Name: Thumb CMC Arthroscopy
Uploaded: 2020-02-13T00:00:00Z
Channel: Arthrex
Description: A.J. Mencias, MD (South Bend, IN), presents cases of and evidence for using the NanoScope™ operative arthroscopy system to treat thumb CMC arthritis.

<p>A.J. Mencias, MD (South Bend, IN), presents cases of and evidence for using the NanoScope™ operative arthroscopy system to treat thumb CMC arthritis.</p>

Not Hidden

English  - en

video

VID1-000659-en-US | A | Thumb CMC Arthroscopy

A.J. Mencias

Human

A video of a live presentation reviewing Arthrex products or techniques.

Video einer Live-Präsentation, die Arthrex Produkte oder Techniken überprüft.

Präsentationsvideos

Presentation Videos

Vídeo de apresentação ao vivo analisando produtos ou técnicas da Arthrex.

Apresentação vídeos

Video de presentación en vivo que revisa los productos o técnicas de Arthrex.

Video presentaciones

Thumb CMC Arthroscopy

So arthroscopic treatment for the CMC joint. Anyone? Anytime someone is a candidate for a hemi resection of the trapezium metacarpal joint, you can think about arthroscopy in stage two. Stage three non. It's not trapezium arthritis and you don't burn any bridges. I was talking to some people yesterday. I think as I've gotten older I've learned I don't like to burn bridges. And as people are younger and they show up with the problems that older people have, you got to be minimally invasive, do things less aggressively. Don't take out the whole trapezium in 45 year olds. I just think if you can do something differently at younger ages, I think it's better. You do have to treat the lateral subluxation of the thumb metacarpal base arthroscopically if they have bad skin, sometimes you don't want to do it. Arthroscopically. Here's some of the portals. The 1R1 you the D two portal, which is the dorsal distal portal that will help you come at a more steep angle so that you can get the ulnar side of the trapezium debrided. So that's the D2 portal. It's kind of in that V between first and second metacarpals just distal to the inner metacarpal ligament. So you can see the bur aggressively taking away about three millimeters of the trapezium. This is me doing an arthroscopy on the CMC joint. You can breed it. You can shrink the capsule. You can shrink some of the ligaments. You got to keep the probe away from cartilage. You need outflow inflow just to maintain that the temperature within the joint. So here's a thermal wand shrinking the volar beak ligament. Some of the volar capsule ligamentous structures. And, you know, in, in patients that have that initial instability. Grade one, grade two. This really does help. You can do an arthroscopic partial trapeziectomy with interposition, partial trapeziectomy without tendon interposition. Use shrinkage pinning. Like, I think you guys heard from me yesterday. I try to not pin very often nowadays. I just don't like the complications of pins. You can salvage it at any time. There's a ton of studies supporting what I do. Arthroscopic hemi trapeziectomy and interposition. Gore-tex wasn't good in study. Berger. Culp. They showed less subsidence with hemi trapeziectomy arthroscopically atoms completely satisfied, partially satisfied, high satisfaction rate and others shorter recovery. So here's the setup again. 1r1 you you can do within our portal. The Thenar portal is about 90 degrees from the one you portal, and you stick it straight through the thenar musculature, and then you can get in there and visualize. Visualize again in the D2 is coming down this way at a steeper angle. So those and then there's the volar radial portal, just radial to the tendon. So with NanoScope you will definitely be able to establish these portals easier and more safely. These are just a ton of schematics as I was just preparing this talk anatomically, seeing where the where the portals are again the one r1 you and the D2 dorsal distal portal. Again you can do synovectomy debridement. Remove loose bodies. Do the hemi trapeziectomy with the bur. Use fluoro guidance if needed. Thermal shrinkage is helpful. You got to be very. Be diligent about debriding the volar, synovitis and synovium and find that beak ligament. You restore stability by thermal shrinkage. It's the fibroplasia and scarring and some sensory receptors are are destroyed. So therefore decreasing the pain. Again I'll just cast them before I pin them, because I think that that stability will occur with some immobilization. And as that capsule tightens up and those ligaments tighten up, here's fluoro guidance. You can you can look under fluoro to make sure that you've removed enough. This is a as I've mentioned, I like to do the scope and bring in a little ArthroFLEX and a flex patch. It's technically a little challenging, but as you can see in the middle, the middle, I kind of ball it up into like a little arrow and then I stuff it in. And then what I'll do is after I know that I've gotten it in and popped it in, I may put a freer elevator through that portal, make sure it's in there, and then I'll kind of spread it out with a freer or a probe. So in my younger patients, this is a teacher, 40 year old teacher, thumb arthritis, post-traumatic. And so this really I mean she's done very well. And you know, you can get them back to doing things pretty quickly, I think I think NanoScope is going to make this really easy. So, you know, there's there's your complication of pins and stuff. I hate pins suture button suspension. Some people are doing trapeziectomy with suture button. I don't have a lot of experience with it. I do, I do love the TightRope. I use the TightRope a double TightRope probably in my revision cases protocol after suspension or really what I'm doing with the interposition with an a flex thumb spike, a splint for a few days suture removal and start range of motion very quickly. And they advance, I think, more quickly than our typical open procedures.

Thumb CMC Arthroscopy

Related Pages

Hand and Wrist

Nano Arthroscopy System for Hand and Wrist

Product