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Treating Painful Snapping EPL Tendon Subluxation – 3-Pronged Approach with Centralizing Neo-Sheath Reconstruction for the EPL Utilizing a Hemi-ECRL Tendon Graft, 1-2 Intermetacarpal Ligament Reconstru
Chris J. McMellen BS, Spencer R. Anderson MD, Sunishka M. Wimalawansa MD MBA.
Dept. of Orthopedic and Plastic Surgery, Wright State University
2018-01-30
Presenter: Chris J. McMellen
Affidavit:
Both the resident and medical student have contributed equally to the production of this paper, with case provided by the associate professor.
Director Name: R. Michael Johnson, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Purpose: Carpometacarpal (CMC) thumb joint instability is traditionally treated with Eaton-Littler techniques for 1-2 intermetacarpal thumb suspensory ligament (IML) using hemi-FCR tendon grafts. Successfully treating EPL subluxation requires stabilizing this joint, but also warrants a dorsal approach; therefore, we recommend using an alternative hemi-ECRL tendon graft. MP extensor mechanism sagittal band diastasis also contributes to this pathology. Here we describe our novel approach utilizing hemi-ECRL tendon autograft CMC stabilization and creation of a centralizing EPL "neo-sheath", as well as post-operative rehabilitative measures and functional outcome.
Methods: Retrospective chart review was performed, with number of rehab visits, final range of motion, and overall function as outcome measures.
Results: We treated a 20-year-old female with painful snapping EPL subluxation, reconstructing 1-2 IML using hemi-ECRL tendon autograft with the modified Eaton-Littler technique. The subluxing right EPL tendon was centralized using the same tendon graft to construct a new EPL sheath, secured to the thumb metacarpal using a mini-corkscrew suture anchor, augmented distally by tightening the thumb MP sagittal band. Post-op modalities include thumb spica splinting, while allowing immediate thumb IP joint EPL gliding exercises. This successfully treated the EPL subluxation, producing full range of motion and complete resolution of her pain.
Conclusion: This case describes an effective, novel approach to painful snapping EPL subluxation using hemi-ECRL tendon autograft for CMC/IML reconstruction, EPL tendon "neo- sheath" reconstruction, and sagittal band tightening, combined with an early EPL gliding rehab protocol.
