The carpometacarpal joint of the thumb is one of the most common locations of degenerative arthritis. Surgical options include trapezio-metacarpal fusion, replacement or resection arthroplasty with or without interposition.

We report the medium term results of a Modified Thompson's suspensionplasty. The radial half of the APL tendon was looped around the FCR tendon to create the suspension. The remainder of the tendon is then used for interposition.

We carried out a retrospective review of 50 patients (67 hands) who underwent this procedure from January 1999 to December 2005. There were 41 female (52 hands) and 9 male (15 hands). The average age at the time of surgery was 62 years (range 41 years – 79 years). The average follow up was 5.33 years (1-9 yrs). 22 patients also had a concurrent second procedure to the same thumb and a further three had a third procedure.

The average PRWHE score was 25 (0 – 80) and the average DASH score was 40 (24 – 100)

There were eight complications which included four persistent radial sided wrist pain. Two of these underwent tenotomy of FCR, whilst two responded to conservative measures. Two patients had symptoms related to scapho-trapezoid arthritis, which responded to an injection. One patient had superficial infection which settled with oral antibiotics, whilst another patient had early chronic regional pain syndrome. Overall the satisfaction rate was 90% with 48 patients (96%) willing to undergo the same procedure again.

We conclude that the modified Thompson's suspensionplasty gives excellent medium term results.

Aims: To evaluate the role of Blatt’s capsulodesis and scapholunate ligament repair in patients with chronic scapholunate instability. Methods: Nineteen (15 males, 4 females) patients with chronic scapholunate instability underwent surgical repair and dorsal capsulodesis. At a mean follow-up of 28 months, all patients were assessed to identify any improvement in analogue pain scores, grip strength, range of movement of wrist and overall result of surgery. Results: Pre-operative arthroscopic findings revealed a scapholunate gap of > 2mm and ease at visualising the capitate by passing the scope through the scapholunate interval confirming the diagnosis. Surgery consisted of repair of torn ligament and supplementary dorsal capsulodesis (Blatt’s technique). 12 patients (63%) had returned to normal working activities at pre-injury level. There was a marked improvement in level of pain (mean pain level= 8.7 pre-operative vs. 2.3 postoperative, p=0.003). Seventeen patients (89.5%) would recommend this operation to others with similar problems. Only one patient (5%) rated the results as worse off following surgical intervention. Statistically significant pain improvement and grip strength were noted. ROM of wrist did not improve in most patients. Conclusion: Treatment of the chronic scapholunate instability remains contentious. It is suggested early surgical intervention will benefit majority of the patients. Our result concluded that Blatt’s capsulodesis has a role in chronic scapholunate instability.

Aim: To evaluate the functional and radiographic results of dorsal capsulodesis in predynamic and dynamic scapholunate instability. Methods: Nineteen patients underwent a scapholunate interosseous ligament repair combined with a dorsal capsulodesis as described by Blatt, in as many wrists for scapholunate instability between 1994 and 1999. The diagnosis was based on a clinical, radiographic and arthroscopic assessment. Mean follow up was 22 months (8 months – 5 years). 15 patients were available for follow up. Most (13 of 15) of the patients presented with predynamic or dynamic instability. Results were analysed clinically and radiologically. Results: Thirteen patients showed a good or excellent clinical result. There was a statistically significant improvement in pain relief (VAS scores) and grip strength (58% of the opposite side). Mean extension and ulnar deviation was significantly better (62% and 53% of the opposite side respectively) and there was a significant reduction in wrist flexion (49% of the opposite side). 13 patients returned to their original level of activity. There was no significant change in the mean SL gap and angle after surgery. Thirteen patients would recommend this operation. Conclusions: We thus believe that this procedure can produce encouraging results in cases of pre dynamic and dynamic instability in a patient population with low demand wrists. Larger case loads and more complete follow ups would be desirable to derive strong evidence based conclusions.