Reconstruction for painful thumb carpometacarpal joint. A, Incision for exposure. B, Schema of ligament support. The volar ligament is reflection of transverse carpal ligament after insertion into crest of trapezium. Note flexor radialis passing directly beneath this ligament. C, Gouge track created in sagittal diameter of metacarpal, emerging at its volar beak. Small branch of radial nerve retracted volarly. D, A 6-cm to 8-cm strip, representing half width of flexor radialis tendon split away and remaining in continuity distally. Split continues 5 mm distal to crest of trapezium. E, Scissor point indicates path of flexor radialis strip rerouted to enter channel at metacarpal beak. Emerging dorsally, flexor carpi radialis is passed deep to extensor pollicis brevis and under insertion of abductor pollicis longus, also reinforcing dorsal capsule. F, Schema of volar and radial ligament reconstruction. Course of tendon strip creates reinforcement in volar, dorsal, and radial aspect of joint.