1995;18:11611165. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Clinical Journal of Sport Medicine23(4):247-254, July 2013. FOIA Background: Your surgeon will discuss these options with you. Acute gamekeeper's thumb. You may also begin strengthening exercises if needed. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 17. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. Bookshelf These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Midterm clinical outcomes of collateral ligament repair of the thumb Objectives: If you log out, you will be required to enter your username and password the next time you visit. 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. Accessibility [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. They may even tear completely. Search for Similar Articles 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. Benson LS, Bailie DS. Non-Fusion. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Main results: Epub 2021 Jan 18. Both purely ligamentous and bony avulsion injuries were included. The Orthopedic Journal of Sports Medicine. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Bethesda, MD 20894, Web Policies At this stage, patients should be advised to wear your splint part-time. [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. If the tear is diagnosed early a repair will be possible. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. 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. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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. Figure 46-2 Approach to the ulnar collateral ligament. 11. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. The https:// ensures that you are connecting to the You've successfully added to your alerts. In some cases, certain risk factors make it more likely that a bone will fail to heal. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics 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 Chir Main. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Anesthesia for Hand Surgery | The Hand & Wrist Center If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. 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. 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. Am J Orthop (Belle Mead NJ). 1989;17:751753. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 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. 35. 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. Sakellarides HT, DeWeese JW. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. If it is appropriate, then surgical consent probably happened before the surgery. 1977;59:1421. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Surgical techniques and a review of 70 patients. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 2006;31:6875. SYMPTOMS: The thumb may be swollen, bruised and painful. 5. Ulnar Collateral Ligament Repair and Reconstruction Unable to load your collection due to an error, Unable to load your delegates due to an error. Studies that duplicated patient populations from the same authors were excluded. 1,5,9,10 In acute cases of complete tears involving high-level . A score of 2 was assigned if the item was completely and accurately performed and reported. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 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. 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. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 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. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 4. 1994;25:2123. 1996;25:474477. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Causes. Injuries to the PIP joint remain swollen for long periods of time. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. The limitations of this systematic review are reliant on the studies analyzed. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Bean CH, Tencer AF, Trumble TE. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 2009;61:623632. 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. Part II: treatment and complications. Am J Sports Med. Before 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. 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. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Ulnar Collateral Ligament (UCL) Repair | SpringerLink In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury The https:// ensures that you are connecting to the Highlight selected keywords in the article text. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Weakened grip or reduced thumb range of motion may occur. 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. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. J Hand Surg Am. Rupture of the. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 2009;34:304308. Outcomes after injury to the thumb ulnar collateral ligament--a 1. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). and transmitted securely. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Careers. 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. 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. FOIA 15. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. [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. It runs from the outer humerus, around the radial head and attaches to the ulna. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Fourteen articles were included and analyzed (293 thumbs). Thumb dominance reported in 8 studies (168 thumbs). A p-value of 0.05 was considered statistically significant. Bostock S, Morris MA. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Louis DS, Huebner JJ Jr, Hankin FM. 1976;58:106112. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. RCL Reconstruction Thumb MPJ - The Hand Treatment Center A common complication following fracture of the distal radius is when the radius shortens. Gamekeepers thumb: a prospective study of functional bracing. Am J Sports Med. Click the topic below to receive emails when new articles are available. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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. 2005;24:217221. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. 2. 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%). SAGE Open Med. Orthop Rev. NR, not reported. 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. 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. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 2013Lippincott Williams & Wilkins. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Diagnosis of displaced, 43. No study reported the outcomes of nonoperative management of chronic UCL injury. The mean patient age was 37.8 years (14.0-78.1). Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 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. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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. 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. Part I of this two-part article focuses on common tendon and . 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. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Sports Med Arthrosc Rev. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. Am J Sports Med. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 36. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Would you like email updates of new search results? A sprained thumb is a common injury among athletes. Jackson M, McQueen MM. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 1999;24:275282. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What 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. 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. 2005;87:26322638. Metacarpophalangeal joint injuries of the thumb. 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. 1987;214:113120. Please try after some time. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. A broken thumb can also cause numbness or tingling. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. *Glickel grading scale. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Data range was reported as minimum to maximum absolute values. 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. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 33. 2009;6:e1000097. sharing sensitive information, make sure youre on a federal Early and late postoperative complications were recorded. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . modify the keyword list to augment your search. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). The torn thumb ligament is repaired or reconstructed during surgery. MeSH 1993;21:800804. A systematic review of ulnar collateral ligament reconstruction techniques. Am J Sports Med. 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. 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. 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 . 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 ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Would you like email updates of new search results? Table 1. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. This site needs JavaScript to work properly. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 2013;23(4):247-254. The Effect of Ulnar Collateral Ligament Repair With Internal Brace Thumb from the common mechanism of falling on the thumb while holding a ski pole. 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). It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. [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. Am J Orthop (Belle Mead NJ). Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 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.
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