important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. The range of motion of the MP joint of the thumb following operative repair of the. 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. Please enable it to take advantage of the complete set of features! Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. sharing sensitive information, make sure youre on a federal Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. The overall complication rate was 13.8% (11/80). Acute gamekeeper's thumb. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. At this stage, patients should be advised to wear your splint part-time. 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. 3. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 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. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. 1992;8:713732. 12. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Downey DJ, Moneim MS, Omer GE Jr. A systematic review of ulnar collateral ligament reconstruction techniques. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. UCLR case series that contained complications data were included. J Bone Joint Surg Am. Educate the patient on anti edema management. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Am J Orthop (Belle Mead NJ). Am J Sports Med. For more information, please refer to our Privacy Policy. 22. National Library of Medicine sharing sensitive information, make sure youre on a federal When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. The limitations of this systematic review are reliant on the studies analyzed. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist 13. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. UCL Repair of the Thumb - MSA Hand Center The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. All but 2 were level IV evidence. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP 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. Complications Following Distal Radius Fractures - Mike Reinold Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Moher D, Liberati A, Tetzlaff J, et al.. Smith RJ. Both purely ligamentous and bony avulsion injuries were included. J Hand Surg Glob Online. 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*. The effect of thumb metacarpophalangeal. 4. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Hand Surg. [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. 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. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. 1. HHS Vulnerability Disclosure, Help Mean study follow-up was 42.8 months. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Benson LS, Bailie DS. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Background: Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Kaplan EB. Riederer S, Nagy L, Buchler U. 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. 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. Continuous variable data were reported as mean SDs from the mean. Would you like email updates of new search results? 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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. This article provides a review of . 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. 15. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. eCollection 2021 Apr. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 18. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. The authors report no funding or conflicts of interest. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). Anesthesia for Hand Surgery | The Hand & Wrist Center Bookshelf 1994;23:797804. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. All techniques improved clinical outcomes, including pain, motion, strength, and stability. POST-OPERATIVE WEEKS 22-24. No study compared different graft types or fixation techniques. 44. 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. 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 . Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Posner MA, Retaillaud JL. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Hand Surgery Recovery Time: Pain, Exercise & Complications Only prospective studies can determine this injury course. Unable to load your collection due to an error, Unable to load your delegates due to an error. Before Ulnar collateral ligament repair surgery Archives | OrthoVirginia 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Complications after this procedure may include nerve or blood vessel damage. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Nonsurgical Management of Ulnar Collateral Ligament Injuries Thus, the true natural history is yet unknown. I was able to work while wearing the splint. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. J Hand Surg Br. 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. This site needs JavaScript to work properly. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This leads to what is know as a positive ulnar variance. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. An official website of the United States government. Orthop Rev. 23. 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. Complications you may experience after Hand Surgery - Rebecca Ayers 7. Please enable scripts and reload this page. Wolters Kluwer Health, Inc. and/or its subsidiaries. and twist using your thumb. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. All rights reserved. J Bone Joint Surg Am. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery and transmitted securely. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. These tears often occur as a result of a radially directed force on an extended thumb. Pain reduction was significantly improved in all subjects (P < 0.05). official website and that any information you provide is encrypted 32. Epub 2013 Nov 12. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 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 . If the force is too strong, the ligaments can tear. Abstract. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Bone Joint Surg Am. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. They may even tear completely. [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. If the tear is diagnosed early a repair will be possible. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. A p-value of 0.05 was considered statistically significant. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. [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. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 1999;24:275282. Results: Your surgeon will discuss these options with you. 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. FOIA Chir Main. Patient Demographics of Thumb RCL and UCL Injuries. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. 1996;25:474477. 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. No study reported the outcomes of nonoperative management of chronic UCL injury. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery 2006;31:6875. Long-term results of ligament reconstruction. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.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.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. The Effect of Ulnar Collateral Ligament Repair With Internal Brace When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 1989;17:751753. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 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). After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Please enter a Recipient Address and/or check the Send me a copy checkbox. Careers. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Rupture and displacement of the. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). Objectives: 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. What Happens If We Sit for More Than 8 Hours Per Day? Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2005;87:26322638. 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. Your surgeon is the person best able to help you avoid any serious recovery problems. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. 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. Before Only prospective studies can determine this injury course. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb.

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