1 i^D=)ngloqvb_3.&3e/.[A GF;'YDL65_lZ4l$!`,yv I(=wY */xZFXDI6%t0^&2L7@~DSN1& !bq\n#z0y/16C0DLP"2wn|e&35`MX2 @@^ !+~(l)2B3% !!PsEUr,!NAqYkT0(*${YNB_sYGDa|)jN!vE ` Gc^N.&/v;5$*'BDh8P}!k!2YK-|)T\{|eF_xXC'o]8 yLt)n REHABILITATION PROTOCOL: ULNAR COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION RADIAL COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION THUMB MP JOINT WITH INTERNAL BRACE A. J. Mencias, M.D. endstream endobj startxref 0 <>>> <>/Metadata 558 0 R/ViewerPreferences 559 0 R>> It's pretty neat to see how it has taken on a whole world of uses, including in the knee and ankle. @` I8 3 0 obj Diagnosis s/p RIGHT/LEFT UCL Repair with Internal Brace Date of Surgery_____ Frequency: ____ times/week Duration: _____ Weeks Week 1: Elbow is immobilized in Hinged Elbow Brace at 75 degrees flexion (7 - 10 days), wrist free, in sling. Thumb UCL may be repaired with Internal Brace Ligament Augmentation. 1-3 Candidates for repair are most commonly young er (pre-professional) and present % The UCL may be strained or torn (partially or completely) producing a weakened grasping or pinching ability of the thumb. endobj The InternalBrace V8FW Thumb UCL Repair With InternalBrace Ligament Augmentation. Edema control is initiated with a light compression dressing. Thumb UCL Repair and Reconstruction With Internal Brace Ligament Augmentation Repair Ulnar collateral ligament (UCL) tears of the thumb are common injuries. by | Jun 3, 2022 | james carone florida energy | when a man criticizes another woman | Jun 3, 2022 | james carone florida energy | when a man criticizes another woman The length of each phase varies depending on each patient and depends on tissue healing and progression. 2 0 obj &H<0LElM0i""(P f4G0 H2a`70&E00v$`?W r 3 0 obj A UCL repair with internal brace is reserved for use in cases of partial or complete tears at the origin or insertion of the UCL with good ligament tissue and low-grade mid-substance partial UCL tears [10]. The UCL repair with Internal Brace was developed as a faster alternative to a full UCL reconstruction. Brotzman, S. & Novotny, S. (2018). UCL Repair Ulnar Collateral Ligament Repair Protocol Ulnar Collateral Ligament Repair Protocol Phase I: Immediate Post-Surgical Phase (Days 1 - 21) Goals: Protect healing tissue, decrease pain and inflammation, increase scar mobility, prevent muscular atrophy Exercises: &H+JIKv)ATPJ};CH endobj stream Abstract and Figures Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if. !-twF)rm16:M.J r]Sc]Oi~ 4 0 obj Hand and Wrist endstream endobj 503 0 obj <. POST-OPERATIVE WEEK 2. Traditional custom-fitted thumb spica orthosis In a recent cadaver study by Gil et. To date, no literat. fPD. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, Surgery may also require repairing the avulsion fracture using a pin, screw, or bone anchor. endstream endobj startxref Clinical Orthopeadic Rehabilitation: A Team Approach E-Book, 4th Edition. invite research legit; orange county police department california; hydra stop brake booster The athletes that were treated with UCL repair and internal . No driving. The internalbrace is the underpinning of the repair procedure. Reference Number: AN1-00264-en-US | Version: C. Related Pages. >W ` 8;d3^ (} oA%Yv:JzFQA 0X"5o A%U- MLZ;?3%RO8?DnQN['y]{_5%x@iSt>K2! endobj endobj 14 Days Postoperative Do NOT remove the surgical bandage. 7-10 day post-op OT to fabricate a custom FA based thumb spica AROM of the wrist and IP of thumb Key Timeframes: (Dr Meister/TMI Protocol) Plyometric Phase: 12-14 weeks. endobj 3BRKpw.4/Y. 132 0 obj <>/Filter/FlateDecode/ID[<74EC21535A719E4081B6460A7EF86336>]/Index[110 39]/Info 109 0 R/Length 107/Prev 88703/Root 111 0 R/Size 149/Type/XRef/W[1 3 1]>>stream your repair for 4 more weeks. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> <>/Metadata 83 0 R/ViewerPreferences 84 0 R>> K`d:V0!QGXCor&J;#Z?='lH3cy?_pOk0qWR_heBU] u)dh5Q :e16&\H11}8 1AE Qf>`?SLXSu {q?u,:g@l2;1FhCSTV9}WKH}[agS~?P3{47*c:lg3l#`vLx}{*_Q]}O)D5*wX[PB{A8k1GtM{@onC 0Ggtz=CiZM.sVLCbi`JC3T)q7]tZ4c^l&XkC~?G.9J7 ]sO0h5_K]@GB[q[Vg"$(MjTy 9f(I#]F)jQ#qbgMkZVcqhLL9{3qjU2s7)#t&"lCn'_|m+L(J:vGagJ}nab<4WGSlc.t)rT)B4"& iaS?DVn##oI&70x~o >I9XbiV`J"mE,R6,qQz"n@d,dSqd{]kE=Jxf0@.,M8^sqAGa[)^-6^`sAI@Q|p4&.grv-P_8 | The success of that surgery resulted in it being called the Tommy John procedure. Finger spring: Place a large rubber band around the outside of your thumb and fingers. |1WwD >(E>[ X\j&7< 6whY+}v39v/1/wJU-nGQ v JCJX*?=XrtbgS#Nl|wk\6Ac /{h6*!(K6abZ}6M3RUl+pm@k=do3aCyF*wrVN7DixiDaLb^x)G. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . endstream endobj startxref Ulnar Collateral. 3 0 obj 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . At 4 to 6 weeks, removable thumb spica splint, and protected range-of-motion exercises. 02M_+ ! <> endstream endobj 111 0 obj <>/Metadata 5 0 R/Outlines 9 0 R/PageLayout/OneColumn/Pages 108 0 R/StructTreeRoot 16 0 R/Type/Catalog>> endobj 112 0 obj <>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 113 0 obj <>stream 3 0 obj 4 0 obj UCL REPAIR WITH INTERNAL BRACE . The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). During this time, active ROM is started as well as light isotonic . The rehabilitation protocol after a Ulnar Collateral Ligament Repair with Internal Brace surgery typically involves several phases. -Aggressive thumb active motion -The use of the internal brace makes for a very stable construct -AROM and PROM of thumb CMC and IP -No pinching/grabbing/lifting . Whilst both terms are often used interchangeably, the skier's thumb refers to the cause as being acute injury. endstream endobj 80 0 obj <>/Metadata 3 0 R/Outlines 7 0 R/PageLayout/OneColumn/Pages 77 0 R/StructTreeRoot 32 0 R/Type/Catalog>> endobj 81 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 82 0 obj <>stream %PDF-1.6 % 502 0 obj <> endobj 0 /&E-{BpR`buqyxw{y1E2vzy!`reY,$OcvCnbv_]pyu_//~0]8~t2Vj-/U sHSlC:">)n2oAGV?vtE6f?r83bSXk8[~@t(zQXA>)V|@)} 1&%_qU}VuA (nKS"(;VB| >`UVtXb#xEpF,Z%ZX["'XP Open your fingers to stretch the rubber band. Duration: 01:52. 104 0 obj <>/Filter/FlateDecode/ID[<33B8DE36AB984B418169C7A4E24F203B><19F8EE0B324BFE44BA1CA95B759557F5>]/Index[79 50]/Info 78 0 R/Length 117/Prev 108309/Root 80 0 R/Size 129/Type/XRef/W[1 3 1]>>stream % endobj endobj : Keep post-operative dressing clean, dry, and in place Keep hand elevated above the level of your heart May use hand for very light activities of daily living, such as eating, writing, typing, getting dressed, and brushing teeth Day 7-14: The newer repair procedure utilizes internalbrace, which comprises high-strength fibertape suture, to reenforce and protect the ligament while it is healing, and provide additional protection during throwing activities. <> Thumb strengthening: Pick up small objects, such as paper clips, pencils, and coins, using your thumb and each of your other fingers, one at a time. hV]OF+B^ The anti edema management will continue for several weeks. stream 0 The UCL is the main ligament, located on the inner aspect at the base of the thumb, which stabilizes the metacarpophalangeal (MCP) joint. Practice this exercise for about 5 minutes. @B 8XqhPTU&] ia$A{B;*QX% ]p7L`k?g.G{"z)UU(YY%y\*.ic-PtB *qjbeBA1~ K\'~8_c3(rKC-,9/$&nd#{:+H>>*/yGG`b9.`\z. The new procedure involves repairing the damaged ligament and reinforcing it with a collagen-coated fiber tape in contrast with the traditional UCL reconstruction that involves drilling tunnels in the bone and using a graft from a tendon in your arm or leg. m"cpQ|fP]3{&N5)M7!s( c A@%'I0*>% J$WNDoN`OM" ,aIENP57SNP zg FQVI@L+ F}t 8Bpt 3x` Q/}2cd}2"[& VL1zeGe:Jz). Acute UCL tears: Thumb spica splint/cast for up to 4 weeks, interphalangeal joint free. With the UCL repair, the surgeon will repair your native ligament and re-attach it to it's respective insertion site. This animation demonstrates repair of the ulnar collateral ligament of the thumb with the InternalBrace ligament augmentation procedure. 533 0 obj <>/Filter/FlateDecode/ID[<6B9C59BBC5B61A4384B9FC807F8AE13A><1E4DC5E074430D4EA5AA205F41080698>]/Index[502 56]/Info 501 0 R/Length 138/Prev 267459/Root 503 0 R/Size 558/Type/XRef/W[1 3 1]>>stream Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol Phase I: Immediate Post-Op (Weeks 0-2) . A bP .a+ZY^tL3ab`y7*n&++c UCL Repair with Internal Bracing versus UCL Reconstruction (Tommy John). 1 0 obj In a reconstruction the old, damaged ligament is removed, new portal holes are drilled and (in an autograft situation) a tendon from somewhere else in your body (palmaris longus, hamstring, etc) is docked as the new UCL. Diagnosis relies upon thumb MCP radial-ulnar stress exam and MRI studies. %PDF-1.6 % The goal is to DOI: 10.32474/OSMOAJ.2019.03.000151. Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. J Orthop Sports Phys Ther. hb```-B ce`a}`QJ se fpXF5#m-2q#M=T.Q,A%@ -& B@P xIq;8W2K0e7oS^s&3w&iO'i`4a` 0 &AaBCZKqi =ip;!%RqhH%1[6[8]fwFxw l4)W%5 Late effect of dislocation (nonspecific) (905.6) Repair lateral collateral ligament, elbow, with local tissue (24343) Repair lateral collateral ligament, elbow, with tendon graft, including graft harvest (24344) Repair medial collateral ligament, elbow, with local tissue (24345) Repair medial collateral . UCL Repair; Young overhead athletes who sustain an injury to their medial ulnar collateral ligament (UCL) complex, isolated to the proximal or distal end of the ligament and without chronic attritional damage, may benefit from a repair rather than a reconstruction procedure.1 Reference 1. This technique involves the reattachment of the ligaments to the bone using FiberWire. We describe the surgical technique of suture tape augmentation for thumb UCL repair. 4 0 obj SYMPTOMS: The thumb may be swollen, bruised and painful. ]rav?4V&%n\(blvdf)TUL"Q+zaH$!EWq,0S4o~!dAf36J5/JqR^)jUx}2}`4vT.5l;c6gA>< MVSxwkHW *LLGrj iBy+9,[Ld~!VpQ[/zT-k.x #M'Ismi>uw a8G PeT{qo| R7RP2rAK(; 0 ~Y$'h9N`haq8"% {s D)gZ2J =ky~ pP],DQgUh6*DM6`vlK ,R /"0q^p3S;LrV?-VS(6E?VAQJ@p EQQKiqLf[~vA]"`qW `!a`05I**ThsrAD8WH6SXb^h:R.?Q(oeR~R^N %PDF-1.7 ?3U,a_~`XRUWcQT2r?B73pgry.v3}w/2\Fz?6-SHK PXUU9:!$\@j)b;}r% /5 V5uz @ TY}]7KX75F1"3#TZLY|A/+{gc_?olhfGmHwiiB%"=CH$ai-`75 gdkZ_ . hWmo6+KI A ;WcIZ2LVaj%%u70y{l800`$p(AI6GBNP8S,CCrJcr\) Thumb UCL Repair with InternalBrace Ligament Augmentation 17,933 views Sep 6, 2018 89 Dislike Share Save Arthrex 64.2K subscribers Show more Comments are turned off. hbbd```b``3@$S=d`6;dq7.`.df`\0LE-`6H rlg4okAdaHMH endobj 15 The results of this study suggest that the technique of augmented UCL repair with internal brace replicates failure strength of the . Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. The UCL provides up to 50% of the frontal plane stabilization of the Abbreviations UCL, ulnar collateral ligament; US, elbow against a valgus load.5 During the clinical evaluation, the ultrasound patient's elbow is placed under a valgus load with the elbow in vary- ing amounts of exion. Z\m>~?)I|%X$;-5X&gV+Kms?XRC5%x_ui6q |KdeW7mQUY3s`NB) =gY|6:51c_t]]MixSTB Above protocol adapted from Dugas and Wilk: Wilk KE, Arrigo CA, Bagwell MS, Rothermich MA, Dugas JR. Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery. On July 25, 1974, Dr Frank Jobe performed the first ulnar collateral ligament (UCL) reconstruction on Los Angeles Dodgers pitcher Tommy John ( Fig. Rehabilitation Guidelines <> Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Rehab Protocol - Thumb UCL Repair (Internal Brace Only) Dr. Broering PRECAUTIONS Full time splint use except for ROM. endobj <> 128 0 obj <>stream %PDF-1.3 *XM qD#qHU vr@^zo+Uwe#-`0XLij1 stream hb```) $- `>bPO,VLW0ba6d.fb>4mfBs2hef`t| c5(Ly%CDer,ZbE+ImgILF cy9 See Tua at the University of Alabama, for examaple. Phase I (weeks 0 to 3): Splint for one week, then transition to a hinged elbow brace with gentle motion from 30 to 110 progressing to 10 to 125 at week 3. Citation: Kevin E Wilk, Christopher A A, Rebekah J A. Resource Type: Surgical Technique Animations. % 1). 49 0 obj <> endobj q Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation - Daniel B. Gibbs, Steven S. Shin, 2020 OSMOAJ.MS.ID.000151. reported 92% success some returning overhead athletes to the same a high level of competition is an average of 6.7 months with UCL repair and internal brace . 8q`Au8UnN6LW6eS4zdH 7gJRco6aDA+)vg+|Pn.Tz8W>dt+O)1L y!my6gvF-~g,8\'N&p[t|x0 u0vNzSKjZ*C(hZ}szu9`3_?=/ Elbow Ulnar Collateral Ligament (UCL) Repair Rehabilitation Protocol Kelly Holtkamp, M.D. x[[o:~xpPh.IvEMmi3C]lQ,z X3*{c{XKbMa;{;o>H&PIffS+e@.+>|7mw;L"cH"dMn8)Sy,2*npGWwE&k=|"tbE}%2*R0(jK(s#.$"X$VcY#>J>2pCMW[XHOq{ = wD0NC?IF5tV$ZtR& K"=,`y];]NxIo>r?R'n)locmMuf$[g6\1eu8^s=POm6|GHkOzDuDiIpqT+"'"%;ED/,H$g=Ie9fRH*/ 6Tc`;GJEwvQ*X}:LGKX`n)Bq)su9:qF~b. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 2019 Apr;49(4):253-261. doi: 10.2519/jospt.2019.8215. Thumb UCL Repair- Conservative This protocol is intended to provide the clinician with a guideline for the postoperative rehabilitation course of a patient who has undergone thumb UCL reconstruction/repair. Non-weight bearing to operative extremity. the thumb. Phase I - Maximum Protection: 0 to 7 Days: Immobilization in posterior splint at 60-90 of elbow flexion . endobj ULNAR COLLATERAL LIGAMENT REPAIR with INTERNAL BRACE Postop protocol for Daniel Myer, M.D. %%EOF k,/f&;}P7# Lg W*lwHOPC(LZc>XgI3j:][1/+YX-?p%"6_NaWFv%k]|{6e@Ij %PDF-1.7 x]kF_!BBf%I(BTb%]3NrqO%)(V}nu+;jvcyiwuY[_4*j{]e>gUQU~"_e? endobj At 6 to 12 weeks, begin adductor and interossei strengthening, avoiding valgus stress on thumb MCP. This design severely limits functional use of the thumb. <> 2 WEEKS (1st Visit) Fit with custom hand based thumb spica splint (Please allow thumb IPJ motion) OT INSTRUCTIONS - Ok to work on wrist, CMP, IPJ motion, & scar massage x[[o~70/5+/@`dk4],`hHp}9C9\YBKP.e?}|S-~K3KbEpSXy~ldpL"$.XHf>_~}d?Te5Zs$Rpdt x\ms6|:6B]3~H-ST]HJHcG@>`w,@~9}}&w]|!\=|'t{_?|qcy5ca|O8%Y,npm&7& sMA-#IG71ub~ZE\@>l3c2fW?$->+zz\{M;)kO1yTS^ ^uoS7I? Rehabilitation Following UCL Repair with Internal Brace. (1) See image 2. They demonstrated a significantly greater resistance to gapping with valgus stress with the UCL repair with internal brace (mean SD, 0.35 0.16 mm) compared to UCL reconstruction (0.53 0.23 mm). Restrictions: No heavy lifting greater than 0 lbs. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The brace may be removed for showering and gentle active motion exercises directed by the therapist. *`]hgTTS:MV{gXS&K|-3m 1. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Its many uses has helped numerous athletes return back from their injuries quicker than ever. cfzn(WH`&8:YUx~Ru1?-K)N(-cY2N[wH.A^Nu1T lTr[wyKt1+oE.Bj^&Q 2)A*a0'AY(|\k2E M * m| ""/+Gq 2 0 obj Phone: 574.247.9441 Fax: 574.247.9442 www.sbortho.com REHABILITATION PROTOCOL: THUMB UCL/RCL REPAIR SAM FULLER, M.D. 148 0 obj <>stream <> Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. 6=J). In a recent laboratory study conducted by the Arthrex Research Department using cadaver specimens, the thumb UCL with internal brace was four times stronger than the standard repair with suture alone. H00:GCp#r x 79 0 obj <> endobj xZS8~AO[H[ULj!W0"Esvo 0h2ULlYRZ?.-ax0Iz_]0lnY>__-\x2`\DL^dRrzIE:d2bdcz{Izw^,&={y@{w=:'=aa=T()VCA6kGQlS9?LX|^+#{zX/.zLNT^Z^jg]X6g8If55/_BYjWpE\,#w+"6A ["BIA+ryv_cNaICaNJ!E.|dXTp3g@9< HTxS %%EOF What causes GameKeeper's Thumb? Background: The purpose of this study is to describe our technique of thumb ulnar collateral ligament (UCL) repair with suture tape augmentation and to evaluate the short-term outcomes in our initial series of patients treated with this method of repair.Methods: Patients with minimum one-year follow up after isolated UCL repair with suture tape augmentation were contacted for clinical . -Hand based thumb spica brace (comfort cool) . hb``d``jd```y <> %PDF-1.6 % Finger and hand range of motion: maintain AROM and PROM Dressing changed at 7-10 days after surgery Week 2 !V!B;nkGL#_cz5asG) 0<>;Qm4P]3@41oJ5i~o;sJvQv9f r4A-C -Z]>T]Fo 6f*&aibfSwv{tNcj7Dcg_7ml0`afdMq{Ccbm*"CAp lI"5JK>nt=tuGi0E1O{c2{n BOIu}B)wQ78LyWe-|k#$B/y*jY8 t7X,RpATy+{,q(3#/Plb 'xA+^v(o[l!O U=2EE#/gtcXjQO17D[=tvq;2T(=X"#n:fZ=%S-` hbbd```b``"'Iwh"HVqD``\y "g= ] l+ =&KU20R4@ US << /Length 5 0 R /Filter /FlateDecode >> At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. <>/Metadata 102 0 R/ViewerPreferences 103 0 R>> 4 0 obj Elevate, ice and modalities to reduce pain and inflammation . TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. ULNAR COLLATERAL LIGAMENT OF THE ELBOW RECONSTRUCTION USING AUTOGENOUS GRAFT PROTOCOL 3 Progress shoulder isometrics to isotonics, emphasize rotator cuff strengthening (Avoid resisted external rotation until 6th week to minimize forces on repaired UCL) Week 6 Brace - hinged elbow brace set 0-130 degrees. %PDF-1.6 % 2 0 obj Please fax initial evaluation and progress notes to 8153817498. 2 0 obj Thumb UCL Repair- Early Mobilization This protocol is intended to provide the clinician with a . hbbd```b`` "gA$d^ Read court documents, court records online and search Trellis.law comprehensive legal database for any state court documents. Mrtl7"l\Q`?v`d: endobj endobj 4 0 obj '_'n}Zj #:qdAa C;wB.Cx/mu 3hf_u*m"ZeD!\4' (l{aef"];c4#P9G4e't\Y1AM)DmgT?G -rG" ojqQPy3e8AcR:N~ N :#1YGokb &h(TA(VG[H}FQ. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 8g14IRxEm`YH#V b6 be1Gv=*K:.;>'!y^vf%lX")z^-vr3[\)U8RnOG8+5[Y#l'^aAWgI>i];%*8jpht4%< pKV[t/ 8]oQ5JF*+zWQ61Hu^DDJT.0H>? %%EOF The rise of ulnar collateral ligament reconstruction and the fall of ulnar collateral ligament repair. stream stream 557 0 obj <>stream Postoperative protocol. 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . Exercises: Continue all exercises listed above Elbow ROM in brace (-30 to 100) Initiate isometric elbow extension Initiate wrist isometrics hbbd```b``Z";d,d"? Thumb Collateral Ligament Injuries, most commonly ulnar collateral (UCL), are athletic injuries that lead to a decrease in effective thumb pinch and grasp. A longitudinal incision was made over the thumb over the metacarpophalangeal (MP) joint, the skin flaps elevated, the extensor shroud released, tendon pulled back, the adductor attachment released and the ulnar collateral ligament identified. x[[oF~70/ 8m6EMc/El%{JaeQlQCwnz5fy3iboob9jV EXHIBIT(S) - D (Motion #1) EXHIBIT D - Verified Bill of Particulas and Responses to Various Demands Redacted per 22 NYCRR - EXHIBIT D - Verified Bill of Particulas and Responses to Various Demands Redacted February 09, 2023.
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