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Metacarpotrapezial Osteoarthritis and Shepler Repair Images

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Metacarpotrapezial osteoarthritis.
VID 59, frame 1

thuP4001

 

Thumb mobility.
VID 59, frame 2

thuG4002

 

Normal metacarpotrapezial joint.
VID 59, frame 3

thuG4003

 

Shepler test (1 of 7).
VID 59, frame 4

thuG4004

 

Shepler test (2 of 7).
VID 59, frame 4

thuG4005

 

Shepler test (3 of 7).
VID 59, frame 4

thuG4006

 

Shepler test (4 of 7).
VID 59, frame 4

thuG4007

 

Shepler test (5 of 7).
VID 59, frame 4

thuG4008

 

Shepler test (6 of 7).
VID 59, frame 4

thuG4009

 

Shepler test (7 of 7).
VID 59, frame 4

thuG4010

 

Joint erosion (1 of 3).
VID 59, frame 5

thuG4011

 

Joint erosion (2 of 3).
VID 59, frame 5

thuG4012

 

Joint erosion (3 of 3).
VID 59, frame 5

thuG4013

 

Dorsal dislocation.
VID 59, frame 6

thuX4014

 

Normal joint.
VID 59, frame 7

thuG4015

 

Dislocation/subluxation.
VID 59, frame 7

thuG4016

 

Dorsal subluxation.
VID 59, frame 8

thuP4017

 

Positioning for x-ray.
VID 59, frame 9

thuG4018

 

X-ray position.
VID 59, frame 10

thuG4019

 

Angle for x-ray.
VID 59, frame 10

thuG4020

 

Trapezium x-ray.
VID 59, frame 11

thuX4021

 

Range of motion evaluation.
VID 59, frame 12

thuP4022

 

Palmar abduction of thumb.
VID 59, frame 13

thuP4023

 

Surgical approach.
VID 59, frame 14

thuP4024

 

MC-T arthrodesis.
VID 59, frame 15

thuG4025

 

Arthrodesis x-ray (1).
VID 59, frame 16

thuX4026

 

Arthrodesis x-ray (2).
VID 59, frame 17

thuX4027

 

Destruction of schapotrapezial joint.
VID 59, frame 18

thuG4028

 

Secondary arthritis.
VID 59, frame 19

thuG4029

 

Secondary arthritis (highlighted).
VID 59, frame 19

thuG4030

 

Trapezium resection.
VID 59, frame 20

thuX4031

 

Resection leads to…
VID 59, frame 21

thuG4032

 

…collapse of joint space.
VID 59, frame 21

thuG4033

 

Ball on stem prosthesis.
VID 59, frame 22

thuX4034

 

Loosening of metal stem (1 of 4).
VID 59, frame 23

thuG4035

 

Loosening of metal stem (2 of 4).
VID 59, frame 23

thuG4036

 

Loosening of metal stem (3 of 4).
VID 59, frame 23

thuG4037

 

Loosening of metal stem (4 of 4).
VID 59, frame 23

thuG4038

 

Erosion of metacarpal shaft.
VID 59, frame 24

thuX4039

 

Silastic prosthesis.
VID 59, frame 25

thuG4041

 

Prosthesis in place.
VID 59, frame 25

thuG4042

 

X-ray shows prosthesis.
VID 59, frame 26

thuX4043

 

Silastic synovitis.
VID 59, frame 27

thuG4044

 

Silastic nipple.
VID 59, frame 28

thuP4040

 

Nipple replaces diseased joint surfaces (1 of 3).
VID 59, frame 29

thuG4045

 

Nipple replaces diseased joint surfaces (2 of 3).
VID 59, frame 29

thuG4046

 

Nipple replaces diseased joint surfaces (3 of 3).
VID 59, frame 29

thuG4047

 

X-ray shows nipple in place.
VID 59, frame 30

thuX4048

 

"Great toe" silastic prosthesis..
VID 59, frame 31

thuG4049

 

Great toe in place.
VID 59, frame 31

thuG4051

 

X-ray shows great toe in place.
VID 59, frame 32

thuX4050

 

Fatigue fracture of great toe.
VID 59, frame 33

thuG4052

 

Great toe as spacer.
VID 59, frame 34

thuX4053

 

Abductor pollicis longus ligament.
VID 59, frame 35

thuP4054

 

Flexor carpi radialis tendon.
VID 59, frame 36

thuG4055

 

FCR tendon used as spacer.
VID 59, frame 36

thuG4056

 

FCR tendon woven through first metacarpal (1 of 3).
VID 59, frame 37

thuG4057

 

FCR tendon woven through first metacarpal (2 of 3).
VID 59, frame 37

thuG4058

 

FCR tendon woven through first metacarpal (3 of 3).
VID 59, frame 37

thuG4059

 

Erosion of FCR tendon "anchovy".
VID 59, frame 38

thuX4060

 

Incision markings for surgical repair of MO.
VID 59, frame 39

thuP4061

 

Radial view of trapezium.
VID 59, frame 40

thuG4062

 

Radial artery.
VID 59, frame 40

thuG4063

 

Extensor pollicis brevis and abductor pollicis longus tendons.
VID 59, frame 40

thuG4064

 

Extensor pollicis brevis and abductor pollicis longus tendons.
VID 59, frame 40

thuL4064

 

Superficial radial nerve, dorsal and volar branches.
VID 59, frame 40

thuG4065

 

Preservation of superficial radial nerve, dorsal and volar branches.
VID 59, frame 41

thuP4066

 

EPB and APL tendons retracted to visualize the radial artery.
VID 59, frame 42

thuP4067

 

Radial artery undermined and retracted.
VID 59, frame 43

thuG4068

 

Metacarpotrapezial joint beneath joint capsule.
VID 59, frame 43

thuG4069

 

Joint capsule opened longitudinally.
VID 59, frame 44

thuG4070

 

Trapezium exposed.
VID 59, frame 45

thuP4071

 

Wedge cut into trapezium.
VID 59, frame 46

thuP4072

 

Longitudinal wedge cut from trapezium to facilitate removal.
VID 59, frame 47

thuG4073

 

Trapezium removed by morsalization using saw and rongeurs.
VID 59, frame 48

thuP4074

 

Trapezium removed.
VID 59, frame 49

thuG4075

 

APL partially detached and pulled through first extensor compartment.
VID 59, frame 50

thuP4077

 

Abductor pollicis longus partially detached.
VID 59, frame 51

thuG4079

 

APL free end looped under intact portion.
VID 59, frame 51

thuG4080

 

Sublimis tendon to ring finger.
VID 59, frame 53

thuG4083

 

Sublimis tendon isolated through palmar incision.
VID 59, frame 53

thuG4084

 

Sublimis tendon isolated at wrist and cut end pulled through carpal tunnel.
VID 59, frame 54

thuG4085

 

Sublimis tendon pulled distally and rolled around hemostat.
VID 59, frame 55

thuG4086

 

Sublimis tendon cut at musculotendinous junction.
VID 59, frame 56

thuP4087

 

Rolled "anchovy" of tendon is sutured together.
VID 59, frame 57

thuG4089

 

Tunnel hole cut through the dorsal radial side of base of first metacarpal.
VID 59, frame 58

thuG4091

 

Case photo shows tunnel hole.
VID 59, frame 58

thuP4092

 

Free slip of abductor pollicis longus threaded through joint capsule and tunnel hole.
VID 59, frame 59

thuG4094

 

Case photo shows APL threaded through joint capsule and tunnel hole.
VID 59, frame 59

thuP4093

 

Anchovy placed in trapezium cavity and anchored with suture (1).
VID 59, frame 60

thuG4096

 

Anchovy placed in trapezium cavity and anchored with suture (2).
VID 59, frame 60

thuG4097

 

Case photo shows anchovy in place.
VID 59, frame 61

thuP4098

 

Thumb ray extended for placement of K-wires.
VID 59, frame 62

thuP4099

 

K-wires placed to fix position of thumb ray.
VID 59, frame 63

thuG4101

 

X-ray shows K-wires in position.
VID 59, frame 63

thuX4100

 

Threaded APL tendon is put under tension.
VID 59, frame 64

thuG4102

 

Threaded APL tendon incorporated into capsular closure by figure of eight sutures (1).
VID 59, frame 64

thuG4103

 

Threaded APL tendon incorporated into capsular closure by figure of eight sutures (2).
VID 59, frame 64

thuG4104

 

Carpal tunnel anatomy (1).
VID 59, frame 65

thuG4105

 

Carpal tunnel anatomy (2).
VID 59, frame 65

thuG4106

 

Carpal tunnel anatomy (3).
VID 59, frame 65

thuG4107

 

Carpal tunnel after Shepler repair.
VID 59, frame 65

thuG4108

 

Placement of anchovy relative to carpal tunnel.
VID 59, frame 65

thuG4109

 

Compression of carpal tunnel due to anchovy placement.
VID 59, frame 65

thuG4110

 

Prophylactic release of carpal tunnel.
VID 59, frame 65

thuG4111

 

This page was last modified on 4/1/1999.
 

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