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Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Methods: 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. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. 8. 16. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Meta-analysis of the pooled data was completed. Epub 2015 Sep 22. You may be trying to access this site from a secured browser on the server. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. 1998;23:503506. 32. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). [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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. MeSH 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. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. 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%). Treatment for thumb collateral ligament injury - KW orthopaedics A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Bennet Fracture. Patient Demographics of Thumb RCL and UCL Injuries. better/same/worse than preoperative status). There are some cases where the fusion is not successful and you will still have pain in . I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. In these patients, after failure of nonoperative treatment at anywhere from 1 month 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. 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. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Instability of the metacarpophalangeal joint of the thumb. Results: Surgical Repair of Ulnar Collateral Ligament of ThumbDr. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Epub 2013 Nov 12. Metacarpophalangeal joint injuries of the thumb. Complications after surgery were rare. 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. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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 . Nonoperative treatment often failed, necessitating surgery. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. Acute gamekeeper's thumb. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 2022 Mar 1;30(1):e1-e8. UCLR case series that contained complications data were included. NR, not reported. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. sharing sensitive information, make sure youre on a federal Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Objectives: Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. 1987;214:113120. Rupture and displacement of the. Engelhardt JB, Christensen OM, Christiansen TG. 2009;34:304308. The site is secure. Your thumb will be immobilized in a splint and should not be moved until follow up. The effect of thumb metacarpophalangeal. A score of 0 was assigned if the item was either omitted or not performed. HHS Vulnerability Disclosure, Help 1999;24:7075. Anesthesia for Hand Surgery | The Hand & Wrist Center government site. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%.16 Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. 1989;14:567573. Diagnosis of displaced, 43. 2006;31:6875. Benson LS, Bailie DS. Unable to load your collection due to an error, Unable to load your delegates due to an error. 1995;23:222226. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Disclaimer. Eurasian J Med. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic It runs from the outer humerus, around the radial head and attaches to the ulna. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Ulnar Collateral Ligament (UCL) Repair | SpringerLink The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 38. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Skier's thumb - Physiopedia 8600 Rockville Pike Stener B. Skeletal injuries associated with rupture of the. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. abduction-adduction motion. Van Dommelen BA, Zvirbulis RA. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Studies that duplicated patient populations from the same authors were excluded. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Epub 2019 Mar 21. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. No study directly compared the different types of graft for UCL reconstruction. Treatment of chronic injuries of the. Outcomes After Injury to the Thumb Ulnar Collateral Ligament Thumb dominance reported in 8 studies (168 thumbs). Nonunions - OrthoInfo - AAOS 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. Dr. Holt will talk to you about when it is safe to return to work. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) J Bone Joint Surg Am. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. *Glickel grading scale. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Management of thumb metacarpophalangeal ulnar collateral ligament injuries. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. [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. Both purely ligamentous and bony avulsion injuries were included. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. When assessed, most patients returned to their preinjury employment. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. A score of 2 was assigned if the item was completely and accurately performed and reported. This damage may lead to temporary or permanent numbness or weakness. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Chir Main. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Melone CP Jr, Beldner S, Basuk RS. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). For example, it can be removed when performing . A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 7. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). This site needs JavaScript to work properly. [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. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. [19] Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis. Sakellarides HT, DeWeese JW. Sixty nine (86.3%) patients had grade 3 tears. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. 17. Would you like email updates of new search results? Frykman G, Johansson O. Surgical repair of rupture of the, 46. 33. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Keywords: Complications of Ulnar Collateral Ligament Repair | SpringerLink The diagnosis is best established clinically, though MRI is the imaging modality of choice. What Happens If We Sit for More Than 8 Hours Per Day? Clipboard, Search History, and several other advanced features are temporarily unavailable. Complications after surgical treatment of UCL injury are rare. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. 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. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. the thumb. There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used.19 Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. Thumb collateral ligament injuries. In these cases, a new graft may be used to perform a second reconstruction. 1977;59:1421. National Library of Medicine Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion 3. Hand Surg. Background: 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. There were 200 acute injuries and 93 chronic injuries. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Tension wire fixation of avulsion fractures in the hand. 2009;61:623632. 8600 Rockville Pike Fourteen articles were included and analyzed (293 thumbs). Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. your express consent. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.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. Moher D, Liberati A, Tetzlaff J, et al.. Ulnar Collateral Ligament Injuries of the Thumb - Panther The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Injury. There is currently no consensus on treatment of acute or chronic UCL injuries. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube Ulnar collateral ligament injury of the thumb - Wikipedia J Bone Joint Surg Am. Am J Sports Med. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Please enter a Recipient Address and/or check the Send me a copy checkbox. If you log out, you will be required to enter your username and password the next time you visit. Descriptive statistics were calculated. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Part I of this two-part article focuses on common tendon and . Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. MeSH Commonly Missed Orthopedic Problems | AAFP Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent J Hand Surg Br. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg.