thumb

Indications for Surgery

Upper limb surgery is mainly in spastic hemiplegia

- many of the CP' s have sensory neglect for affected limbs   

- won't use limb post surgery anyway

Surgical indications

- a reasonable level of IQ (>70)

- spastic not athetoid 

- voluntary grasp and release

Definition

Also known as Chauffeur's Thumb

Epidemiology

Much less common than UCL injuries

Issues

Rarely get soft tissue interposition

Management

Chronic Instability

Nalebuff Classification

Type I - Boutonniere 

- commonest

- MP flexion /  IP hyperextension

- usually EPB rupture with EPL subluxation

Type II

- Boutonniere & Swan Neck

- doesn't exist according to Nalebuff

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Aetiology

Initial description

- chronic laxity of British gamekeeper's thumb's 

- no specific trauma

- secondary to breaking pheasant's neck

Acute trauma

- snow ski

- ball games

Valgus / forced abduction

Anatomy

UCL

Definition

Replant

- reattachment of body part that has been completely severed

Revascularisation of incomplete Amputation