Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction.

Swan neck deformity, or hyperextension of the proximal interphalangeal joint, may occur secondary to trauma, rheumatoid arthritis, cerebral palsy, or Ehlers-Danlos syndrome, and can be treated with tenodesis of one slip of the flexor digitorum sublimis tendon. This technique has several variations, differing primarily in the specific location and method that a single slip of the flexor digitorum sublimis tendon is secured, but they all serve to create a static volar restraint against hyperextension. Options include tunneling the tendon through the bone of the proximal phalanx, attaching the tendon to the A1 or A2 pulley, or securing the tendon with bone anchors in the proximal phalanx.

Treatment of boutonniere finger deformity in rheumatoid arthritis.

Boutonniere finger deformities occur frequently in patients with rheumatoid arthritis. The deformity consists of flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint. Treatment decisions are based on the degree of joint deformity, joint motion, passive joint correctability, and the status of the articular surface. Treatment options can then be based on the classification of the deformity; options consist of corrective splinting, injections, synovectomy, terminal tenotomy, extensor reconstruction, or salvage surgery (arthrodesis or arthroplasty).

Metacarpophalangeal joint arthroplasty in rheumatoid arthritis.

In patients with rheumatoid arthritis, metacarpophalangeal joint deformities can significantly affect hand function. Flexible hinge implant arthroplasty, designed in the 1960s, remains the most accepted and widely performed technique for treatment of severely involved metacarpophalangeal joints in rheumatoid arthritis. An arc of motion of 40 degrees to 60 degrees can be expected after arthroplasty, with improvement of finger extension and ulnar deviation. Silicone implant arthroplasty, although technically challenging, is the standard surgical procedure for improving hand function in these patients. Complications include recurrent ulnar deviation, extensor lag, implant fracture, infection, and silicone-induced particulate synovitis. Despite these limitations, patient satisfaction is high with enhancement of hand appearance and function and relief of pain.

Dorsal intercarpal augmentation ligamentoplasty for scapholunate dissociation.

Carpal instability secondary to scapholunate ligament tears can lead to significant disability of the wrist. Disruption of the ligamentous stabilizers of the scaphoid causes rotatory subluxation of the scaphoid and subsequent abnormal loads across the radioscaphoid joint. Arthritic changes involving the radioscaphoid and midcarpal joint will develop if the wrist is untreated. Treatment of scapholunate ligament tears has varied widely in the literature. Today, most surgeons perform either a soft tissue reconstruction using local tissue or a limited fusion. Motion of the wrist favors soft tissue reconstructions. Also, the relative intercarpal motion with a more flexible carpus may prevent abnormal load patterns that are associated with a rigid radial column and limited fusions. We have reconstructed flexible subacute (>3 weeks) and chronic (>2 months) scapholunate dissociations with a radial-based dorsal intercarpal ligament. Clinical results have demonstrated increased grip strength, decreased pain, and improved intercarpal alignment.