• Be aware of possibility of intraarticular injection of Marcaine into radial artery
• Rupture of the FCR tendon is possible with an injection. It can be avoided by using an orthoplast splint for 10 days postinjection.
Anteroposterior (AP) and lateral oblique and Robert's view (hyperpronated AP of the thumb) show abnormalities of the CMC joint (Fig. 31-2).
Basal joint arthritis of the thumb
Flexor Carpi Radialis (FCR) Tendinitis
Repetitive wrist motions experienced by some athletes can lead to a stenosis and synovitis within the fibro-osseous tunnel containing the FCR.
The FCR passes through a synovial tunnel bordered by the scaphoid tuberosity, trapezial ridge, and the transverse carpal ligament (Fig. 31-3). Within the tunnel, the tendon occupies 90% of the available space. As the tendon enters this tunnel, it
deviates 30 degrees dorsally over the volar pole of the scaphoid to insert at the base of the second and third metacarpals and provides a slip to the trapezial ridge. Weeks has suggested that this angulation may create mechanical irritation and predispose the athlete to tenosynovitis.
Athletes with FCR tendonitis have pain over the volar aspect of the wrist, proximal to the wrist crease and overlying the FCR tendon. Lister described a provocative test performed by abruptly extending a relaxed wrist to reproduce the pain. Pain also may be elicited on resisted flexion and radial deviation. Chronic synovitis and tendon ruptures may not allow active testing in some patients.
Immobilization, antiinflammatory medication, and a corticosteroid injection may provide relief in the setting of a primary tendinitis (Fig. 31-4). Chronic processes may be resistant and often require decompression of the fibro-osseous tunnel. In the setting of an FCR rupture, simple debridement of the stump can provide effective pain relief. A wrist splint placed in neutral rotation often will alleviate all the pain.
Surgical treatment is rarely, if ever, needed and performed only in conjunction with CMC arthroplasty. If nonoperative treatment fails, the FCR tunnel can be decompressed. An incision is made radial to the FCR to prevent injury to the palmar cutaneous branch. The thenar muscles are reflected off the transverse carpal ligament and the tendon sheath is opened proximal to distal. The fibro-osseous tunnel along the ulnar border of the trapezium is released. The FCR should then be free to its insertion. Following surgery, range-of-motion exercises should be started early under the guidance of and occupational hand therapist (Fig. 31—5).
Rupture of FCR tendon Intraarteriolar Marcaine injection
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