thumb

Upper Limb

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

Rheumatoid Thumb

Nalebuff Classification

 

Type I - Boutonniere 

- commonest

- MP flexion /  IP hyperextension

- usually EPB rupture with EPL subluxation

 

Rheumatoid Boutonniere Thumb

 

Type II

- Boutonniere & Swan Neck

- doesn't exist according to Nalebuff

 

Gamekeeper's Thumb

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

Replants

Replant 4 FingersReplant 4 fingers post

 

Definition

 

Replant

- reattachment of body part that has been completely severed

 

Revascularisation of incomplete Amputation