Ulna collateral ligament
Definition
Injury to ulnar collateral ligament of thumb MCPJ
Interferes with pinch grip and grasp and thumb is ineffective as a post
reconstruction
Surgical management
Issues
Operative v Nonoperative
Levy et al Arthroscopy 2009
- systematic Review
- improved outcomes with operative management
https://pubmed.ncbi.nlm.nih.gov/19341932/
Vicenti et al. Injury 2019
- systematic review
- two studies compare operative v nonoperative
Pectoralis Major Tears
Epidemiology
Middle age men
Steroids / Growth Hormone
Aetiology
Usually occurs in gym
Bench Press
Clinical
Significant bruising in the acute phase
In chronic setting, ask patient to adduct against hip / resistance
Quadriceps Tendon Rupture
Epidemiology
Usually occurs in patients over 60
- due to decreased vascularity & collagen weakness
Younger patient on steroids / growth hormone
Occasionally occurs in young athlete with excessive contracture
Aetiology
Often preceded by quadriceps tendinosis
LARS PCL Reconstruction Technique
Indication
1. Acute < 3/52
- single bundle
2. Chronic
- double bundle
Technique Single Bundle
Set up
- knee at 90 degrees on bolster
- x-ray getting lateral of knee
DRUJ instability
Types
Dorsal
- most common
Volar
Causes
1. Acute traumatic peripheral tear TFCC with DRUJ dislocation
- usually major trauma
- dorsal or volar
2A. Distal radial fracture
De Quervain syndrome
Definition
Stenosing tenosynovitis of the first dorsal compartment of wrist
Epidemiology
Most are middle aged women
Aetiology
Repetitive thumb movements
- abduction & extension
- combined with RD & UD movements
Any mechanical irritation
- foreign body
- prominent bony surface
- restricted fascial compartment
Patella Tendon Rupture
Epidemiology
Usually occurs in young people
- often previous history of tendonitis ± steroid injections
Location
Usually at level of inferior pole of patella
- less common at tibial tubercle
- mid-substance ruptures rare
Clinical
Severe pain
Palpable defect
Extensor deficit / unable to SLR
Xray
Patella alta / high riding patella
Chronic PLC Management
Issues
Limb alignment
Risk that late posterolateral corner reconstruction will fail in the setting of the varus knee
- varus knee alignment and varus thrust in stance phase
- consider osteotomy first in this setting
Results
Posterolateral Corner Reconstruction
Moulton et al. Am J Sports Med 2016
- systematic review of PCL reconstruction for chronic injuries
- 450 patients