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The authors report their experience in the treatment of isolated STT arthritis using a novel technique and propose a new clinico-radiological classification for the condition in four stages. In STT arthritis, the joint is rendered unstable due to the rupture of the capitotrapezium and volar scaphotrapezial ligaments. The objective of the operation is to stabilise this joint and, thus, eliminate the pain and the tenosynovitis that occurs due to the instability.
MATERIAL AND METHODOS. The technique involves deepening of the gutter for the flexor carpi radialis in the trapezium, excision of the distal part of the scaphoid and anchorage of the FCR in its fibro-osseous canal.
The hand is immobilised in a plaster for 2-3 weeks depending upon the condition of the tenosynovium and the tendon noted during surgery.
This technique has been utilised in 11 patients between 1995 and 2004 and the results have been reviewed.
RESULTS. Complete and permanent relief of pain was obtained in each of the 11 patients within an average period of 6 months. The follow-up ranged from 1-9 years. There was no loss of range of flexion nor extension as compared to the pre-operative conditions. In fact, we only noted an improvement in the mobility or it remained unchanged.
The scapho-lunate angle, too, was not affected following surgery. The increased angle noted in two patients before surgery, too, remained intact.
CONCLUSIONS. This technique of FCR tenodesis and minimal bony resection of the distal end of the scaphoid is a simple and efficient method that offers consistent results in the treatment of STT arthritis. It probably owes its success to the fact that it tackles the cause of pain i.e. the instability due to the ruptured capitotrapezium and volar scaphotrapezial ligaments.