Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Complications after surgery were rare. Possible complications include: - The mean patient age was 37.8 years (14.0-78.1). Complications after surgery were rare. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Engelhardt JB, Christensen OM, Christiansen TG. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Epub 2019 Mar 21. This leads to what is know as a positive ulnar variance. 2005;87:26322638. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Careers. Evaluation and management of elbow injuries in the adolescent overhead athlete. These exercises may be directed by a physical or occupational therapist. Moher D, Liberati A, Tetzlaff J, et al.. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Hand Clin. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 1994;23:797804. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Objectives: 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. [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. The LUCL is located on the lateral or outside part of the elbow. 6. 16. Orthop Rev. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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. The .gov means its official. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Sixty nine (86.3%) patients had grade 3 tears. 44. Thirty-two thumbs were treated nonoperatively and 261 operatively. Long-term results of ligament reconstruction. You may search for similar articles that contain these same keywords or you may 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . There is currently no consensus on treatment of acute or chronic UCL injuries. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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. Orthop Clin North Am. If the force is too strong, the ligaments can tear. official website and that any information you provide is encrypted Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. They may even tear completely. 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. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. The anti edema management will continue for several weeks. Thumb collateral ligament injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. Infection is a rare complication of hand surgery. All rights reserved. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 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. 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. A broken thumb can also cause numbness or tingling. You are being redirected to Medscape Education. Studies that duplicated patient populations from the same authors were excluded. 23. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Subject demographics are reported in Table 2. This site needs JavaScript to work properly. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. No study compared different graft types or fixation techniques. Epub 2021 Jan 18. Chir Main. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". These tears often occur as a result of a radially directed force on an extended thumb. 10. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Acta Chir Scand. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. 32. Injury. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. The limitations of this systematic review are reliant on the studies analyzed. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Early and late postoperative complications were recorded. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Conclusion: 19. 1989;17:751753. A systematic review of ulnar collateral ligament reconstruction techniques. 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. Part II: treatment and complications. Rupture of the. The https:// ensures that you are connecting to the Am J Sports Med. Proximal interphalangeal joint injuries of the hand. 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. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Sports Health. Epub 2015 Sep 22. Patient Demographics of Thumb RCL and UCL Injuries. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. J Hand Surg Br. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Jupiter JB, Sheppard JE. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 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. All authors independently performed the search. Categorical variable data were reported as frequency with percentages. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. [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. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Fourteen articles were included and analyzed (293 thumbs). 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. 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. Meta-analysis of the pooled data was completed. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Search for Similar Articles your express consent. Disclaimer. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Am J Orthop (Belle Mead NJ). A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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. 14. 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. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. Thus, the true natural history is yet unknown. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Am J Sports Med. 2005;24:217221. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 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). Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Posner MA, Retaillaud JL. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Surgical techniques and a review of 70 patients. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . eCollection 2021 Mar. 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. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. eCollection 2021. 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. Pichora DR, McMurtry RY, Bell MJ. 1993;21:800804. Part I of this two-part article focuses on common tendon and . gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 2021 Apr 15;3(2):e527-e533. [38] Chuter et al[40] 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. Catalano LW III, Cardon L, Patenaude N, et al.. Gamekeeper's thumb. J Hand Surg Am. You will receive email when new content is published. Wolters Kluwer Health Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Arthrosc Sports Med Rehabil. Epub 2021 Sep 7. 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. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. eCollection 2021 Apr. 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 were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Before 2006;31:6875. MeSH 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 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.
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