Elsevier

The Journal of Hand Surgery

Volume 31, Issue 7, September 2006, Pages 1171-1175
The Journal of Hand Surgery

First CMC joint
Entire Flexor Carpi Radialis Tendon Harvest for Thumb Carpometacarpal Arthroplasty Alters Wrist Kinetics

https://doi.org/10.1016/j.jhsa.2006.05.005Get rights and content

Purpose

To investigate the clinical outcome of thumb carpometacarpal arthroplasty with entire-thickness flexor carpi radialis (FCR) ligament reconstruction and tendon interposition and to investigate the isokinetic wrist flexion/extension torque and flexion fatigue strength of the surgically treated wrist compared with the nonsurgically treated wrist.

Methods

Thirty-nine patients with osteoarthritis who had unilateral thumb carpometacarpal arthroplasty with the entire FCR tendon were studied prospectively with a minimum follow-up period of 24 months. Preoperative Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, grip, pinch, and postoperative DASH score, grip, pinch, and Biodex (Shirley, NY) isokinetic wrist flexion/extension torques were recorded. The nonsurgically treated extremity served as the control for each patient with unilateral ligament reconstruction and tendon interposition. Peak torque ratios and fatigue were measured for the control and surgically treated extremities with the Biodex.

Results

Postoperative DASH scores were 12 ± 4 and were improved significantly from preoperative scores of 43 ± 4. The surgically treated extremity showed a significantly lower wrist flexion-to-extension peak torque ratio than the control extremity. The control extremity had 2.5 times greater wrist flexion fatigue resistance than the surgically treated side. After surgery the surgically treated extremity had significantly improved grip strength and thumb–index tip pinch compared with the preoperative status.

Conclusions

Our data show conclusively that wrist flexion extension torque ratio decreases and wrist flexion fatigue resistance decreases when the entire FCR tendon is harvested even though the final outcome is favorable and uniformly based on traditional DASH, grip, and pinch scores.

Section snippets

Methods

From 2002 to 2004, 39 patients with osteoarthritis who had unilateral LRTI with the entire width of the FCR tendon were studied prospectively. The nonsurgically treated extremity served as the control limb. Institutional review board approval was obtained before proceeding with the study. All patients were assessed before and after surgery for Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, grip, key pinch, tip pinch, and tripod pinch. Postoperative data were obtained

Results

The average age of the study population was 57 years (range, 43–81 years). There were 9 men and 30 women. There were no major complications. Superficial radial nerve neuritis symptoms were encountered in about 20% of patients within the first 3 months after surgery; however, 3 patients had persistent sensory complaints along the superficial radial nerve distribution at the 2-year follow-up evaluation.

Before surgery the affected extremity was 14% weaker than the control extremity in grip

Discussion

Relative strengths of the flexor and extensor tendons are well established in the tendon transfer literature. With the FCR muscle as the reference it is well known that the relative strengths of the FCU, flexor pollicis longus, each of the digital flexors, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, and each of the digital extensors are 2, 1, 0.5, 1, 1, 1, and 0.5, respectively.8 When one takes the ratio of all the flexors to all the extensors the

References (10)

There are more references available in the full text version of this article.

Cited by (50)

  • Indications for Ligament Reconstruction and Suspensionplasty in Carpometacarpal Arthroplasty

    2022, Hand Clinics
    Citation Excerpt :

    Burton and Pellegrini43 described the original technique of ligamentous reconstruction, in which half of the FCR was harvested and woven through a hole drilled into the base of the thumb metacarpal.41,42 Later studies have demonstrated that the entire FCR can be harvested.51 Often when the entire FCR is harvested, it is routed through a bone tunnel in the base of the thumb metacarpal, tensioned, and then the excess tendon is folded in a fashion to create a cushion between the scaphoid and thumb metacarpal (Fig. 2).

View all citing articles on Scopus

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

View full text