Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. This site needs JavaScript to work properly. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 35. Subject demographics are reported in Table 2. Possible complications include: - Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. 2006;31:6875. sharing sensitive information, make sure youre on a federal What Happens If We Sit for More Than 8 Hours Per Day? When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. If the latter was executed only partially, a score of 1 was assigned. 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. Only prospective studies can determine this injury course. A secondary purpose was to compare graft choice and surgical technique for reconstruction. A systematic review of ulnar collateral ligament reconstruction techniques. 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. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Thirty-two thumbs were treated nonoperatively and 261 operatively. 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%). 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. *Gender reported in 12 studies (218 subjects). Thumb sidedness reported in 3 studies (51 thumbs). Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. The effect of thumb metacarpophalangeal. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Engelhardt JB, Christensen OM, Christiansen TG. sharing sensitive information, make sure youre on a federal RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Click the topic below to receive emails when new articles are available. These exercises may be directed by a physical or occupational therapist. Epub 2021 Sep 7. MCP collateral ligament sprain is most commonly an acute injury related to trauma. What are the symptoms of GameKeeper's Thumb? Please try again soon. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Wong TC, Ip FK, Wu WC. 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. The mean time from reported injury date to surgery was 202.4 days (2-5969). If the tear is diagnosed early a repair will be possible. 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. 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. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Nonoperative treatment often failed, necessitating surgery. Conclusion: Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Epub 2019 Mar 21. eCollection 2021 Apr. Accessibility You are being redirected to Medscape Education. J Hand Surg Am. The limitations of this systematic review are reliant on the studies analyzed. Fourteen articles were included and analyzed (293 thumbs). Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Clipboard, Search History, and several other advanced features are temporarily unavailable. Arnold DM, Cooney WP, Wood MB. 25. Chir Main. 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). Systematic review and meta-analysis. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 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%). 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Fusetti C, Papaloizos M, Meyer H, et al.. Data range was reported as minimum to maximum absolute values. 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. 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. your express consent. 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). **Stener lesion status reported in 6 studies (145 thumbs). Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. 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. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Epub 2014 Oct 22. 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.. 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. Pain reduction was significantly improved in all subjects (P < 0.05). It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Epub 2016 Jan 13. better/same/worse than preoperative status). 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. 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. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Sports Med Arthrosc Rev. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. abduction-adduction motion. 8. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . There were 200 acute injuries and 93 chronic injuries. Ulnar Collateral Ligament Repair . Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. There is currently no consensus on treatment of acute or chronic UCL injuries. Figure 46-2 Approach to the ulnar collateral ligament. Bethesda, MD 20894, Web Policies Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 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). This article provides a review of . Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Am J Sports Med. Rupture of the. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Part I of this two-part article focuses on common tendon and . Accessibility Your surgeon will discuss these options with you. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 1994;23:797804. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. SYMPTOMS: The thumb may be swollen, bruised and painful. Before If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. 8600 Rockville Pike 1998;23:503506. 34. If your bone is broken, a pin will be used to put it in place. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Orthop J Sports Med. Am J Sports Med. 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. 31. 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. Federal government websites often end in .gov or .mil. J Hand Surg Am. 38. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Am J Sports Med. The https:// ensures that you are connecting to the 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. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. The site is secure. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 11. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Louis DS, Huebner JJ Jr, Hankin FM. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Am J Orthop (Belle Mead NJ). Metacarpophalangeal joint injuries of the thumb. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Upper extremity injuries in snow skiers. to maintaining your privacy and will not share your personal information without The injury involves the ulnar collateral ligament (UCL) 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. Continue to stretch before and after throwing . 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. 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. 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. All but 2 were level IV evidence. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). No study directly compared the different types of graft for UCL reconstruction. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Kaplan EB. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Complications after surgery were rare. 8600 Rockville Pike The anti edema management will continue for several weeks. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 14 It is important to diagnose complete tears early because . 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 range of motion of the MP joint of the thumb following operative repair of the. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 1999;24:7075. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). An official website of the United States government. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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. Mitsionis GI, Varitimidis SE, Sotereanos GG. eCollection 2021. Meta-analysis of the pooled data was completed. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Purpose. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Gamekeeper's thumb. FOIA 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. Educate the patient on anti edema management. Fourteen articles were included and analyzed (293 thumbs). MCP fusion was performed . Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Before 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. unstable when the thumb is used. 1995;18:11611165. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 7. Non-Fusion. three muscles provide deforming forces at the base of the thumb. Proximal interphalangeal joint injuries of the hand. Pichora DR, McMurtry RY, Bell MJ. Am J Orthop (Belle Mead NJ). may email you for journal alerts and information, but is committed If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Orthop Rev. 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. [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]. Abstract. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 2013Lippincott Williams & Wilkins. Please enable scripts and reload this page. [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. Jupiter JB, Sheppard JE. 20. A p-value of 0.05 was considered statistically significant. 39. [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. 3. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Unauthorized use of these marks is strictly prohibited. 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. 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 . Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Bethesda, MD 20894, Web Policies Injuries to the PIP joint remain swollen for long periods of time. Early diagnosis and treatment. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Conflicts of interest The authors report no funding or conflicts of interest. This damage may lead to temporary or permanent numbness or weakness. 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. Infection is a rare complication of hand surgery. Objectives: Thumb collateral ligament injuries. Keywords: 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). There is currently no consensus on treatment of acute or chronic UCL injuries. J Bone Joint Surg Am. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Various levels of pain, bruising, or edema may present at the site of damage. Arthrosc Sports Med Rehabil. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The https:// ensures that you are connecting to the Thumb dominance reported in 8 studies (168 thumbs). 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. The overall complication rate was 13.8% (11/80). A score of 0 was assigned if the item was either omitted or not performed. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. PLoS Med. Continuous variable data were reported as mean SDs from the mean. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Injury. You've successfully added to your alerts. Surgical techniques and a review of 70 patients. 14. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. 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. Your message has been successfully sent to your colleague. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Your thumb will be immobilized in a splint and should not be moved until follow up.