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Both purely ligamentous and bony avulsion injuries were included. 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. 1999;24:275282. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). History. Accessibility Data is temporarily unavailable. 10. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 1989;14:567573. Only prospective studies can determine this injury course. Mean subject age was 33.9 years. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Educate the patient on anti edema management. 2021 Apr 15;3(2):e527-e533. Thirty-two thumbs were treated nonoperatively and 261 operatively. What are the symptoms of GameKeeper's Thumb? Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. What Happens If We Sit for More Than 8 Hours Per Day? 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. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. 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%). Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. [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. Surgical management of chronic, 42. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 1992;8:713732. The doctor won't know if the repair is . 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 . Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Am J Orthop (Belle Mead NJ). eCollection 2021 Apr. Am J Orthop (Belle Mead NJ). Am J Sports Med. 38. Descriptive statistics were calculated. Eurasian J Med. This damage may lead to temporary or permanent numbness or weakness. The .gov means its official. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Moher D, Liberati A, Tetzlaff J, et al.. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. National Library of Medicine J Bone Joint Surg Am. Main results: 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. 2005;87:26322638. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Injury. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Conclusions: There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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). [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. 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%). All authors independently performed the search. 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. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 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. The effect of thumb metacarpophalangeal. Both repair and reconstruction (autograft and allograft) techniques were inclusive. All rights reserved. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Please confirm that you would like to log out of Medscape. Smith RJ. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Click the topic below to receive emails when new articles are available. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Continuous variable data were reported as mean SDs from the mean. Search performed on November 17, 2011. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 1995;18:11611165. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral 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 . Chir Main. 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. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 2022 Mar 1;30(1):e1-e8. Bethesda, MD 20894, Web Policies Docs Struggle to Keep Up With the Flood of New Medical Knowledge. 21. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . J Bone Joint Surg Am. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. HHS Vulnerability Disclosure, Help The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 33. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Purpose: 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. *Glickel grading system. Pichora DR, McMurtry RY, Bell MJ. Bookshelf Unable to load your collection due to an error, Unable to load your delegates due to an error. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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*. FOIA These tears often occur as a result of a radially directed force on an extended thumb. 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. [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. A broken thumb can also cause numbness or tingling. The mean patient age was 37.8 years (14.0-78.1). 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. Some error has occurred while processing your request. 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. 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. Orthopedics. 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. 34. 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. Symptoms are dependent on the cause and severity of injury to the UCL. 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. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 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. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Please enter a Recipient Address and/or check the Send me a copy checkbox. Louis DS, Huebner JJ Jr, Hankin FM. 32. A sprained thumb is a common injury among athletes. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Downey DJ, Moneim MS, Omer GE Jr. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. POST-OPERATIVE WEEKS 22-24. abduction-adduction motion. They may even tear completely. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Dr. Holt will talk to you about when it is safe to return to work. Am J Sports Med. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Study design: Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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. Background: 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. Muscles. The grip strength and the pinch strength were 94.3% and 92.27%,. Search for Similar Articles Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. There were no cases of intraoperative ulnar nerve injury reported. 10. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . to maintaining your privacy and will not share your personal information without Tension wire fixation of avulsion fractures in the hand. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. The site is secure. 24. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. It runs from the outer humerus, around the radial head and attaches to the ulna. 1,5,9,10 In acute cases of complete tears involving high-level . Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. J Hand Surg Am. *Glickel grading scale. Hand Clin. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. HHS Vulnerability Disclosure, Help 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. J Hand Surg Glob Online. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. Please try again soon. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. The LUCL is located on the lateral or outside part of the elbow. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Thumb dominance reported in 8 studies (168 thumbs). It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. A score of 2 was assigned if the item was completely and accurately performed and reported. You may also begin strengthening exercises if needed. 1987;214:113120. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 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. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Conflicts of interest The authors report no funding or conflicts of interest. Objectives: 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. 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. 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. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Am J Sports Med. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. doi: 10.1016/j.asmr.2020.12.004. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. The .gov means its official. and twist using your thumb. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Thumb collateral ligament injuries. Superficial infections tend to settle quickly with oral antibiotics and regular dressings.