Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Jackson M, McQueen MM. 31. The overall complication rate was 13.8% (11/80). Dr. Holt will talk to you about when it is safe to return to work. Bookshelf and transmitted securely. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Epub 2021 Sep 7. Mean study follow-up was 42.8 months. Meta-analysis of the pooled data was completed. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Epub 2014 Oct 22. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. better/same/worse than preoperative status). doi: 10.1016/j.asmr.2020.12.004. 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). Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Complications after this procedure may include nerve or blood vessel damage. 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. 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 limitations of this systematic review are reliant on the studies analyzed. Doi: 10.1177/2325967118769328. To date, no literat. 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Most times, they won't know until they're in the surgery if the internal brace is appropriate. You will receive email when new content is published. J Bone Joint Surg Am. Clipboard, Search History, and several other advanced features are temporarily unavailable. 4. 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. Acute gamekeeper's thumb. All but 2 were level IV evidence. There were no cases of intraoperative ulnar nerve injury reported. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. Hand Surg. Descriptive statistics were calculated. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Part II: treatment and complications. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. UCLR case series that contained complications data were included. These tears often occur as a result of a radially directed force on an extended thumb. 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. 24. 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. Bostock S, Morris MA. Continuous variable data were reported as mean SDs from the mean. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Thumb collateral ligament injuries. 1989;17:751753. 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. 1994;23:797804. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 20. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 5. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". PMC Am J Sports Med. 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%). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Infection is a rare complication of hand surgery. 25. The authors report no funding or conflicts of interest. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). 3. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. the thumb. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 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. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Complications after surgery were rare. Sports Med Arthrosc Rev. 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 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. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Epub 2019 Mar 21. 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. Conclusions: official website and that any information you provide is encrypted Arthrosc Sports Med Rehabil. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? MCP fusion was performed . Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 1993;21:800804. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. **Stener lesion status reported in 6 studies (145 thumbs). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Please try after some time. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 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). These exercises may be directed by a physical or occupational therapist. 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. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Mean subject age was 33.9 years. 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. You are being redirected to Medscape Education. J Hand Surg Br. Your message has been successfully sent to your colleague. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 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. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 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 mean time from reported injury date to surgery was 202.4 days (2-5969). All but 2 were level IV evidence. This article provides a review of . Epub 2020 Jun 29. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. PMC 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. Posner MA, Retaillaud JL. *Gender reported in 12 studies (218 subjects). Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). J Bone Joint Surg Am. 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. Thumb sidedness reported in 3 studies (51 thumbs). The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 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. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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). 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. You may be trying to access this site from a secured browser on the server. 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. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. They may even tear completely. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 2006;31:6875. 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 2015 Sep 22. No study directly compared the different types of graft for UCL reconstruction. 6. The injury happens when you fall . Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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. A systematic review of ulnar collateral ligament reconstruction techniques. Nonoperative treatment often failed, necessitating surgery. 44. Eventually this abnormal movement will wear out the joint and it will become arthritic. 2013;23(4):247-254. Purpose: Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. No study compared different graft types or fixation techniques. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. J Hand Surg Am. 1976;58:106112. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. abduction-adduction motion. Throwing status reported in 4 studies. Fusetti C, Papaloizos M, Meyer H, et al.. Tension wire fixation of avulsion fractures in the hand. Early diagnosis and treatment. The https:// ensures that you are connecting to the Wolters Kluwer Health, Inc. and/or its subsidiaries. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 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. 8600 Rockville Pike Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. UCLR case series that contained complications data were included. MeSH Only prospective studies can determine this injury course. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Long-term results of ligament reconstruction. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 1996;25:527530. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Evaluation and management of elbow injuries in the adolescent overhead athlete. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. Search performed on November 17, 2011. 37. Orthop J Sports Med. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Thirty-two thumbs were treated nonoperatively and 261 operatively. This site needs JavaScript to work properly. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Wong TC, Ip FK, Wu WC. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Am J Sports Med. Only prospective studies can determine this injury course. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. For more information, please refer to our Privacy Policy. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. [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. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. doi: 10.1097/JSA.0000000000000322. Am J Sports Med. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Gamekeepers thumb: a prospective study of functional bracing. Engelhardt JB, Christensen OM, Christiansen TG. 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. eCollection 2021 Apr. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. [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. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). [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. Unable to load your collection due to an error, Unable to load your delegates due to an error. eCollection 2021. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Search for Similar Articles 1,5,9,10 In acute cases of complete tears involving high-level . Bennet Fracture. 1987;214:113120. 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. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 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. Mean study follow-up was 42.8 months. What Happens If We Sit for More Than 8 Hours Per Day? Mechanism of injury to the RCL of the MCP joint of the thumb is force . The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. Bean CH, Tencer AF, Trumble TE. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Post-traumatic instability of the metacarpophalangeal joint of the thumb. 7. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Upper extremity injuries in snow skiers. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 1999;24:7075. Rupture of the. 35. 1994;25:2123. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Abstract. 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. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. 18. 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. If the latter was executed only partially, a score of 1 was assigned. Subject demographics are reported in Table 2. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm.
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