Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. There were 61 studies eliminated as secondary for being in a language other than English. Early and late postoperative complications were recorded. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. I was able to work while wearing the splint. **Stener lesion status reported in 6 studies (145 thumbs). 18. Complications after this procedure may include nerve or blood vessel damage. 1996;25:527530. Smith RJ. 2. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair All techniques improved clinical outcomes, including pain, motion, strength, and stability. Would you like email updates of new search results? Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Complications after surgical treatment of UCL injury are rare. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Studies that duplicated patient populations from the same authors were excluded. Please try after some time. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Nonoperative treatment often failed, necessitating surgery. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Moher D, Liberati A, Tetzlaff J, et al.. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Orthop Rev. your express consent. eCollection 2021 Mar. 10. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 If the force is too strong, the ligaments can tear. abduction-adduction motion. Am J Sports Med. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 1994;23:797804. Acute gamekeeper's thumb. Purpose: Complications you may experience after Hand Surgery - Rebecca Ayers J Hand Surg Am. Thirty-two thumbs were treated nonoperatively and 261 operatively. Infection is a rare complication of hand surgery. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. flexion-extension motion. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Please enable it to take advantage of the complete set of features! UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Purpose. FOIA Highlight selected keywords in the article text. You may be trying to access this site from a secured browser on the server. Bookshelf A systematic review of ulnar collateral ligament reconstruction techniques. Mean study follow-up was 42.8 months. SYMPTOMS: The thumb may be swollen, bruised and painful. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. [15,39] It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Am J Sports Med. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. RCL Reconstruction Thumb MPJ - The Hand Treatment Center 1962;124:396411. All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). [38] Chuter et al[40] contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. 33. [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. 23. Epub 2014 Dec 30. J Hand Surg Am. Skier's thumb - Physiopedia *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Before 2009;6:e1000097. 1993;21:800804. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Orthop J Sports Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Thumb collateral ligament injuries. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb 8600 Rockville Pike Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Sakellarides HT, DeWeese JW. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. 22. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. official website and that any information you provide is encrypted Systematic review and meta-analysis. Rupture and displacement of the. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. The .gov means its official. 35. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. [23,3638] Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. Base of Thumb Fractures - Hand - Orthobullets The https:// ensures that you are connecting to the 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 . Eurasian J Med. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. If you log out, you will be required to enter your username and password the next time you visit. 1995;18:11611165. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. UCL injuries: Defining risk and improving treatment - Mayo Clinic 1992;8:713732. Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. MCP (MetaCarpophalangeal) Collateral Ligament Sprain 44. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Click the topic below to receive emails when new articles are available. 1989;17:751753. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. What are the symptoms of GameKeeper's Thumb? Jupiter JB, Sheppard JE. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. 1,5,9,10 In acute cases of complete tears involving high-level . Your ligament may need to be reattached to the bone using a bone anchor. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Treatment of chronic injuries of the. Kozin SH, Bishop AT. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. A broken thumb can also cause numbness or tingling. Complications Following Distal Radius Fractures - Mike Reinold When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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 inadequately treated. Bailie DS, Benson LS, Marymont JV. These tears often occur as a result of a radially directed force on an extended thumb. Bostock S, Morris MA. 13. All but 2 were level IV evidence. Am J Sports Med. There were 200 acute injuries and 93 chronic injuries. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Ulnar Collateral Ligament Repair and Reconstruction The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). Would you like email updates of new search results? 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. There are some cases where the fusion is not successful and you will still have pain in . and transmitted securely. The .gov means its official. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Accessibility 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Search performed on November 17, 2011. The doctor won't know if the repair is . Thus, the true natural history is yet unknown. unstable when the thumb is used. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb History. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. This site needs JavaScript to work properly. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Rupture of the ulnar collateral ligament of the thumb - a review Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 2022 Mar 1;30(1):e1-e8. Hand Clin. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Injuries to the PIP joint remain swollen for long periods of time. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. FOIA Abstract. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. If the latter was executed only partially, a score of 1 was assigned. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. A common complication following fracture of the distal radius is when the radius shortens. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. The limitations of this systematic review are reliant on the studies analyzed. Thumb Collateral Ligament Injury - Hand - Orthobullets There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair You may search for similar articles that contain these same keywords or you may Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. The mean patient age was 37.8 years (14.0-78.1). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Results: Am J Sports Med. 17. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Various levels of pain, bruising, or edema may present at the site of damage. Sports Med Arthrosc Rev. If the tear is diagnosed early a repair will be possible. #Injury location reported only in 3 studies. Study design: Hand Clin. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Outcomes After Injury to the Thumb Ulnar Collateral Ligament This site needs JavaScript to work properly. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. MeSH Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. 4. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). The Orthopedic Journal of Sports Medicine. Categorical variable data were reported as frequency with percentages. Instability of the metacarpophalangeal joint of the thumb. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Epub 2013 Nov 12. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. Continue to stretch before and after throwing . 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.30 The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles.31 The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Causes. This website also contains material copyrighted by 3rd parties. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery J Bone Joint Surg Am. doi: 10.1097/JSA.0000000000000322. No study directly compared nonoperative to operative treatment. Figure 46-2 Approach to the ulnar collateral ligament. This ligament prevents the thumb from pointing too far away from the hand. The overall complication rate was 13.8% (11/80). Thumb from the common mechanism of falling on the thumb while holding a ski pole. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). Federal government websites often end in .gov or .mil. Only prospective studies can determine this injury course. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. [17,34] Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. Complications after surgical treatment of UCL injury are rare. 25. Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). eCollection 2021. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 2021 Apr 15;3(2):e527-e533. Clin Orthop Relat Res. 1987;214:113120. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 1. Doi: 10.1177/2325967118769328. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES.
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