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. 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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Descriptive statistics were calculated. Am J Sports Med. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. unstable when the thumb is used. A systematic review of ulnar collateral ligament reconstruction techniques. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. They may even tear completely. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). There were no cases of intraoperative ulnar nerve injury reported. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. and transmitted securely. sharing sensitive information, make sure youre on a federal Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Accessibility If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 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. A common complication following fracture of the distal radius is when the radius shortens. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Abstract. 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. 33. and twist using your thumb. Some error has occurred while processing your request. the splint for protection or at night until twelve weeks after the operation. Continuous variable data were reported as mean SDs from the mean. MCP fusion was performed . Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 1989;14:567573. There is currently no consensus on treatment of acute or chronic UCL injuries. There are some cases where the fusion is not successful and you will still have pain in . Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Studies that duplicated patient populations from the same authors were excluded. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 1994;23:797804. 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. 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. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. The limitations of this systematic review are reliant on the studies analyzed. Diagnosis of displaced, 43. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. SYMPTOMS: The thumb may be swollen, bruised and painful. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Various levels of pain, bruising, or edema may present at the site of damage. 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. official website and that any information you provide is encrypted In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. This article provides a review of . Dr. Holt will talk to you about when it is safe to return to work. An official website of the United States government. 26. 13. Am J Orthop (Belle Mead NJ). 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. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 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. 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). Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. 25. Please enable it to take advantage of the complete set of features! For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Objectives: Infection is a rare complication of hand surgery. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 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)]. 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. Ulnar Collateral Ligament Repair . 4. Kaplan EB. Gamekeepers thumb: a prospective study of functional bracing. 34. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. SAGE Open Med. Proximal interphalangeal joint injuries of the hand. Gamekeeper's thumb. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). A p-value of 0.05 was considered statistically significant. The diagnosis is best established clinically, though MRI is the imaging modality of choice. All authors independently performed the search. If the force is too strong, the ligaments can tear. 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%). This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 10. Arnold DM, Cooney WP, Wood MB. Meta-analysis of the pooled data was completed. 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. Both purely ligamentous and bony avulsion injuries were included. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 2. Systematic review and meta-analysis. 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. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Stener B. Skeletal injuries associated with rupture of the. Wong TC, Ip FK, Wu WC. The injury happens when you fall . Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Highlight selected keywords in the article text. sharing sensitive information, make sure youre on a federal 1995;18:11611165. Hand Surg. 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]). 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%. 1999;24:275282. 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 . 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. When assessed, most patients returned to their preinjury employment. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Proximal interphalangeal joint injuries of the hand. 1962;124:396411. There were 200 acute injuries and 93 chronic injuries. The overall complication rate was 13.8% (11/80). Meta-analysis of the pooled data was completed. The anti edema management will continue for several weeks. Would you like email updates of new search results? 1999;24:7075. 39. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Table 1. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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. Careers. Posner MA, Retaillaud JL. 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). Federal government websites often end in .gov or .mil. 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. Am J Sports Med. 21. Acute gamekeeper's thumb. Bean CH, Tencer AF, Trumble TE. Rupture of the. Unilateral injuries: 291 and bilateral injury: 1. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 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 2009;6:e1000097. 2018;6(4):1-7. Please enable it to take advantage of the complete set of features! J Hand Surg Am. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 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. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . abduction-adduction motion. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Complications after this procedure may include nerve or blood vessel damage. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. 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). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. All techniques improved clinical outcomes, including pain, motion, strength, and stability. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. MeSH The site is secure. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Conclusion: Eurasian J Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 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. Muscles. 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. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Injury. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. He too had the internal brace augmentation. 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. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. **Stener lesion status reported in 6 studies (145 thumbs). [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. Part I: anatomy and diagnosis. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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. 12. An official website of the United States government. 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. PMC You've successfully added to your alerts. The .gov means its official. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. This website also contains material copyrighted by 3rd parties. 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. 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.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.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. Instability of the metacarpophalangeal joint of the thumb. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Bennet Fracture. HHS Vulnerability Disclosure, Help 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 8. 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. Complications after surgical treatment of UCL injury are rare. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Mean study follow-up was 42.8 months. Study design: Both repair and reconstruction (autograft and allograft) techniques were inclusive. [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. Disclaimer. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 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. There were 61 studies eliminated as secondary for being in a language other than English. 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). This site needs JavaScript to work properly. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. For more information, please refer to our Privacy Policy. 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. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 1992;8:713732. Only prospective studies can determine this injury course. There were 200 acute injuries and 93 chronic injuries. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. For example, it can be removed when performing . Epub 2021 Jan 18. Am J Sports Med. 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. 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. 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. POST-OPERATIVE WEEKS 22-24. Patient Demographics of Thumb RCL and UCL Injuries. If it is appropriate, then surgical consent probably happened before the surgery. Fusetti C, Papaloizos M, Meyer H, et al.. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Unable to load your collection due to an error, Unable to load your delegates due to an error. Thirty-two thumbs were treated nonoperatively and 261 operatively. 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. 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. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Clin Orthop Relat Res. The injury involves the ulnar collateral ligament (UCL) of the thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Search performed on November 17, 2011. Am J Orthop (Belle Mead NJ). No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint.
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