The approach that will be described is yet unpublished but was developed by Dr. Thomas Shepler of the Manus Center in Vienna, Virginia. The first case was done in 1979. Dr. Shepler has followed carefully over a period of 22 years 170 MC-T arthroplasties, in which the procedure described has been performed over 90 times. This procedure works extremely well and holds up over a long period of time.
The trapezium is approached radially through a longitudinal capsular incision between the tendons of the extensor pollicis brevis and abductor pollicis longus.