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. Subject demographics are reported in Table 2. Am J Sports Med. In these cases, a new graft may be used to perform a second reconstruction. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. [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. Unauthorized use of these marks is strictly prohibited. There were 200 acute injuries and 93 chronic injuries. 10. The injury involves the ulnar collateral ligament (UCL) of the thumb. What Happens If We Sit for More Than 8 Hours Per Day? Dr. Holt will talk to you about when it is safe to return to work. J Hand Surg Br. Background: Melone CP Jr, Beldner S, Basuk RS. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 14 It is important to diagnose complete tears early because . Injury. Click the topic below to receive emails when new articles are available. 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 . 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. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Posner MA, Retaillaud JL. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. The grip strength and the pinch strength were 94.3% and 92.27%,. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Accessibility The LUCL is located on the lateral or outside part of the elbow. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. 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). MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Only prospective studies can determine this injury course. 16. eCollection 2021 Apr. 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. 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. 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. Kaplan EB. The mean patient age was 37.8 years (14.0-78.1). may email you for journal alerts and information, but is committed 1987;214:113120. 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. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. If the tear is diagnosed later a ligament reconstruction might be a better option. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Diagnosis of displaced, 43. 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. 1994;23:797804. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. There is currently no consensus on treatment of acute or chronic UCL injuries. Clin J Sport Med. Orthopedics. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 2009;6:e1000097. Hand Surg. The authors report no funding or conflicts of interest. eCollection 2021 Mar. Gamekeepers thumb: a prospective study of functional bracing. A score of 2 was assigned if the item was completely and accurately performed and reported. The anti edema management will continue for several weeks. Early and late postoperative complications were recorded. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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 Long-term results of ligament reconstruction. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. 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 . 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.. *Gender reported in 12 studies (218 subjects). Please enter a Recipient Address and/or check the Send me a copy checkbox. eCollection 2021. 11. Categorical variable data were reported as frequency with percentages. J Bone Joint Surg Am. doi: 10.1016/j.asmr.2020.12.004. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 6. 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. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. better/same/worse than preoperative status). Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. He too had the internal brace augmentation. The Orthopedic Journal of Sports Medicine. official website and that any information you provide is encrypted Please enable scripts and reload this page. Conflicts of interest The authors report no funding or conflicts of interest. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. This ligament prevents the thumb from pointing too far away from the hand. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. J Hand Surg Am. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Am J Sports Med. Thumb sidedness reported in 3 studies (51 thumbs). You may search for similar articles that contain these same keywords or you may your express consent. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. [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. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Before Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). History. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. You may also begin strengthening exercises if needed. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. Main results: government site. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Results: 1998;23:503506. 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. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 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. If your bone is broken, a pin will be used to put it in place. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. For example, it can be removed when performing . There were 200 acute injuries and 93 chronic 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%). Only prospective studies can determine this injury course. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Epub 2014 Oct 22. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Bethesda, MD 20894, Web Policies A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Thirty-two thumbs were treated nonoperatively and 261 operatively. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 1,5,9,10 In acute cases of complete tears involving high-level . National Library of Medicine Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. The .gov means its official. In some cases, certain risk factors make it more likely that a bone will fail to heal. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). flexion-extension motion. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Part II: treatment and complications. Systematic review and meta-analysis. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. Meta-analysis of the pooled data was completed. Abstract. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. All authors independently performed the search. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). 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). 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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Thumb dominance reported in 8 studies (168 thumbs). There were 61 studies eliminated as secondary for being in a language other than English. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Careers. doi: 10.1097/JSA.0000000000000322. 38. Non-Fusion. 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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. All but 2 were level IV evidence. Conclusions: Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 1996;25:474477. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Orthop Rev. J Hand Surg Glob Online. 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Rupture and displacement of the. 8. No study directly compared the different types of graft for UCL reconstruction. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Exercises: Gradually progress to competitive throwing and sports . eCollection 2022 May.
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