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The authors report on 11 cases of ulnar dislocation of the extensor pollicis longus (EPL) due to rupture of the dorsal aponeurosis at the thumb metacarpophalangeal (MCP) joint. This condition is rare. By performing a descriptive study of this injury, we were able to establish a classification system for thumb extensor tendon dislocation. The series included 11 patients with a mean age of 27years. All patients presented with either varus or rotational thumb injury. This resulted in an active extension deficit in the thumb MCP joint with EPL dislocation behind the MCP. Surgery was required in all cases. We defined three different injury presentations: 1) dissociated form with isolated EPL dislocation, but the EPB still in place; 2) complete form with dislocation of both tendons on the ulnar side of the MCP; 3) dissociated or complete form associated with a severe sprain of the lateral collateral ligament of the thumb MCP joint. The surgical treatment was adapted to each case. A classification into three types of dislocation of the extensor tendons at the MCP joint of the thumb was established. This rare condition must be identified at the time of thumb MCP joint injury and also when harvesting the EPB. This new classification system has a diagnostic and therapeutic role as it precisely describes the dislocation type and the resulting damage. Only a surgical treatment can produce good repairs., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: To report the MR imaging findings of painful injured metacarpophalangeal (MCP) joints of the fingers., Design and Patients: MR imaging of 39 injured MCP joints in 38 patients was performed after a mean delay of 8.8 months. The MR images were obtained with the fingers in extended and flexed positions using T2-weighted and T1-weighted sequences before and after intravenous injection of a gadolinium compound. Ten patients were treated surgically. Mean clinical follow-up was 1.8 years., Results: Tears of the collateral ligaments were the most common lesion (30/39), most being radial in location. Contrast-enhanced axial T1-weighted images with the MCP joint in a flexed position showed these lesions optimally. Ten tears were partial and 20 were complete. In 13 patients, MR images showed 17 associated lesions including injuries of the extensor hood (10/17), interosseous tendon (3/17), palmar plate (3/17), and an osteochondral lesion (1/17). Sagittal MR images were essential to highlight palmar plate tears., Conclusion: Partial or complete tears of the collateral ligaments are prevalent MR imaging findings in patients with chronic disability resulting from injuries to the MCP joints. Although conservative treatment generally is sufficient for isolated injuries of the collateral ligaments, surgical repair is often required in cases of more extensive injuries. MR imaging may clearly delineate associated lesions of and about the MCP joints.

The authors report five cases of ulnar dislocation of the Extensor pollicis longus caused by rupture of the hood at the metacarpophalangeal of joint the thumb. This rarely described lesion is well known in long fingers but seems to be less common in the thumb and no previous series can be found in the literature. This dislocation gives a deficit on active extension of the metacarpophalangeal joint of the thumb. During trauma of MP, the expansion of abductor pollicis brevis cans be damaged which provokes ulnar dislocation of EPL. An anatomical study of this region is reported by the authors. 10 dissections on fresh or prepared cadavers were performed with two series of slices of all of the extensor apparatus on the MCP. The hood of the MCP has two superposed planes: one is superficial with transverse fibers which run over the joint from the Abductor to the adductor with the EPL getting through it and a deep plane composed of the EPB and the capsule. Diagnosis is made on clinical observation. The patient has partial deficit of extension of the MCP with a history of old thumb trauma. EPL is active and palpable under the skin. On the MCP it is ulnarly dislocated and lesion front of the rotation center. Dislocation can be reduced manually by a skin pinch on the dorsal part of the MCP. Extension is then possible and complete. This lesion is rare, as we have found only five patients reported between 1984 and 1991. Two patients presented an isolated dislocation of the EPL due to a lesion of the superficial plane.(ABSTRACT TRUNCATED AT 250 WORDS)

Dislocation of the extensor tendon over the MP joint as a result of trauma is a rare and unrecognized injury as our six patients were only operated subsequently. The diagnosis is simple: flexion is possible, while extension is not. The patient is able to hold the extension despie resistance if the dislocation is reduced by artificial extension. X-rays eliminate any possible fracture. Six cases have revealed two different assumptions: either the two tendons (extensor digitorum communis and extensor digiti quinti proprius) are simultaneously dislocated together on the ulnar side, or they are dislocated on either sides of the joint. In the first assumption, the injury occurred ulnar-wise tearing the sagittal band. This case concerns the three older patients. The dislocation was reduced and stabilized by the Michon surgery method. The second assumption concerns the three youngest patients who suffered from a direct axial shock. This separation was reduced by suture of the two tendons on the dorsal base of the joint. The postoperative care was ensured in all cases by a splint attached to the palm, keeping the MP joint in extension and enabling immediate web-fingered reeducation. This therapeutic technique has given satisfactory results as over an average period of six years no recurrence of stiffness has been observed.

The consequences of the division of the pulley of the flexor hallucis longus are described. This division may be necessary for the repair of tendon or in the treatment of trigger thumb. After division, the pulley cannot be sutured and the flexor tendon remains displaced anteriorly. The authors describe a technique of repair using a flap detached from the tendon of the adductor pollicis. 6 cases have been operated on with good results.

The thumb is frequently impaired in rheumatoid arthritis. This leads to major disability in affected patients. Through a clinical case, we describe a reconstructive strategy for a three-joint adduction thumb deformity that caused instability of the interphalangeal and metacarpophalangeal joints, without cartilaginous lesion. Ulnar collateral ligament destruction was treated by a bone-ligament-bone graft at the interphalangeal joint and by a Littler ligamentoplasty at the metacarpophalangeal joint. The trapeziometacarpal lesion was treated by trapeziectomy in combination with suspension ligamentoplasty. Clinical and radiological assessments at 22 months of follow-up revealed good outcomes. This technique is a new option to include in the reconstructive treatment for thumb instability, particularly when caused by rheumatoid arthritis. [ABSTRACT FROM AUTHOR]