Surgical management of chronic, 42. SYMPTOMS: The thumb may be swollen, bruised and painful. Background: 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. [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. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Descriptive statistics were calculated. 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. Jupiter JB, Sheppard JE. Please confirm that you would like to log out of Medscape. eCollection 2021. 14. 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%. Commonly Missed Orthopedic Problems | AAFP Thumb from the common mechanism of falling on the thumb while holding a ski pole. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. [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. Nonoperative treatment often failed, necessitating surgery. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 2006;31:6875. 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. There were no cases of intraoperative ulnar nerve injury reported. 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. Table 1. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. Wong TC, Ip FK, Wu WC. 36. 1976;58:106112. and transmitted securely. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. Complications after surgical treatment of UCL injury are rare. 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). 20. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia 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. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Part I of this two-part article focuses on common tendon and . Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Data sources: UCL Repair of the Thumb - MSA Hand Center Smith RJ. Meta-analysis of the pooled data was completed. 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. Thumb sidedness reported in 3 studies (51 thumbs). 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 17. Accessibility 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. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Am J Sports Med. Eurasian J Med. If your bone is broken, a pin will be used to put it in place. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. A score of 2 was assigned if the item was completely and accurately performed and reported. The grip strength and the pinch strength were 94.3% and 92.27%,. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. No study reported the outcomes of nonoperative management of chronic UCL injury. 2018;6(4):1-7. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. The overall complication rate was 13.8% (11/80). Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) 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 Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape 3. Melone CP Jr, Beldner S, Basuk RS. [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]. flexion-extension motion. Epub 2014 Dec 30. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Subject demographics are reported in Table 2. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. J Hand Surg Am. Long-term results of ligament reconstruction. 7. Kuz JE, Husband JB, Tokar N, et al.. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of 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. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. All but 2 were level IV evidence. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. History. PMC Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 2005;24:217221. Orthopedics. Proximal interphalangeal joint injuries of the hand. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). **Stener lesion status reported in 6 studies (145 thumbs). 1977;59:1421. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. The injury involves the ulnar collateral ligament (UCL) of the thumb. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Sixty nine (86.3%) patients had grade 3 tears. Pain reduction was significantly improved in all subjects (P < 0.05). 1989;71:383387. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. J Hand Surg Br. Orthop Rev. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 8600 Rockville Pike sharing sensitive information, make sure youre on a federal This site needs JavaScript to work properly. 1993;21:800804. Data range was reported as minimum to maximum absolute values. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 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. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Unable to load your collection due to an error, Unable to load your delegates due to an error. There were 61 studies eliminated as secondary for being in a language other than English. 21. The range of motion of the MP joint of the thumb following operative repair of the. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. The injury happens when you fall . 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. 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 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. Metacarpophalangeal joint injuries of the thumb. UCLR case series that contained complications data were included. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Quantitative outcome of surgical repair. and transmitted securely. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2021 Apr 15;3(2):e527-e533. The torn thumb ligament is repaired or reconstructed during surgery. 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. Thirty-two thumbs were treated nonoperatively and 261 operatively. Arnold DM, Cooney WP, Wood MB. unstable when the thumb is used. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 22. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Epub 2020 Jun 29. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. Proximal interphalangeal joint injuries of the hand. Bailie DS, Benson LS, Marymont JV. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 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. Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Systematic review and meta-analysis. The Orthopedic Journal of Sports Medicine. *Glickel grading system. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). If you log out, you will be required to enter your username and password the next time you visit. PMC Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. All but 2 were level IV evidence. 2. Doi: 10.1177/2325967118769328. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Federal government websites often end in .gov or .mil. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Bookshelf Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). MCP collateral ligament sprain is most commonly an acute injury related to trauma. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 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. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) Upper extremity injuries in snow skiers. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 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. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. J Bone Joint Surg Am. Mechanism of injury to the RCL of the MCP joint of the thumb is force . [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. Dr. Holt will talk to you about when it is safe to return to work. Am J Sports Med. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Please try after some time. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". A score of 0 was assigned if the item was either omitted or not performed. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Complications you may experience after Hand Surgery - Rebecca Ayers The .gov means its official. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics Studies that duplicated patient populations from the same authors were excluded. Data is temporarily unavailable. Jackson M, McQueen MM. Skier's thumb - Physiopedia 1998;23:503506. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Clin J Sport Med. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. J Bone Joint Surg Am. 1996;25:527530. Unauthorized use of these marks is strictly prohibited. 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Wolters Kluwer Health 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 . 26. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. The LUCL is located on the lateral or outside part of the elbow. Sports Med Arthrosc Rev. Thumb collateral ligament injuries. Your surgeon is the person best able to help you avoid any serious recovery problems. In some cases, certain risk factors make it more likely that a bone will fail to heal. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 12. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Mean study follow-up was 42.8 months. Clipboard, Search History, and several other advanced features are temporarily unavailable. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. For more information, please refer to our Privacy Policy. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 2009;34:304308. Ulnar collateral ligament repair surgery Archives | OrthoVirginia 8. For example, it can be removed when performing . What Happens If We Sit for More Than 8 Hours Per Day? 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. 18. Acta Chir Scand. Your message has been successfully sent to your colleague. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . Thumb dominance reported in 8 studies (168 thumbs). 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. Am J Orthop (Belle Mead NJ). PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Thus, the true natural history is yet unknown. 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. Search for Similar Articles Epub 2015 Sep 22. 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. Mean subject age was 33.9 years. Diagnosis of displaced, 43. Complications of Ulnar Collateral Ligament Repair | SpringerLink Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). J Hand Surg Glob Online. 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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Outcomes after injury to the thumb ulnar collateral ligament--a 38. 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. Eventually this abnormal movement will wear out the joint and it will become arthritic. A systematic review of ulnar collateral ligament reconstruction techniques.

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