35. Symptoms are dependent on the cause and severity of injury to the UCL. doi: 10.1016/j.asmr.2020.12.004. 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. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Mitsionis GI, Varitimidis SE, Sotereanos GG. 22. 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%). Clin Orthop Relat Res. Non-Fusion. Am J Sports Med. 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.
Outcomes after injury to the thumb ulnar collateral ligament--a Kozin SH, Bishop AT. 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. This article provides a review of . eCollection 2021. Objectives: Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. There were 200 acute injuries and 93 chronic injuries. Conflicts of interest The authors report no funding or conflicts of interest. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms.
Anesthesia for Hand Surgery | The Hand & Wrist Center For example, it can be removed when performing . The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 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). Unauthorized use of these marks is strictly prohibited. Please enable it to take advantage of the complete set of features! 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.
Rupture of the ulnar collateral ligament of the thumb - a review There is currently no consensus on treatment of acute or chronic UCL injuries.
PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine 1994;25:2123. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Your surgeon is the person best able to help you avoid any serious recovery problems. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 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. 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. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Wolters Kluwer Health, Inc. and/or its subsidiaries. UCLR case series that contained complications data were included. Bookshelf Before UCLR case series that contained complications data were included. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Riederer S, Nagy L, Buchler U. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Abstract. 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. 1,5,9,10 In acute cases of complete tears involving high-level .
Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Careers.
Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics A secondary purpose was to compare graft choice and surgical technique for reconstruction. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. 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. 1992;8:713732. Diagnosis of displaced, 43. 15.
PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair MeSH Arnold DM, Cooney WP, Wood MB. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Bennet Fracture. 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. Bostock S, Morris MA. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. No study directly compared the different types of graft for UCL reconstruction. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Study design: 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. What Happens If We Sit for More Than 8 Hours Per Day? Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. There were 61 studies eliminated as secondary for being in a language other than English. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. If the force is too strong, the ligaments can tear. 2013;23(4):247-254. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complications after this procedure may include nerve or blood vessel damage. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. government site. may email you for journal alerts and information, but is committed
The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Long-term results of ligament reconstruction. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Disclaimer. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Meta-analysis of the pooled data was completed. Sakellarides HT, DeWeese JW. 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. 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. Please try again soon. Main results:
Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. This leads to what is know as a positive ulnar variance. 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. For more information, please refer to our Privacy Policy.
Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Weakened grip or reduced thumb range of motion may occur. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping.
PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher The Complications of CMC Thumb Surgery | Healthy Living 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). 27. Search performed on November 17, 2011. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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. Pichora DR, McMurtry RY, Bell MJ. J Bone Joint Surg Am. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Am J Sports Med. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures.
Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Careers. 2009;34:304308. 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. 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. Causes. 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.
Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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 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. Am J Orthop (Belle Mead NJ). Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 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. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 2006;31:6875. Complications after surgery were rare. 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. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only).
Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Federal government websites often end in .gov or .mil. Epub 2014 Dec 30. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. 2005;87:26322638.
PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery 7. To date, no literat. Part I of this two-part article focuses on common tendon and . Epub 2021 Jan 18. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Smith RJ. 5. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Downey DJ, Moneim MS, Omer GE Jr. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). 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. 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. 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery.
Nonunions - OrthoInfo - AAOS Both purely ligamentous and bony avulsion injuries were included. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 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. Doi: 10.1177/2325967118769328. FOIA Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 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. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. 1996;25:474477. Early diagnosis and treatment. [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. 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. PMC 8600 Rockville Pike 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. Thirty-two thumbs were treated nonoperatively and 261 operatively. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. SAGE Open Med. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. If you log out, you will be required to enter your username and password the next time you visit. 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. 2022 Mar 1;30(1):e1-e8.
Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries 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%). 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. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. three muscles provide deforming forces at the base of the thumb. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Data range was reported as minimum to maximum absolute values. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. These tears often occur as a result of a radially directed force on an extended thumb. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes.