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The Orthopedic Journal of Sports Medicine. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Bethesda, MD 20894, Web Policies 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. 2005;24:217221. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Riederer S, Nagy L, Buchler U. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 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. The .gov means its official. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 1962;124:396411. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Am J Sports Med. the splint for protection or at night until twelve weeks after the operation. Clin J Sport Med. MeSH Am J Orthop (Belle Mead NJ). In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. sharing sensitive information, make sure youre on a federal Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 36. 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. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 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. Am J Sports Med. government site. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 1992;8:713732. Search performed on November 17, 2011. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Complications after this procedure may include nerve or blood vessel damage. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Causes. Conclusions: Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Studies that duplicated patient populations from the same authors were excluded. 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. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 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. 14. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Mechanism of injury to the RCL of the MCP joint of the thumb is force . The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. National Library of Medicine 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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Pichora DR, McMurtry RY, Bell MJ. The doctor won't know if the repair is . A score of 2 was assigned if the item was completely and accurately performed and reported. unstable when the thumb is used. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 31. Arnold DM, Cooney WP, Wood MB. Metacarpophalangeal joint injuries of the thumb. Hand Clin. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 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. Dr. Holt will talk to you about when it is safe to return to work. You will receive email when new content is published. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. flexion-extension motion. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Fusetti C, Papaloizos M, Meyer H, et al.. [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. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Infection is a rare complication of hand surgery. The site is secure. Eventually this abnormal movement will wear out the joint and it will become arthritic. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. 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. 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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. There were no cases of intraoperative ulnar nerve injury reported. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. This website also contains material copyrighted by 3rd parties. Bostock S, Morris MA. Catalano LW III, Cardon L, Patenaude N, et al.. These exercises may be directed by a physical or occupational therapist. Meta-analysis of the pooled data was completed. J Hand Surg Am. Van Dommelen BA, Zvirbulis RA. A score of 0 was assigned if the item was either omitted or not performed. Long-term results of ligament reconstruction. 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. Table 1. Part II: treatment and complications. 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. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. 12. Only prospective studies can determine this injury course. Thirty-two thumbs were treated nonoperatively and 261 operatively. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Am J Orthop (Belle Mead NJ). Both purely ligamentous and bony avulsion injuries were included. Thumb collateral ligament injuries. Disclaimer. Please try again soon. J Bone Joint Surg Am. 15. 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. 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. The https:// ensures that you are connecting to the Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 8600 Rockville Pike Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 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 limitations of this systematic review are reliant on the studies analyzed. 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. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). 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. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). [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. 8. Clipboard, Search History, and several other advanced features are temporarily unavailable. There were 61 studies eliminated as secondary for being in a language other than English. Federal government websites often end in .gov or .mil. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. [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. Systematic review and meta-analysis. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. 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. For more information, please refer to our Privacy Policy. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. What are the symptoms of GameKeeper's Thumb? Exercises: Gradually progress to competitive throwing and sports . The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 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. Orthopedics. Both repair and reconstruction (autograft and allograft) techniques were inclusive. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Bailie DS, Benson LS, Marymont JV. Complications after surgical treatment of UCL injury are rare. 16. Meta-analysis of the pooled data was completed. 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. 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. Bethesda, MD 20894, Web Policies It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 44. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Continue to stretch before and after throwing . 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. A sprained thumb is a common injury among athletes. 1989;17:751753. 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. [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. official website and that any information you provide is encrypted Purpose. 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. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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. No study directly compared nonoperative to operative treatment. Various levels of pain, bruising, or edema may present at the site of damage. J Hand Surg Am. 38. A broken thumb can also cause numbness or tingling. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. J Bone Joint Surg Am. 45. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. government site. Abrahamsson SO, Sollerman C, Lundborg G, et al.. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Epub 2016 Jan 13. The anti edema management will continue for several weeks. PMC 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. 39. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. If the tear is diagnosed later a ligament reconstruction might be a better option. Rupture and displacement of the. I was able to work while wearing the splint. 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. Symptoms are dependent on the cause and severity of injury to the UCL. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. 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. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Conclusion: Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Please enable scripts and reload this page. 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. HHS Vulnerability Disclosure, Help 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. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Your thumb will be immobilized in a splint and should not be moved until follow up. Would you like email updates of new search results? When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. and transmitted securely. 6. You are being redirected to Medscape Education. 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).