45. All authors independently performed the search. 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. Clin J Sport Med. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . The authors report no funding or conflicts of interest. [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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Purpose: Fourteen articles were included and analyzed (293 thumbs). Disclaimer. [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. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Sakellarides HT, DeWeese JW. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. A p-value of 0.05 was considered statistically significant. the splint for protection or at night until twelve weeks after the operation. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Surgical management of chronic, 42. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used. Pain reduction was significantly improved in all subjects (P < 0.05). RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. [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. Melone CP Jr, Beldner S, Basuk RS. UCL Repair of the Thumb - MSA Hand Center J Hand Surg Am. SAGE Open Med. You may also begin strengthening exercises if needed. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 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 . Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 27. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . All rights reserved. Categorical variable data were reported as frequency with percentages. Long-term results of ligament reconstruction. NR, not reported. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Epub 2016 Jan 13. 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 Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). The torn thumb ligament is repaired or reconstructed during surgery. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. J Hand Surg Am. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Instability of the metacarpophalangeal joint of the thumb. Epub 2021 Jan 18. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Epub 2014 Oct 22. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. abduction-adduction motion. 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%). Mean study follow-up was 42.8 months. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Complications of Ulnar Collateral Ligament Repair | SpringerLink There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. RCL Reconstruction Thumb MPJ - The Hand Treatment Center 44. 1961;43-A:541546. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine UCL injuries: Defining risk and improving treatment - Mayo Clinic The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Results: 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. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Am J Sports Med. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. 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. 4. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. doi: 10.1016/j.asmr.2020.12.004. Patient Demographics of Thumb RCL and UCL Injuries. your express consent. 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. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Jackson M, McQueen MM. The Complications of CMC Thumb Surgery | Healthy Living 2. 2013Lippincott Williams & Wilkins. 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. Unauthorized use of these marks is strictly prohibited. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). 38. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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%.16 Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. 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. 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. FOIA Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. There is currently no consensus on treatment of acute or chronic UCL injuries. Kozin SH, Bishop AT. Outcomes After Injury to the Thumb Ulnar Collateral Ligament Pichora DR, McMurtry RY, Bell MJ. The Effect of Ulnar Collateral Ligament Repair With Internal Brace Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. 3. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Data sources: Jupiter JB, Sheppard JE. Keywords: eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. sharing sensitive information, make sure youre on a federal Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. You've successfully added to your alerts. 31. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Orthop Clin North Am. eCollection 2021. Only prospective studies can determine this injury course. Thumb dominance reported in 8 studies (168 thumbs). Study design: The grip strength and the pinch strength were 94.3% and 92.27%,. Hand Clin. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb What are the symptoms of GameKeeper's Thumb? 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. Throwing status reported in 4 studies. The https:// ensures that you are connecting to the Bookshelf Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 15. 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. Early diagnosis and treatment. 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 prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 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). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 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. 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 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. 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. Your surgeon is the person best able to help you avoid any serious recovery problems. There were 200 acute injuries and 93 chronic injuries. 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. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Studies that duplicated patient populations from the same authors were excluded. Part I of this two-part article focuses on common tendon and . Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. *Glickel grading scale. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. may email you for journal alerts and information, but is committed Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. doi: 10.1097/JSA.0000000000000322. 19. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Acta Chir Scand. Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP A secondary purpose was to compare graft choice and surgical technique for reconstruction. Data is temporarily unavailable. [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. 6. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 14. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 10. eCollection 2022 May. Complications after surgical treatment of UCL injury are rare. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Downey DJ, Moneim MS, Omer GE Jr. 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. 1989;17:751753. No study directly compared the different types of graft for UCL reconstruction. MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute 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. Please enable scripts and reload this page. J Bone Joint Surg Am. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers.
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