Please enable it to take advantage of the complete set of features! Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 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 thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. J Bone Joint Surg Am. Am J Sports Med. 15. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Part II: treatment and complications. MeSH your express consent. Bean CH, Tencer AF, Trumble TE. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Complications of Ulnar Collateral Ligament Repair | SpringerLink Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Accessibility eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Patient Demographics of Thumb RCL and UCL Injuries. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. There were 200 acute injuries and 93 chronic injuries. Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). A score of 0 was assigned if the item was either omitted or not performed. MCP fusion was performed . Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. UCLR case series that contained complications data were included. Educate the patient on anti edema management. 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. This website also contains material copyrighted by 3rd parties. Please confirm that you would like to log out of Medscape. Commonly Missed Orthopedic Problems | AAFP 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. Early and late postoperative complications were recorded. The site is secure. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 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. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. HHS Vulnerability Disclosure, Help Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. No study compared different graft types or fixation techniques. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Mean subject age was 33.9 years. Acute gamekeeper's thumb. 2009;61:623632. 25. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. *Glickel grading system. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. 8600 Rockville Pike Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. SYMPTOMS: The thumb may be swollen, bruised and painful. Bailie DS, Benson LS, Marymont JV. eCollection 2021. Early diagnosis and treatment. This site needs JavaScript to work properly. modify the keyword list to augment your search. 1,5,9,10 In acute cases of complete tears involving high-level . The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. There are some cases where the fusion is not successful and you will still have pain in . After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Ulnar Collateral Ligament (UCL) Repair | SpringerLink and twist using your thumb. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Moher D, Liberati A, Tetzlaff J, et al.. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Ulnar Collateral Ligament (UCL) Injuries of the Elbow 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. 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. Injury. Highlight selected keywords in the article text. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Conclusion: Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 14. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Objectives: MeSH PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. Ulnar Collateral Ligament Injuries of the Thumb - Panther Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Orthop Rev. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 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%). The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. The anti edema management will continue for several weeks. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 1961;43-A:541546. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Abrahamsson SO, Sollerman C, Lundborg G, et al.. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. UCL Repair of the Thumb - MSA Hand Center PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery 39. Sixty nine (86.3%) patients had grade 3 tears. Please try again soon. Proximal interphalangeal joint injuries of the hand. No study reported the outcomes of nonoperative management of chronic UCL injury. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). UCLR case series that contained complications data were included. 17. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Epub 2014 Dec 30. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. Federal government websites often end in .gov or .mil. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. History. An anatomic basis for treatment. 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. J Hand Surg Am. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. 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. J Hand Surg Am. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Am J Sports Med. 3. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 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. If your bone is broken, a pin will be used to put it in place. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Sports Health. [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. 5. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. 10. PMC 10. 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 . 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%. 23. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Catalano LW III, Cardon L, Patenaude N, et al.. Accessibility Disclaimer. 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. An official website of the United States government. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Proximal interphalangeal joint injuries of the hand. 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. Background: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. If you log out, you will be required to enter your username and password the next time you visit. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Eventually this abnormal movement will wear out the joint and it will become arthritic. 2. 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. Orthop J Sports Med. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Rupture and displacement of the. Sakellarides HT, DeWeese JW. 1976;58:106112. 1992;8:713732. Keywords: Bethesda, MD 20894, Web Policies Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. official website and that any information you provide is encrypted 1995;18:11611165. 1989;14:567573. J Hand Surg Glob Online. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Wong TC, Ip FK, Wu WC. Thirty-two thumbs were treated nonoperatively and 261 operatively. Thus, the true natural history is yet unknown. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. It runs from the outer humerus, around the radial head and attaches to the ulna. #Injury location reported only in 3 studies. 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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Range of motion returns much sooner, too. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Data range was reported as minimum to maximum absolute values. Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 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. Engelhardt JB, Christensen OM, Christiansen TG. 2000;16:345357. 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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction Bookshelf Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Am J Sports Med. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Bookshelf A broken thumb can also cause numbness or tingling. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 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. PMC Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. In some cases, certain risk factors make it more likely that a bone will fail to heal. 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. Nonunions - OrthoInfo - AAOS 1. 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. flexion-extension motion. Epub 2016 Jan 13. At this stage, patients should be advised to wear your splint part-time. 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. 2013Lippincott Williams & Wilkins. Nonsurgical Management of Ulnar Collateral Ligament Injuries 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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 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. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Nonoperative treatment often failed, necessitating surgery. FOIA Outcomes after injury to the thumb ulnar collateral ligament--a Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Mean subject age was 33.9 years. unstable when the thumb is used. Your thumb will be immobilized in a splint and should not be moved until follow up. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 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. Exercises: Gradually progress to competitive throwing and sports . 19. All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Unauthorized use of these marks is strictly prohibited. 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. 26. 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).
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