Thumb pain secondary to arthritis at the basal joint of the thumb is a common condition, especially in women, and can be quite disabling. An accurate diagnosis can be readily made from the history and examination. Radiographs are used to stage the severity of the arthritis. Splinting is the mainstay of conservative care. Reconstructive procedures for each stage of the disease are aimed at restoring thumb motion and strength. Partial or complete trapeziectomy with tendon interposition and ligament reconstruction to stabilize the metacarpal base is used for advanced disease. Secondary metacarpophalangeal joint hyper-extension deformity may need to be addressed. Surgery can reliably improve function and engender high patient satisfaction.

Female↗

PubMedDate not supplied

Volkmann's ischemia. A volar compartment syndrome of the forearm.

In a series of 19 patients with Volkmann's iscemia, 63 per cent had suffered skeletal trauma, whereas 38 per cent had received non-skeletal trauma. Non-specific trauma may trigger an ischemia-edema cycle, producing increased intracompartmental pressure. This cycle, if unrelieved, can involve all of the muscles in the compartment, via cyclic propagation and reinforcement of arterial spasm. The volar compartmental syndrome is not an all or none phenomenon. Localized ischemia may trigger a gradually spreading arterial spasm which results in slowly progressive clinical changes as late as 3-4 months after onset. Decompression not only of the compartment but of each individual muscle which shows evidence of vascular compromise, may reverse this destructive cycle even as late as 3-4 months but it should be performed promptly with the onset of symptoms, when its effect is rapid and dramatic. Induration of the compartment is pathognomonic of the compartmental syndrome. As long as it is present, benefit can be expected from decompression procedures. Regeneration of necrotic ischemic muscle is possible following restoration of circulation.

Adolescent↗

PubMedDate not supplied

The digital neurovascular bundle. A microanatomic study of its contents.

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Adipose Tissue↗