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THUMB LIGAMENTS


WHAT YOU SHOULD KNOW

Thumb Ligament RepairThe ligaments that stabilize the thumb where it meets the hand can be torn either partially or completely. The ligament on the inside of this group is critical for all pinch and grasp functions. If it heals loose or fails to heal, the function of that hand can become terribly incapacitated.

MEDICAL HISTORY

Patients usually can name the specific event that caused the injury, noting pain, swelling, stiffness and sometimes deformity immediately after. Failure to pinch or grasp without the thumb giving way may be obvious to the patient.

EXAMINATION

Visible swelling, loss of motion, and tenderness are usually present. The key to the examination is specific testing of the ligament's function under stress.

ADDITIONAL TESTS: Plain x-rays are taken to prove that there are no associated fractures.

TREATMENT OPTIONS

 NON-OPERATIVESURGICAL REPAIRSURGICAL RECONSTRUCTION
CONSISTS OFSplint immobilizationTacking the ligament back to its original locationRebuilding the ligament using a graft
FEATURES4-6 weeks of protection of the thumb onlyOutpatient surgery, temporary pin across joint x 4 weeksSlender tendon strip used to reconnect the attachments made by the previous ligament
ADVANTAGESAvoids surgerySolid healing with original ligamentEffective up to any time point after injury
DISADVANTAGESNot effective when ligament displacedIncreased stiffness, only possible early after injurySlightly more invasive

RECOVERY

Sutures are removed in the office at 2 weeks. The pin across the joint is removed at 4 weeks. Exercises to increase motion are started at this time, but pinching against the ligament still must be avoided. From 6 to 10 weeks after surgery, the patient is gradually allowed to pinch more forcefully against the healing ligament until the hand is eventually strengthened. Normal activities with this hand are difficult during the first 4 weeks followed by full use for light activities not requiring forceful pinch. Heavy use of the hand is not possible until around 3 months after surgery.
 
 
 
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