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
Thumb Radial Collateral Ligament
Definition
Also known as Chauffeur's Thumb
Epidemiology
Much less common than UCL injuries
Issues
Rarely get soft tissue interposition
Management
Chronic Instability
Rheumatoid Thumb
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
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
Definition
Replant
- reattachment of body part that has been completely severed
Revascularisation of incomplete Amputation