Thumb “sublaxation”

[Diane]

Hi Steve, I scanned a male today who presents with chronic “sublaxation” of his 1st MCPJ. He complains of pain when typing because he works on the computer all day. The xray was reported as normal but I was thinking there was some anterior sublaxation of the prox phalanx?

I was wondering if there was anything specific we should be looking at in terms of sublaxation?

I scanned the APL, EPB, EPL, FPL , A1 pulley. I briefly looked at the volar plate.

I saw a TINY bit of fluid around the FPL at the level of the metarcarpal shaft that wasn’t seen on the left side. Pt was midly tender. Would you consider this as mild tenosynovitis or would you palm it off as physiological fluid?

Also I saw a tiny bit a fluid around the dorsal MCPJ and IPJ. Yet again just mildy sore. Would you also call this a mild joint effusion or yet again just physiological? I get confused.

Thanks!

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[Stephen Bird]

Hi Diane,

This is a complex joint and requires some niche knowledge to best assess the volar beak ligament (between the trapezium and the metacarpal base on the solar aspect) and the dorsal radial ligament between the same bones on the radial aspect.
The transverse carpal ligament (roof of the carpal tunnel) also helps stabilise the joint.
The master of this joint is the great Greg Lammers from Melbourne,
In 2019 he presented a cracking good paper on the subject at the ASA meeting.

I can share some of Greg’s amazing work with you via email.

I also have some journal articles I can share.

Steve.

[Lucy Hellberg]

Hi Steve would you be able to share those articles with me too? I’ve just scanned two patents today with requests to look at the beak ligament and I am rather unpractised in this area. Can it be rather small in some patients?
With many thanks, Lucy

[Stephen Bird]

Indeed,

I will send you the articles,

I have many !

Yes, the beak ligament is only small, but you can see it well,

I have difficulty with arthritic joints unfortunately !

I also need some Greg Lammers magic tuition!

Steve.

[Author]

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