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Trapezium - Wheeless' Textbook of Orthopaedics
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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Trapezium


- See:
      - Blood Supply to the Wrist
      - Thumb Deformities in Rheumatoid Arthritis
      - Thumb Fractures

- Discussion:
    - articulates w/ thumb;
    - move distal to snuff box to snuffbox to palpate trapezium-thumb articulation;
    - trapezium-thumb articulation is saddle like & lies immediately proximal to thenar eminence; (ask pt to flex and extend thumb)

- Blood Supply:
    - trapezium receives nutrient arteries thru two non articular surfaces, & have consistent intraosseous anastomosies which explains the rare occurance of AVN;

- Sprain of Thumb CMC:
    - seen in skiers and are usually related to the pole and strap leverage in first web space during falls;
    - range from subluxation to chondral shear injuries, w/ former analogous to Bennett's fracture injury;
    - avoidance of wide thumb abduction will allow the capsule to heal;

- Trapezium Fracture:
    - Differential Diagnosis:
    - avulsion frx occurs more often than a pure dislocation attests to strenght of the anterior oblique ligament;
           - AOL anchors volar lip of metacarpal to tubercle of trapezium;
    - follows a direct blow of the fist or a fall on the on the radially deviated closed hand may resemble findings assoc scaphoid frx
    - swelling and pain are usually directed at base of thumb, rather than over the scaphoid;

- Degenerative Dz:
    - second most common degenerative pattern in the wrist;
    - treatment options include STT Fusion, trapeziectomy w/ soft tissue tissue interposition (LRTI);

- Physical Exam:
    - common site for degenerative arthritis is the thumb basal joint;
    - axial compression of the metacarpal upon the Trapezium gives a grinding sensation and is painful;
    - thumb often has adducted stance w/ prominent "knob" at basal joint, adduction of metacarpal, & hyperextension of the MCP joint;
             - this must be distinguished from DeQuervain's Disease



 



Trapeziometacarpal-I--Symposium: Reconstruction of the thumb basal joints. Development and current status of implant techniques.

Trapeziometacarpal-I--Symposium: Long-Term Complications of Trapeziometacarpal Silicone Arthroplasty.

Trapeziometacarpal-I--Symposium: Arthrodesis of the carpometacarpal joint of the thumb. A review of patients with a long postoperative period.

Trapeziometacarpal total joint replacement using the Steffee prosthesis.

The kinesiology of the thumb trapeziometacarpal joint.

Fusion of the first metacarpotrapezial joint for degenerative arthritis.

Post-traumatic instability of the metacarpophalangeal joint of the thumb.

Fracture of the trapezial ridge.

Anatomy of trapeziometacarpal ligaments.

Functional anatomy of the carpometacarpal joint of the thumb.

Reconstruction of the thumb basal joints. Development and current status of implant techniques.

Ligament reconstruction for the painful "prearthritic" thumb carpometacarpal joint.

Carpometacarpal dislocations. Long-term follow-up.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 20, 2012 11:04 pm