Name of the Procedure:

Closed Treatment of Carpometacarpal Dislocation, Thumb with Manipulation (CMC Dislocation Reduction)

Summary

This procedure involves realigning a dislocated thumb joint (at the base of the thumb) without making an incision. The physician manipulates the bones back into place through external pressure and alignment techniques.

Purpose

This procedure addresses dislocations of the thumb at the carpometacarpal joint. The primary goal is to restore the normal alignment and functionality of the thumb, alleviate pain, and prevent long-term joint instability or arthritis.

Indications

• Acute thumb pain and swelling following trauma or injury
• Visible deformity or malalignment of the thumb
• Inability to move the thumb properly
• Confirmation of dislocation via X-ray or other imaging

Preparation

• The patient may need to fast if sedation is planned.
• Adjustments in medication, especially blood thinners, as advised by the doctor.
• Diagnostic imaging (X-rays) to confirm the nature and extent of the dislocation.

Procedure Description

1. Preparation: The patient is positioned comfortably, and sedatives or local anesthesia may be administered to minimize pain and discomfort.
2. Manipulation: The healthcare provider uses their hands to apply gentle but firm pressure to guide the dislocated bone back into its proper position.
3. Confirmation: Post-reduction X-rays are taken to confirm that the thumb is correctly realigned.
4. Immobilization: The thumb may be immobilized using a splint or cast to ensure it stays in place and begins the healing process.

Duration

The manipulation process itself usually takes less than 30 minutes, but the total time, including preparation and post-procedure care, is typically around 1 to 2 hours.

Setting

This procedure is typically performed in an outpatient clinic, emergency room, or a doctor's office equipped for minor orthopedic manipulations.

Personnel

• Orthopedic surgeon or emergency room physician
• Nurse or medical assistant
• Radiologic technologist for X-ray imaging
• Anesthesiologist if sedation is used

Risks and Complications

• Pain during manipulation
• Re-dislocation
• Damage to surrounding ligaments, nerves, or blood vessels
• Incomplete reduction
• Swelling and bruising
• Potential need for surgical intervention if closed reduction fails

Benefits

• Immediate relief from pain and functional impairment
• Restoration of thumb alignment without invasive surgery
• Quick procedure with minimal recovery time compared to open surgery

Recovery

• The thumb will be immobilized for a few weeks to allow proper healing.
• Pain medication and anti-inflammatories may be prescribed.
• Follow-up appointments to monitor healing progress.
• Physical therapy may be recommended to restore strength and mobility.

Alternatives

• Open surgical reduction, which involves making an incision to realign the bones.
• Non-intervention, which may lead to improper healing and long-term complications.
• Both alternatives have higher risks and longer recovery times compared to closed manipulation.

Patient Experience

• Patients will experience some discomfort during manipulation, which is minimized through sedation or local anesthesia.
• Post-procedure, there may be some pain and swelling, manageable with prescribed medication.
• Proper splinting and follow-up care are crucial for successful recovery.

Pain management and comfort measures are prioritized throughout the process to ensure patient well-being.