local tissue and application of an InternalBrace is performed, is the procedure reported with CPT code 24343 or is it more appropriate to report the unlisted code, 24999, since they are using an InternalBrace in addition to local tissue? Your lifting restrictions will gradually be increased over the next 2-3 months. Through a standard S-shaped incision over the dorsoulnar aspect of the thumb, one or two 1.5-or 1.3-mm microanchors are fixed to the base of the proximal phalanx in the footprint of the avulsed ligament and used to suture the proximally based flap after temporary pinning of the MCP joint. 2012. rheumatoid arthritis) spontaneously during routine activities Associated conditions MCP joint collateral ligament injuries Anatomy Extensor mechanism comprises tendons EDC/EIP/EDM 10.19 Illustration of Mitek mini anchor. All patients had equal stability and normal pinch grip when comparing with the untreated thumb, allowing all patients to return to preinjury activities, including sports, except one (96% of cases). DX code 841.1 is not correct for THUMB collateral ligament sprain. Tommy John didnt invent this procedurehe was a baseball pitcher who was the first to undergo it and successfully return to his sport. The splint will gradually be discontinued in the weeks to follow as you progress with occupational therapy. Tech Hand Up Extrem Surg. Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-PCS) An official website of the United States government. Because of this, it is critical that these injuries receive appropriate attention and treatment. The AHA Coding Clinic for HCPCS includes: The official publication for Level I HCPCS (CPT-4 codes) for hospital providers. Billing for hand procedures is among the most complex types of orthopaedic coding. A right elbow lateral collateral ligament rupture, ripped from the origin with gross instability of the lateral soft tissue, was repaired with local tissue and application of an InternalBrace. 10.15 Small bony segment avulsed off proximal phalanx, bony segment is removed before fixation with Mitek mini anchor onto the proximal phalanx. 4b). Repair of UCL of the MCP joint of the thumb with this technique is an effective, durable, and safe method to allow restoration and maintenance of a stable, pain-free thumb. Rest involves not using your finger. The two ends of the LabralTape were placed on the suture anchor and implanted. Arthroscopy 1999;15:333 . There is a lot of good info about wrist arthroplasties. Certain products may not be approved for sale in all countries. radial:ulnar = 9:1 Etiology Mechanism traumatic forceful resisted flexion or extension laceration of extensor hood direct blow to MCP joint atraumatic inflammatory (e.g. What are the 5 objectives of physical development? CPT Codes Primary repair of collateral ligament, metacarpophalangeal joint (26540) Primary repair of collateral ligament, metacarpophalangeal joint; with tendon or fascial graft (includes obtaining graft) (26541) Primary repair of collateral ligament, metacarpophalangeal joint; with local tissue eg, adductor advancement) (26542) Any damaged tissues are removed. One or two weeks after the surgery, you can start moving your elbow joint. Cpt Code For Repair Of Radial Collateral Ligament Finger ; Hofbauer, M. . Participants selectively contracted the forearm . 103, Fig. You can start physical therapy right away, focusing on your wrist, fingers, shoulder and biceps to help avoid muscle atrophy. A fluid filled gap is present at the normal distal insertion site of the RCL on the final provided slice (red arrowhead). tissue(s), including lateral band(s), each finger 26428 Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft . Federal government websites often end in .gov or .mil. Reconstruction of a chronic tear is achieved by utilizing two 3 mm x 8 mm Bio-Tenodesis . 4 Corner, STT, RSL Partial Wrist Fusion. 2012 Dec;26(12):1466-8. . Current Procedural Terminology (CPT) includes references to specific locations in the forearm, wrist, hand, and fingers for reporting flexor and extensor tendon repair codes. There was an error retrieving the content. View. It is performed under general anesthesia and may last anywhere from 60 to 90 minutes. The addition of the internal brace . We are vaccinating all eligible patients. New, less invasive techniques are also being developed by researchers. Also specific Level II HCPCS codes for hospitals, physicians and other health professionals. This surgery takes approximately 1 hour, and is performed as an outpatient surgery, meaning you will be able to go home that day. Lawrence Ambrose. J Hand Surg Am. Likewise, physicians often refer to the medial collateral ligament as the "MCL," and the ulnar collateral ligament as "UCL.". 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Ulnar collateral ligament (UCL) injuries occur 10 times more . How do you treat a torn ligament in your finger? Clipboard, Search History, and several other advanced features are temporarily unavailable. Enjoy a guided tour of FindACode's many features and tools. Johns Hopkins elbow specialists diagnosed Michael and discovered how serious his injury was. thumb metacarpophalangeal ulnar collateral ligament tears. medial (SBQ17SE.78) Tommy John Surgery, more formally known as ulnar collateral ligament (UCL) reconstruction, is used to repair a torn ulnar collateral ligament inside the elbow. Copyright 2023 Lineage Medical, Inc. All rights reserved. The elbow was then reduced and a horizontal stitch was placed through the origin of the lateral collateral ligament and tied off using FiberWire suture. Sometimes also referred to as the ulnar collateral ligament (UCL), the MCL of the elbow attaches the ulna (which, along with the radius, makes up the bones of the lower arm) to the humerus, the bone of the upper arm. Have an Arthrex representative contact me. Read on for more information on causes, symptoms and treatments. Surgical Procedures on the Hand and Fingers. Ryan W. Paul, BS, Nutley, New Jersey UNITED STATES . Accompanying fractures These reconstructions were all done with the docking plus technique and utilized the contralateral palmaris longus tendon for the graft when present. The ulnar collateral ligament is an important stabilizer of the thumb. DX code 841.1 is not correct for THUMB collateral ligament sprain. Case Study 3 - Coding CPT 27870 20680 20900 27707 ICD-9-CM 996.78 23 Case Study 4 - Where Degenerative arthritis secondary to avascular necrosis, left femoral head of the hip Degenerative arthritis of the right knee 24 official website and that any information you provide is encrypted Having Mike Trout out injured is bad for the Angels, fantasy owners and anyone who loves baseball. Accessibility The present study evaluated prospectively the functional results of 27 patients who had open repair of the UCL of the thumb using microanchors either acutely or delayed (up to 9 weeks postinjury). Diagnosis is usually made by a combination of physical exam and MRI studies. National Library of Medicine Laxity of over 35 degrees with no clear endpoint signifies rupture (Fig. This damage may lead to temporary or permanent numbness or weakness. The two common descriptive terms for injuries to the ulnar collateral ligament are: Skier's thumb Gamekeeper's thumb These names are often used interchangeably, although they describe slightly different types of injury. The ulnar collateral ligament (UCL) or internal lateral ligament is a thick triangular ligament at the medial aspect of the elbow uniting the distal aspect of the humerus to the proximal aspect of the ulna. The thumb is then placed in a cast or splint to protect the repair. Acute rupture of the metacarpophalangeal joint (MCPJ) ulnar collateral ligament (UCL) also known as Skier thumb is a result of forced abduction that can further result in a UCL tear. eCollection 2021 Sep. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. - Gamekeepers thumb: a prospective study of functional bracing. The ulnar collateral ligament is a strong band that is attached to the middle joint of the thumb (metacarpophalangeal joint). Midterm clinical outcomes of collateral ligament repair of the thumb and lesser digits: a retrospective analysis of 35 cases. If this is your first visit, be sure to check out the. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. If you are an athlete, you may need a longer rehabilitation before you can return to your sport. The ulnar collateral ligament (blue arrows) demonstrates proximal edema but is intact. 102, Fig. Ex: 76641 Category II Codes Provides supplementary tracking codes that are designed for use in performance assessment and quality improvement activities. 10.9 Final skin closure with subcuticular 5.0 Monocryl. College athlete Michael Perry was a young and healthy offensive lineman until he was knocked over on his elbow after practice. The primary role of the MCPJ of the thumb is flexion and extension. Jos Maas, cofundador de WDNA y vicepresidente de GSBIT. 1016, Fig. radial collateral ligaments (RCL) are more horizontal than ulnar collateral ligaments (UCL) RCL and UCL have 2 parts each: proper and accessory ligaments accessory ligament fan shaped more volar tight in extension attachment from metacarpal head at center of rotation to palmar plate and deep transverse metacarpal ligament clinical test 10.1 Ulnar Collateral Ligament Repair Acute rupture of the metacarpophalangeal joint (MCPJ) ulnar collateral ligament (UCL) also known as Skier thumb is a result of forced abduction that can further result in a UCL tear. BMC Musculoskelet Disord. doi:10.1177/2325967116S00071. At 90 of flexion, it provides 55% of the resistance to valgus stress at the elbow. Tommy Johns Surgery is typically used for UCL tears that happened due to overuse, rather than a single traumatic event. The mean time off work was 10 weeks. Tension sutures are placed proximally and distally through the graft and soft tissue. After showering, pat incision dry and replace splint. Treatment. government site. We present a novel technique to augment the repair of the UCL with suture tape to provide immediate biomechanical support and strength during the critical time of ligament healing. Methods: 24343 Repair lateral collateral ligament, elbow, with local tissue . Ebrahimpour A, Okhovatpour MA, Tabrizi A. Arch Bone Jt Surg. excellent rate of return to sport without residual laxity or disability, >90% with outcomes rated excellent for UCL repair, 96% good to excellent outcomes for RCL repair, reconstruction of ligament with tendon graft, 100% return to sport reported in one series, salvage procedure for failed repairs or reconstructions, immobilization in splint or cast to off-load injured UCL or RCL, some protocols advocate for use of removable splint and immediate active and passive range of motion, patient must avoid stress on ligament during exercises, grip and pinch strengthening began around 4-6 weeks, straight longitudinal incision on radial aspect of the thumb, abductor aponeurosis may need to be resected to expose joint capsule and ligament, take care to spare dorsal cutaneous branches of the radial sensory nerve, pull-out sutures or loaded suture anchors can be used to re-oppose the ligament to its origin, repair MCP joint capsule and abductor tissues, K-wire may be placed to immobilize the joint temporarily, S-shaped or chevron incision overlying MCP joint, trans-osseous sutures, suture anchors with or without suture augmentation, and direct ligament repair to periosteum all described, joint immobilization leaving the IP joint free, multiple techniques described using various tissues sources, configurations and fixation constructs, palmaris longus autograft weaved through bone tunnels, can be secured with interference screws, cortical button or suture anchors, adductor aponeurosis repaired to native distal insertion of UCL, dictated by prior surgeries and concomitant pathology, various fixation methods (k-wire, compression screws, plates), MCP and IP stiffness most common complication following repair, 15% with residual instability for grade 3 injuries treated with immobilization, ligament reconstruction for chronic injuries, return to play rates approach 100% following anatomic repair, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease).
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