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%. 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. Am J Sports Med. Epub 2013 Nov 12. 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. 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. 19. J Bone Joint Surg Am. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 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. Clin Orthop Relat Res. 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. National Library of Medicine Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Kozin SH, Bishop AT. This article provides a review of . Arthritis Rheum. 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. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Thirty-two thumbs were treated nonoperatively and 261 operatively. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. government site. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Conclusion: Am J Sports Med. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? eCollection 2021. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 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. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 11. Van Dommelen BA, Zvirbulis RA. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Meta-analysis of the pooled data was completed. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Pichora DR, McMurtry RY, Bell MJ. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. J Hand Surg Am. Epub 2014 Dec 30. Conclusions: Some error has occurred while processing your request. Part I of this two-part article focuses on common tendon and . Frykman G, Johansson O. Surgical repair of rupture of the, 46. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Acta Chir Scand. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 2013Lippincott Williams & Wilkins. 34. J Hand Surg Am. Stretching or even a rupture of the graft is also possible. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. The site is secure. official website and that any information you provide is encrypted Continuous variable data were reported as mean SDs from the mean. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Sports Med Arthrosc Rev. *Glickel grading system. Both purely ligamentous and bony avulsion injuries were included. A broken thumb can also cause numbness or tingling. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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%). 2003;8:8185. HHS Vulnerability Disclosure, Help If your bone is broken, a pin will be used to put it in place. 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. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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. 2000;16:345357. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. In some cases, certain risk factors make it more likely that a bone will fail to heal. 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. 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. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. Jupiter JB, Sheppard JE. Am J Sports Med. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Before 1989;71:383387. 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*. 12. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Orthop J Sports Med. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. may email you for journal alerts and information, but is committed This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Kuz JE, Husband JB, Tokar N, et al.. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. There were no cases of intraoperative ulnar nerve injury reported. Federal government websites often end in .gov or .mil. Am J Sports Med. The .gov means its official. The anti edema management will continue for several weeks. If the tear is diagnosed later a ligament reconstruction might be a better option. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Please try after some time. [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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 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 . 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. 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. Rupture and displacement of the. The https:// ensures that you are connecting to the Catalano LW III, Cardon L, Patenaude N, et al.. The injury happens when you fall . 15. Mean study follow-up was 42.8 months. Clinical Journal of Sport Medicine23(4):247-254, July 2013. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . Please confirm that you would like to log out of Medscape. 24. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Proximal interphalangeal joint injuries of the hand. 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.. The effect of thumb metacarpophalangeal. A common complication following fracture of the distal radius is when the radius shortens. Epub 2021 Jan 18. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. eCollection 2021 Mar. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 20. Orthop Rev. 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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 8. Complications after this procedure may include nerve or blood vessel damage. 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%). A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Hand Clin. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). doi: 10.1016/j.asmr.2020.12.004. 8600 Rockville Pike I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. 5. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). 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 It runs from the outer humerus, around the radial head and attaches to the ulna. [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 https:// ensures that you are connecting to the Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 44. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Data is temporarily unavailable. Eventually this abnormal movement will wear out the joint and it will become arthritic. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 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. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Federal government websites often end in .gov or .mil. 2009;34:304308. the splint for protection or at night until twelve weeks after the operation. Chir Main. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 1994;25:2123. Sixty nine (86.3%) patients had grade 3 tears. Non-Fusion. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Range of motion returns much sooner, too. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Please enter a Recipient Address and/or check the Send me a copy checkbox. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. There is currently no consensus on treatment of acute or chronic UCL injuries. flexion-extension motion. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. You may also begin strengthening exercises if needed. Possible complications include: - Bookshelf After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 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. 10. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. MeSH A systematic review of ulnar collateral ligament reconstruction techniques. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 1995;23:222226. An anatomic basis for treatment. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Bennet Fracture. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. The injury involves the ulnar collateral ligament (UCL) of the thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. No study reported the outcomes of nonoperative management of chronic UCL injury. Educate the patient on anti edema management. An official website of the United States government. The grip strength and the pinch strength were 94.3% and 92.27%,. All rights reserved. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Categorical variable data were reported as frequency with percentages. Careers. Weakened grip or reduced thumb range of motion may occur. 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. You may search for similar articles that contain these same keywords or you may 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. Complications after surgical treatment of UCL injury are rare. 1992;8:713732. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. What are the symptoms of GameKeeper's Thumb? It is the result of repetitive stretching and abduction stresses of the ulnar collateral . The range of motion of the MP joint of the thumb following operative repair of the. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 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. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.".
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