Injuries to the PIP joint remain swollen for long periods of time. Ulnar Collateral Ligament Repair . *Glickel grading system. three muscles provide deforming forces at the base of the thumb. Before This damage may lead to temporary or permanent numbness or weakness.
Hand Surgery Recovery Time: Pain, Exercise & Complications In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 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*. 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 article provides a review of . There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Chir Main. There is currently no consensus on treatment of acute or chronic UCL injuries. SAGE Open Med. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 1992;8:713732. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Please try after some time. Am J Sports Med. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 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. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. The torn thumb ligament is repaired or reconstructed during surgery. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. The Orthopedic Journal of Sports Medicine. PMC Before UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament Purpose.
Ulnar collateral ligament injury of the thumb - Wikipedia Thumb dominance reported in 8 studies (168 thumbs). 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. Possible complications include: - Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. There is, 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. Eurasian J Med. Arthrosc Sports Med Rehabil. Most times, they won't know until they're in the surgery if the internal brace is appropriate. You are being redirected to Medscape Education. Smith RJ. 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%). J Bone Joint Surg Am. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). No study directly compared the different types of graft for UCL reconstruction. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor.
Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. You will receive email when new content is published. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Epub 2019 Mar 21. All techniques improved clinical outcomes, including pain, motion, strength, and stability.
Nonsurgical Management of Ulnar Collateral Ligament Injuries Ulnar Collateral Ligament Injuries of the Thumb - Panther 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%. 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. Bookshelf PLoS Med. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. [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.
Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 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. Epub 2014 Oct 22. 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. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 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. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. A systematic review of ulnar collateral ligament reconstruction techniques. 11. 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). The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. J Hand Surg Am. 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. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. #Injury location reported only in 3 studies. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Bennet Fracture. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Fourteen articles were included and analyzed (293 thumbs). 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. Orthop J Sports Med. Thus, the true natural history is yet unknown. National Library of Medicine Louis DS, Huebner JJ Jr, Hankin FM.
UCL Repair of the Thumb - MSA Hand Center 5. 20. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Sports Med Arthrosc Rev. Weakened grip or reduced thumb range of motion may occur. Would you like email updates of new search results? Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Mean subject age was 33.9 years.
Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 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. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Complications after this procedure may include nerve or blood vessel damage. 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. Descriptive statistics were calculated. [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 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Abstract. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. [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. eCollection 2022 May. Bethesda, MD 20894, Web Policies
Ulnar Collateral Ligament Repair and Reconstruction Surgical techniques and a review of 70 patients. This website also contains material copyrighted by 3rd parties. Nonoperative treatment often failed, necessitating surgery. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 A broken thumb can also cause numbness or tingling. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. 1995;18:11611165. Epub 2020 Jun 29. 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. Unilateral injuries: 291 and bilateral injury: 1.
Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Posner MA, Retaillaud JL. Metacarpophalangeal joint injuries of the thumb. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 2009;61:623632. HHS Vulnerability Disclosure, Help
PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Quantitative outcome of surgical repair. If it is appropriate, then surgical consent probably happened before the surgery. 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. 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. 7. J Bone Joint Surg Am. 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. 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). There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. POST-OPERATIVE WEEKS 22-24.
Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Please enter a Recipient Address and/or check the Send me a copy checkbox. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. At this stage, patients should be advised to wear your splint part-time. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 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. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 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. Methods: Keyword Highlighting
Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 1999;24:7075. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 1994;23:797804. [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. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. 13. The .gov means its official. Epub 2016 Jan 13. Sports Health. Am J Orthop (Belle Mead NJ). It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis.
Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 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. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Ulnar collateral ligament injuries of the thumb: a comprehensive review. An official website of the United States government. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 38. The site is secure. Systematic review and meta-analysis. An official website of the United States government. FOIA The LUCL is located on the lateral or outside part of the elbow. If the force is too strong, the ligaments can tear. A sprained thumb is a common injury among athletes. 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. Infection is a rare complication of hand surgery. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Tension wire fixation of avulsion fractures in the hand. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Doi: 10.1177/2325967118769328. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. Accessibility 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. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. 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. Early and late postoperative complications were recorded. 37. Please enable scripts and reload this page. There were 200 acute injuries and 93 chronic injuries. J Hand Surg Am. 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%). 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Data is temporarily unavailable. Clipboard, Search History, and several other advanced features are temporarily unavailable. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers.