Background/Objectives: Chronic injuries of the radial collateral ligament (RCL) of the thumb metacarpophalangeal (TMCP) joint are becoming an increasingly common clinical challenge. In cases without degenerative changes, surgical treatment with ligament reconstruction may be effective. However, coexisting cartilage damage significantly worsens treatment outcomes and may necessitate arthrodesis, which limits joint mobility and carries a high risk of complications. In the present case, an alternative surgical approach was employed—combining RCL reconstruction using a palmaris longus (PL) tendon with interpositional arthroplasty. The aim of this report is to present an innovative method for treating chronic TMCP instability with focal cartilage damage through simultaneous ligament reconstruction and interpositional grafting using autologous tissue. Methods/Case presentation: A 60-year-old male manual laborer presented with chronic TMCP joint instability and pain impairing daily activities and preventing him from working. Intraoperatively, cartilage damage to the head of the first metacarpal was identified. Radial collateral ligament reconstruction was performed using the Glickel technique with the PL tendon, incorporating two modifications: (1) advancement of a capsuloligamentous flap as an interpositional graft, and (2) additional reinforcement of the dorsal capsule with a tendon strip. Results: At 24-month follow-up, complete pain relief was noted, handgrip strength increased by 10.4%, key pinch strength by 25%, palmar abduction improved by 27%, TMCP joint extension improved by 20% and TMCP joint total range of motion improved by 66.7%. Conclusions: The combination of ligament reconstruction with interposition of autologous tissue may be a promising alternative for treating TMCP instability with limited cartilage damage.

Aim: An incorrectly placed implant during surgery to fracture the distal end of the radius may cause damage to the flexor pollicis longus tendon. Aim. Presentation of the case of removal the plate from the distal radius with simultaneous reconstruction of the lacerated flexor pollicis longus tendon performed under WALANT anaesthesia.Material and methods: The tendon rupture was caused by the protruded distal edge of the palmar plate inserted for fixation of the distal radial fracture 2 years earlier. The patient was a 28-year-old patient who had stopped bending the distal phalanx of his right thumb 2 months prior to the presentation.Case report: Performance of anaesthesia and operation is presented in details. The operation went smoothly, bleeding was minimal despite the relatively extensive wound, and the patient felt only little pain at the end of the operation.Summary: The authors believe that presentation of this case can be interesting for hand surgeons and will encourage them to extend the scope of operations performed under WALANT.

Introduction: This prospective pilot study assessed the effectiveness of two new clinical tests (Szczecin 1 and Szczecin 2) by comparing them with the All-India Institute of Medical Sciences (AIIMS) and Schaeffer’s tests for detecting the presence of the palmaris longus (PL) tendon, using ultrasonography as the reference method. Methods: A total of 370 wrists were assessed in 210 patients (107 male, 103 female) aged 18–86 years (median age: 54 years; IQR: 43 to 67), with a median body mass index of 27 kg/m² (IQR: 24 to 30). Four clinical tests were used: the Schaeffer’s, AIIMS, Szczecin 1 and Szczecin 2. Tendon visibility, the difficulty of distinguishing the PL from the flexor carpi radialis tendon, the number of attempts required for correct execution and the subjective ease of the test were analysed. The presence of the PL tendon was confirmed by ultrasonographic examination. Results: The sensitivity for the right hand was: Schaeffer’s, 71%; AIIMS, 63%; Szczecin 1, 87%; Szczecin 2, 89%. For the left hand it was: Schaeffer’s. 72%; AIIMS, 65%; Szczecin 1, 88%; Szczecin 2; 91%. Palmaris longus tendon absence in one or both hands was found in 13% of patients (or in 16% of all assessed hands). Conclusions: The two new tests showed higher sensitivity than the reference tests and may be more useful in daily clinical practice. Level of evidence: III.