Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. A score of 0 was assigned if the item was either omitted or not performed. 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). The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. For more information, please refer to our Privacy Policy. POST-OPERATIVE WEEKS 22-24. 1,5,9,10 In acute cases of complete tears involving high-level . If the tear is diagnosed early a repair will be possible. 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. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. An anatomic basis for treatment. No study reported the outcomes of nonoperative management of chronic UCL injury. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Accessibility PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery Epub 2020 Jun 29. J Bone Joint Surg Am. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. Please enter a Recipient Address and/or check the Send me a copy checkbox. Am J Sports Med. doi: 10.1097/JSA.0000000000000322. 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. MCP fusion was performed . Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Would you like email updates of new search results? Before Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. The range of motion of the MP joint of the thumb following operative repair of the. 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. Subject demographics are reported in Table 2. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 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. Tension wire fixation of avulsion fractures in the hand. A systematic review of ulnar collateral ligament reconstruction techniques. The injury happens when you fall . 2003;8:8185. Clipboard, Search History, and several other advanced features are temporarily unavailable. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Conclusions: If the latter was executed only partially, a score of 1 was assigned. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Thirty-two thumbs were treated nonoperatively and 261 operatively. Continuous variable data were reported as mean SDs from the mean. Chir Main. 1999;24:275282. Treatment of chronic injuries of the. The Orthopedic Journal of Sports Medicine. Epub 2019 Mar 21. Complications after surgical treatment of UCL injury are rare. Am J Sports Med. SYMPTOMS: The thumb may be swollen, bruised and painful. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. The LUCL is located on the lateral or outside part of the elbow. 27. Your surgeon will discuss these options with you. Abrahamsson SO, Sollerman C, Lundborg G, et al.. All but 2 were level IV evidence. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape and twist using your thumb. Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP 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%). 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. Nonoperative treatment often failed, necessitating surgery. 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 . Ulnar Collateral Ligament (UCL) Repair | SpringerLink It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. There is currently no consensus on treatment of acute or chronic UCL injuries. Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). A score of 0 was assigned if the item was either omitted or not performed. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. PLoS Med. Non-Fusion. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. The Complications of CMC Thumb Surgery | Healthy Living Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Orthop Clin North Am. Systematic review and meta-analysis. 31. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Hand Surgery Recovery Time: Pain, Exercise & Complications Ulnar Collateral Ligament Repair . Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary 8. 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. The overall complication rate was 13.8% (11/80). Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Causes. Proximal interphalangeal joint injuries of the hand. MeSH PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Purpose: Arthrosc Sports Med Rehabil. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist 33. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. This leads to what is know as a positive ulnar variance. 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. 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. 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. Midterm clinical outcomes of collateral ligament repair of the thumb Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 2005;87:26322638. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 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. *Glickel grading scale. Wolters Kluwer Health, Inc. and/or its subsidiaries. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Orthop Rev. Clin Orthop Relat Res. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Data sources: 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). Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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 HHS Vulnerability Disclosure, Help Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. 14 It is important to diagnose complete tears early because . A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. You are being redirected to Medscape Education. 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. They may even tear completely. What are the symptoms of GameKeeper's Thumb? Abstract. The torn thumb ligament is repaired or reconstructed during surgery. 45. [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]. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. J Bone Joint Surg Am. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. 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. 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. Please try again soon. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 44. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 1. Epub 2021 Sep 7. Search performed on November 17, 2011. Wong TC, Ip FK, Wu WC. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. 36. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 1994;25:2123. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. unstable when the thumb is used. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 1976;58:106112. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Unauthorized use of these marks is strictly prohibited. Bostock S, Morris MA. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. PIP Joint Injuries of the Finger - Orthogate After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. #Injury location reported only in 3 studies. 8600 Rockville Pike If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. All techniques improved clinical outcomes, including pain, motion, strength, and stability. The mean time from reported injury date to surgery was 202.4 days (2-5969). three muscles provide deforming forces at the base of the thumb. 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. 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. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 2009;6:e1000097. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Gamekeeper's thumb. Mean subject age was 33.9 years. Thus, the true natural history is yet unknown. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 2018;6(4):1-7. The https:// ensures that you are connecting to the The authors report no funding or conflicts of interest. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Nonsurgical Management of Ulnar Collateral Ligament Injuries Hand Clin. 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.. Treatment for thumb collateral ligament injury - KW orthopaedics sharing sensitive information, make sure youre on a federal Gamekeepers thumb: a prospective study of functional bracing. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 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. Before This site needs JavaScript to work properly. The effect of thumb metacarpophalangeal. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. For example, it can be removed when performing . Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. 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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Complications after surgery were rare. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. National Library of Medicine No study directly compared the different types of graft for UCL reconstruction. The https:// ensures that you are connecting to the 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. Quantitative outcome of surgical repair. eCollection 2022 May. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). **Stener lesion status reported in 6 studies (145 thumbs). Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois 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 overall complication rate after primary thumb RCL and UCL repair was 13.8%. In these cases, a new graft may be used to perform a second reconstruction. 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. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Rupture of the. Fourteen articles were included and analyzed (293 thumbs). Kaplan EB. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Fourteen articles were included and analyzed (293 thumbs). A score of 2 was assigned if the item was completely and accurately performed and reported. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 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. Dr. Holt will talk to you about when it is safe to return to work. [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. eCollection 2021 Mar. Thumb Collateral Ligament Injury - Hand - Orthobullets Posner MA, Retaillaud JL. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Mean study follow-up was 42.8 months. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. abduction-adduction motion. Methods: MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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. Injuries to the PIP joint remain swollen for long periods of time. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia J Bone Joint Surg Am. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540).