Complications, failures, and reoperations are rare after surgical treatment of UCL injury. PMC Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. J Hand Surg Br. Stretching or even a rupture of the graft is also possible. You've successfully added to your alerts. Epub 2019 Mar 21. There were no cases of intraoperative ulnar nerve injury reported. Pain reduction was significantly improved in all subjects (P < 0.05). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Thirty-two thumbs were treated nonoperatively and 261 operatively. Unable to load your collection due to an error, Unable to load your delegates due to an error. Nonoperative treatment often failed, necessitating surgery. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . For example, it can be removed when performing . Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Smith RJ. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery and transmitted securely. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 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. 1996;25:527530. There is currently no consensus on treatment of acute or chronic UCL injuries. 2022 Mar 1;30(1):e1-e8. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. If it is appropriate, then surgical consent probably happened before the surgery. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Gamekeeper's thumb. 21. Unable to load your collection due to an error, Unable to load your delegates due to an error. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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. Injury. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Epub 2015 Sep 22. This site needs JavaScript to work properly. 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 27. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Epub 2020 Jun 29. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. PMC 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Rupture of the. Meta-analysis of the pooled data was completed. 20. Treatment of chronic injuries of the. Mean study follow-up was 42.8 months. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. No study directly compared nonoperative to operative treatment. J Hand Surg Am. 23. [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. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. [38] Chuter et al[40] 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. sharing sensitive information, make sure youre on a federal Causes. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. The grip strength and the pinch strength were 94.3% and 92.27%,. 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. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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%). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 1996;25:474477. FOIA 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. The .gov means its official. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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. Am J Orthop (Belle Mead NJ). 25. Purpose: 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. doi: 10.1097/JSA.0000000000000322. 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. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Exercises: Gradually progress to competitive throwing and sports . 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%). Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. J Bone Joint Surg Am. Pichora DR, McMurtry RY, Bell MJ. If you log out, you will be required to enter your username and password the next time you visit. You are being redirected to Medscape Education. Thus, the true natural history is yet unknown. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 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%). However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Epub 2014 Oct 22. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Metacarpophalangeal joint injuries of the thumb. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Purpose. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Careers. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Range of motion returns much sooner, too. The authors report no funding or conflicts of interest. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. 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). doi: 10.1016/j.asmr.2020.12.004. If your bone is broken, a pin will be used to put it in place. 8. POST-OPERATIVE WEEKS 22-24. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Continue to stretch before and after throwing . There is currently no consensus on treatment of acute or chronic UCL injuries. 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. 1976;58:106112. Chir Main. 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. 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. National Library of Medicine 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. 2005;87:26322638. 31. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 2. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Table 1. Mitsionis GI, Varitimidis SE, Sotereanos GG. Please try after some time. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 26. 2013;23(4):247-254. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Orthop J Sports Med. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. The doctor won't know if the repair is . modify the keyword list to augment your search. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 1. Am J Orthop (Belle Mead NJ). Weakened grip or reduced thumb range of motion may occur. Doi: 10.1177/2325967118769328. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Orthop Rev. The mean patient age was 37.8 years (14.0-78.1). Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Jackson M, McQueen MM. Click the topic below to receive emails when new articles are available. Systematic review and meta-analysis. NR, not reported. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. If the tear is diagnosed later a ligament reconstruction might be a better option. You may be trying to access this site from a secured browser on the server. 1995;23:222226. Both repair and reconstruction (autograft and allograft) techniques were inclusive. unstable when the thumb is used. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. The anti edema management will continue for several weeks. Clinical Journal of Sport Medicine23(4):247-254, July 2013. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Thumb dominance reported in 8 studies (168 thumbs). SYMPTOMS: The thumb may be swollen, bruised and painful. 39. The effect of thumb metacarpophalangeal. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. and transmitted securely. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 1962;124:396411. 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). Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. 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. All but 2 were level IV evidence. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 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 rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Please enable it to take advantage of the complete set of features! Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Your surgeon is the person best able to help you avoid any serious recovery problems. 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. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Engelhardt JB, Christensen OM, Christiansen TG. If the latter was executed only partially, a score of 1 was assigned. 35. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Orthopedics. 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 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. Data is temporarily unavailable. flexion-extension motion. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. J Bone Joint Surg Am. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Unauthorized use of these marks is strictly prohibited. Am J Sports Med. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. 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. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Conflicts of interest The authors report no funding or conflicts of interest. The limitations of this systematic review are reliant on the studies analyzed. 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. 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. sharing sensitive information, make sure youre on a federal 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. 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. 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. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Search for Similar Articles The https:// ensures that you are connecting to the Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. your express consent. A common complication following fracture of the distal radius is when the radius shortens. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Unauthorized use of these marks is strictly prohibited. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Eurasian J Med. 1992;8:713732. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 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. 1994;25:2123. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups.
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