Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). Engelhardt JB, Christensen OM, Christiansen TG. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. [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. Sakellarides HT, DeWeese JW. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). Quantitative outcome of surgical repair. 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). Continuous variable data were reported as mean SDs from the mean. 1995;18:11611165. [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. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Unauthorized use of these marks is strictly prohibited. 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. You may search for similar articles that contain these same keywords or you may
2006;31:6875. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. J Hand Surg Glob Online. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Fourteen articles were included and analyzed (293 thumbs). Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. You may also begin strengthening exercises if needed. sharing sensitive information, make sure youre on a federal 12. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Descriptive statistics were calculated. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. 4. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Meta-analysis of the pooled data was completed. For more information, please refer to our Privacy Policy. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 2009;61:623632. 23. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. 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. 1994;23:797804. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. 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 . Post-traumatic instability of the metacarpophalangeal joint of the thumb. Orthop Rev. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. POST-OPERATIVE WEEKS 22-24. Downey DJ, Moneim MS, Omer GE Jr. Studies that duplicated patient populations from the same authors were excluded. Educate the patient on anti edema management. NR, not reported. 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. When assessed, most patients returned to their preinjury employment. 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. Your surgeon is the person best able to help you avoid any serious recovery problems. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 1998;23:503506. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Bookshelf 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. #Injury location reported only in 3 studies. 6. *Glickel grading system. Throwing status reported in 4 studies. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. If your bone is broken, a pin will be used to put it in place. J Bone Joint Surg Am. Please enable it to take advantage of the complete set of features! [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]. J Hand Surg Am. Please confirm that you would like to log out of Medscape. Proximal interphalangeal joint injuries of the hand. Background: 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. All techniques improved clinical outcomes, including pain, motion, strength, and stability. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. doi: 10.1097/JSA.0000000000000322. 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. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). J Hand Surg Am. Bostock S, Morris MA. To date, no literat. [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. Please enable it to take advantage of the complete set of features! 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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Infection is a rare complication of hand surgery. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 2009;6:e1000097. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 1995;23:222226. He too had the internal brace augmentation. Chir Main. 35. 1977;59:1421. Moher D, Liberati A, Tetzlaff J, et al.. 22. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Before UCLR case series that contained complications data were included. Systematic review and meta-analysis. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. The Orthopedic Journal of Sports Medicine. 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). It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). [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. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Am J Sports Med. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. There are some cases where the fusion is not successful and you will still have pain in . Bean CH, Tencer AF, Trumble TE. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. better/same/worse than preoperative status). At this stage, patients should be advised to wear your splint part-time. Clipboard, Search History, and several other advanced features are temporarily unavailable. Proximal interphalangeal joint injuries of the hand. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. Complications after surgery were rare. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Riederer S, Nagy L, Buchler U. Weakened grip or reduced thumb range of motion may occur. 14 It is important to diagnose complete tears early because . All but 2 were level IV evidence. 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. Thumb dominance reported in 8 studies (168 thumbs). No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 20. and transmitted securely. 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. For example, it can be removed when performing . Hand Surg. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. Exercises: Gradually progress to competitive throwing and sports . 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 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. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. National Library of Medicine 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. A broken thumb can also cause numbness or tingling. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. If it is appropriate, then surgical consent probably happened before the surgery. The limitations of this systematic review are reliant on the studies analyzed. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 38. 2013Lippincott Williams & Wilkins. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Bookshelf Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. eCollection 2021. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) The anti edema management will continue for several weeks. 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. Catalano LW III, Cardon L, Patenaude N, et al.. 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). Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. SYMPTOMS: The thumb may be swollen, bruised and painful. 1994;25:2123. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Data range was reported as minimum to maximum absolute values. Am J Sports Med. Methods: Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 2009;34:304308. Only prospective studies can determine this injury course. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. A common complication following fracture of the distal radius is when the radius shortens. 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). This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Pain reduction was significantly improved in all subjects (P < 0.05). Epub 2014 Dec 30. HHS Vulnerability Disclosure, Help 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%). Please try after some time. 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. 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 . MeSH There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Surgical management of chronic, 42. Wong TC, Ip FK, Wu WC. 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. 1962;124:396411. 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. 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. Long-term results of ligament reconstruction. Your ligament may need to be reattached to the bone using a bone anchor. 2005;87:26322638. Tension wire fixation of avulsion fractures in the hand. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 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. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 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 Most times, they won't know until they're in the surgery if the internal brace is appropriate. No study directly compared the different types of graft for UCL reconstruction. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Nonoperative treatment often failed, necessitating surgery. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Bennet Fracture. Orthopedics. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Epub 2016 Jan 13. Keywords: Ulnar Collateral Ligament Repair . Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Jupiter JB, Sheppard JE. Search performed on November 17, 2011. 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%. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. may email you for journal alerts and information, but is committed
Unauthorized use of these marks is strictly prohibited. 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. Rupture of the. I was able to work while wearing the splint. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. The mean patient age was 37.8 years (14.0-78.1). MCP collateral ligament sprain is most commonly an acute injury related to trauma. The LUCL is located on the lateral or outside part of the elbow. Your thumb will be immobilized in a splint and should not be moved until follow up. Complications after this procedure may include nerve or blood vessel damage. 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. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. Kuz JE, Husband JB, Tokar N, et al.. 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. Unilateral injuries: 291 and bilateral injury: 1. Thirty-two thumbs were treated nonoperatively and 261 operatively. Thumb collateral ligament injuries. The authors report no funding or conflicts of interest. Fusetti C, Papaloizos M, Meyer H, et al.. the splint for protection or at night until twelve weeks after the operation. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Pichora DR, McMurtry RY, Bell MJ. J Hand Surg Am. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation.