15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. Orthop Clin North Am. 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 2021 Apr 15;3(2):e527-e533. 34. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. Orthop Rev. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) POST-OPERATIVE WEEKS 22-24. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. *Glickel grading system. Kaplan EB. 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. The grip strength and the pinch strength were 94.3% and 92.27%,. If the latter was executed only partially, a score of 1 was assigned. *Glickel grading scale. Your message has been successfully sent to your colleague. 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. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. No study directly compared nonoperative to operative treatment. 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. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Both purely ligamentous and bony avulsion injuries were included. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. You've successfully added to your alerts. The site is secure. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. Surgical techniques and a review of 70 patients. In these patients, after failure of nonoperative treatment at anywhere from 1 month to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Wong TC, Ip FK, Wu WC. sharing sensitive information, make sure youre on a federal Post-traumatic instability of the metacarpophalangeal joint of the thumb. Eurasian J Med. National Library of Medicine Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 2013;23(4):247-254. eCollection 2022 May. 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 2003;8:8185. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Part I of this two-part article focuses on common tendon and . Causes. the splint for protection or at night until twelve weeks after the operation. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. They may even tear completely. Figure 46-2 Approach to the ulnar collateral ligament. government site. Downey DJ, Moneim MS, Omer GE Jr. Bennet Fracture. If you log out, you will be required to enter your username and password the next time you visit. Acute gamekeeper's thumb. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Table 1. The authors report no funding or conflicts of interest. 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 . Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 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. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. 31. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. All authors independently performed the search. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. There is currently no consensus on treatment of acute or chronic UCL injuries. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Kozin SH, Bishop AT. Part I: anatomy and diagnosis. Data sources: J Bone Joint Surg Am. 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. Epub 2020 Jun 29. The https:// ensures that you are connecting to the Thirty-two thumbs were treated nonoperatively and 261 operatively. 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. Your surgeon will discuss these options with you. Subject demographics are reported in Table 2. Results: A systematic review of ulnar collateral ligament reconstruction techniques. These exercises may be directed by a physical or occupational therapist. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. 1994;25:2123. Clin Orthop Relat Res. Arthritis Rheum. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Jupiter JB, Sheppard JE. Objectives: 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). 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. Careers. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. The site is secure. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Clinical Journal of Sport Medicine23(4):247-254, July 2013. The doctor won't know if the repair is . There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Federal government websites often end in .gov or .mil. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. If it is appropriate, then surgical consent probably happened before the surgery. Clipboard, Search History, and several other advanced features are temporarily unavailable. Diagnosis of displaced, 43. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Clin J Sport Med. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 20. Thumb sidedness reported in 3 studies (51 thumbs). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 1998;23:503506. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. and transmitted securely. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. All rights reserved. 2013Lippincott Williams & Wilkins. Keywords: The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. and transmitted securely. SYMPTOMS: The thumb may be swollen, bruised and painful. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. He too had the internal brace augmentation. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. 37. [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. I was able to work while wearing the splint. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. The mean patient age was 37.8 years (14.0-78.1). Tension wire fixation of avulsion fractures in the hand. The LUCL is located on the lateral or outside part of the elbow. Would you like email updates of new search results? You may search for similar articles that contain these same keywords or you may 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Meta-analysis of the pooled data was completed. PLoS Med. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. NR, not reported. 4. J Bone Joint Surg Am. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Before In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Search performed on November 17, 2011. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Injuries to the PIP joint remain swollen for long periods of time. Some error has occurred while processing your request. 12. Am J Sports Med. J Hand Surg Glob Online. 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. 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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. History. Careers. Weakened grip or reduced thumb range of motion may occur. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 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). The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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). Hand Clin. 27. If the latter was executed only partially, a score of 1 was assigned. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 17. MCP fusion was performed . The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Clipboard, Search History, and several other advanced features are temporarily unavailable. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Unauthorized use of these marks is strictly prohibited. Part II: treatment and complications. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. No study directly compared the different types of graft for UCL reconstruction. SAGE Open Med. 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. 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. The https:// ensures that you are connecting to the Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Complications after this procedure may include nerve or blood vessel damage. 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%). 2006;31:6875. Instability of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am. If the force is too strong, the ligaments can tear. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Nonoperative treatment often failed, necessitating surgery. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Various levels of pain, bruising, or edema may present at the site of damage. Stretching or even a rupture of the graft is also possible. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. 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%). Am J Sports Med. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 39. A score of 0 was assigned if the item was either omitted or not performed. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. J Hand Surg Am. 35. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Disclaimer. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 2005;87:26322638. Kuz JE, Husband JB, Tokar N, et al.. Systematic review and meta-analysis. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Epub 2014 Dec 30. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 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. HHS Vulnerability Disclosure, Help TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. There is currently no consensus on treatment of acute or chronic UCL injuries. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Data range was reported as minimum to maximum absolute values. 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. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. For more information, please refer to our Privacy Policy. 1989;17:751753. 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. Continuous variable data were reported as mean SDs from the mean. 2022 Mar 1;30(1):e1-e8. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Only prospective studies can determine this injury course. Before Accessibility After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Unauthorized use of these marks is strictly prohibited. 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. 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. Wolters Kluwer Health 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. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. 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.
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