The extensor sling procedure for an unstable carpometacarpal joint

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Biomechanics

Background:

• Carpometacarpal (CMC) joint instability of the thumb causes pain and functional deficits.
• Weakness of the intermetacarpal ligament can lead to thumb dislocation.
• Existing surgical methods for ligamentous reinforcement have limitations.

Purpose of the Study:

• To describe a novel surgical procedure for reinforcing the thumb's intermetacarpal ligament.
• To evaluate the efficacy of this new technique in restoring CMC joint stability and thumb function.

Main Methods:

• A reconstructive surgical technique using a portion of the extensor carpi radialis longus tendon to create a reinforcing sling.
• The tendon sling is routed around the base of the first metacarpal and through the second and third metacarpal interspace.
• The sling is sutured to itself upon returning to its entry point, deep to the adductor pollicis longus.

Main Results:

• All 10 patients undergoing the procedure demonstrated full metacarpal excursion.
• Patients regained the ability to oppose their thumb to the base of the small finger.
• The technique successfully restored joint stability without compromising first metacarpal mobility.

Conclusions:

• This novel surgical sling technique effectively stabilizes the unstable thumb carpometacarpal joint.
• The procedure restores thumb function and range of motion, offering a viable treatment option.
• The technique provides durable stability without limiting essential thumb movements.