Descriptive statistics were calculated. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Proximal interphalangeal joint injuries of the hand. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Your message has been successfully sent to your colleague. 1992;8:713732. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 5. Metacarpophalangeal joint injuries of the thumb. What are the symptoms of GameKeeper's Thumb? The .gov means its official. Please try after some time. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 10. 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. Fusetti C, Papaloizos M, Meyer H, et al.. What Happens If We Sit for More Than 8 Hours Per Day? UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Dr. Holt will talk to you about when it is safe to return to work. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 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. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Exercises: Gradually progress to competitive throwing and sports . Am J Orthop (Belle Mead NJ). The .gov means its official. Doi: 10.1177/2325967118769328. 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. Diagnosis of displaced, 43. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. 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. Patient Demographics of Thumb RCL and UCL Injuries. 32. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 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. Bookshelf Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. unstable when the thumb is used. 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. 23. Complications after surgery were rare. PLoS Med. An anatomic basis for treatment. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. 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 . Am J Sports Med. 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. 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. Orthop Rev. The torn thumb ligament is repaired or reconstructed during surgery. Your ligament may need to be reattached to the bone using a bone anchor. Throwing status reported in 4 studies. Non-Fusion. Kuz JE, Husband JB, Tokar N, et al.. You've successfully added to your alerts. Engelhardt JB, Christensen OM, Christiansen TG. Bethesda, MD 20894, Web Policies He too had the internal brace augmentation. Moher D, Liberati A, Tetzlaff J, et al.. There were 61 studies eliminated as secondary for being in a language other than English. Mitsionis GI, Varitimidis SE, Sotereanos GG. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Chir Main. Wong TC, Ip FK, Wu WC. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Unable to load your collection due to an error, Unable to load your delegates due to an error. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Instability of the metacarpophalangeal joint of the thumb. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . All rights reserved. J Hand Surg Am. 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. Sakellarides HT, DeWeese JW. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. MeSH In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 2. Eventually this abnormal movement will wear out the joint and it will become arthritic. There is currently no consensus on treatment of acute or chronic UCL injuries. Accessibility Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Conclusions: Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. The limitations of this systematic review are reliant on the studies analyzed. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 19. Please enable it to take advantage of the complete set of features! Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 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. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 2000;16:345357. 18. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Studies that duplicated patient populations from the same authors were excluded. The injury happens when you fall . Bostock S, Morris MA. Abrahamsson SO, Sollerman C, Lundborg G, et al.. The grip strength and the pinch strength were 94.3% and 92.27%,. 27. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 34. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Please try again soon. 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. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Would you like email updates of new search results? A sprained thumb is a common injury among athletes. 1962;124:396411. 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Study design: [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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Injury. Search for Similar Articles 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 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. 1961;43-A:541546. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. [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]. Thirty-two thumbs were treated nonoperatively and 261 operatively. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 1989;17:751753. Pichora DR, McMurtry RY, Bell MJ. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Mean study follow-up was 42.8 months. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. When assessed, most patients returned to their preinjury employment. SAGE Open Med. 1989;14:567573. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 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. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Sports Health. These tears often occur as a result of a radially directed force on an extended thumb. 16. You will receive email when new content is published. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. NR, not reported. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. A score of 0 was assigned if the item was either omitted or not performed. 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. J Hand Surg Br. MeSH Main results: 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. 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 . Careers. Unable to load your collection due to an error, Unable to load your delegates due to an error. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 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 Keyword Highlighting The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Epub 2013 Nov 12. Surgical techniques and a review of 70 patients. may email you for journal alerts and information, but is committed When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 13. Nonoperative treatment often failed, necessitating surgery. The limitations of this systematic review are reliant on the studies analyzed. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 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. 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. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. This damage may lead to temporary or permanent numbness or weakness. 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). CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. There were no cases of intraoperative ulnar nerve injury reported. Range of motion returns much sooner, too. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. The LUCL is located on the lateral or outside part of the elbow. The overall complication rate was 13.8% (11/80). 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. Kozin SH, Bishop AT. Am J Sports Med. Injuries to the PIP joint remain swollen for long periods of time. 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. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Am J Orthop (Belle Mead NJ). Nonoperative treatment often failed, necessitating surgery. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Meta-analysis of the pooled data was completed. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. [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. 2009;34:304308. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 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. Thumb dominance reported in 8 studies (168 thumbs). Surgical management of chronic, 42. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Methods: 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. Sports Med Arthrosc Rev. 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 . A score of 2 was assigned if the item was completely and accurately performed and reported. 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. The mean patient age was 37.8 years (14.0-78.1). It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Federal government websites often end in .gov or .mil. Arthrosc Sports Med Rehabil. 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. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Orthop Clin North Am. PMC Thirty-two thumbs were treated nonoperatively and 261 operatively. Purpose: Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Only prospective studies can determine this injury course. Rupture and displacement of the. the splint for protection or at night until twelve weeks after the operation. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. 12. 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. For example, it can be removed when performing . sharing sensitive information, make sure youre on a federal [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. 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. Melone CP Jr, Beldner S, Basuk RS. Louis DS, Huebner JJ Jr, Hankin FM. 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. 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). Keywords: Orthopedics. Epub 2014 Dec 30. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Catalano LW III, Cardon L, Patenaude N, et al.. FOIA [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. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. In some cases, certain risk factors make it more likely that a bone will fail to heal. 2005;87:26322638. Mean study follow-up was 42.8 months. Eurasian J Med. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Causes. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). 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. FOIA Part I: anatomy and diagnosis. Treatment of chronic injuries of the. You may also begin strengthening exercises if needed. [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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint.
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complications after ucl repair of thumb