ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Catalano LW III, Cardon L, Patenaude N, et al.. Thumb from the common mechanism of falling on the thumb while holding a ski pole. A score of 0 was assigned if the item was either omitted or not performed. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 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. 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. the thumb. 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. 2013Lippincott Williams & Wilkins. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 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*. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Injuries to the PIP joint remain swollen for long periods of time. NR, not reported.
Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) Melone CP Jr, Beldner S, Basuk RS. Early diagnosis and treatment. Part I: anatomy and diagnosis. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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.. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 37. 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. Continue to stretch before and after throwing . official website and that any information you provide is encrypted Please enable scripts and reload this page. This article provides a review of . Quantitative outcome of surgical repair. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. *Glickel grading scale. Kaplan EB. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. 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 . 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Studies that duplicated patient populations from the same authors were excluded. 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. 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. Categorical variable data were reported as frequency with percentages. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 1962;124:396411. Unauthorized use of these marks is strictly prohibited. Acute gamekeeper's thumb. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis.
Treatment for thumb collateral ligament injury - KW orthopaedics Surgical Repair of Ulnar Collateral Ligament of ThumbDr.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 24.
PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois Mean subject age was 33.9 years. Objectives: Bennet Fracture. [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. Possible complications include: - Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 23. eCollection 2021 Apr. No study directly compared nonoperative to operative treatment. There is currently no consensus on treatment of acute or chronic UCL injuries. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. You've successfully added to your alerts. Diagnosis of displaced, 43.
Ulnar collateral ligament repair surgery Archives | OrthoVirginia 10. A score of 2 was assigned if the item was completely and accurately performed and reported. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Early and late postoperative complications were recorded. 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. 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%). 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. Would you like email updates of new search results?
[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. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . 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.
Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia Bethesda, MD 20894, Web Policies Am J Orthop (Belle Mead NJ). Muscles. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Gamekeeper's thumb. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. You will receive email when new content is published. unstable when the thumb is used. PLoS Med. #Injury location reported only in 3 studies. Your surgeon will discuss these options with you. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 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. 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. Your surgeon is the person best able to help you avoid any serious recovery problems. 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. 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%. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Meta-analysis of the pooled data was completed. 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). may email you for journal alerts and information, but is committed
Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. The injury happens when you fall . Nonoperative treatment often failed, necessitating surgery. Mean study follow-up was 42.8 months. J Hand Surg Am. to maintaining your privacy and will not share your personal information without
Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. sharing sensitive information, make sure youre on a federal Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 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.
Complications Following Distal Radius Fractures - Mike Reinold POST-OPERATIVE WEEKS 22-24. Disclaimer. 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. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. You are being redirected to Medscape Education. Patient Demographics of Thumb RCL and UCL Injuries. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. You may also begin strengthening exercises if needed. 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. 2021 Apr 15;3(2):e527-e533. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 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. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Thumb dominance reported in 8 studies (168 thumbs). This website also contains material copyrighted by 3rd parties. The https:// ensures that you are connecting to the National Library of Medicine Am J Sports Med. Bean CH, Tencer AF, Trumble TE. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 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. Orthop J Sports Med. Keyword Highlighting
Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Proximal interphalangeal joint injuries of the hand. 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. 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. Sakellarides HT, DeWeese JW.
Midterm clinical outcomes of collateral ligament repair of the thumb Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Fusetti C, Papaloizos M, Meyer H, et al.. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756.
Complications you may experience after Hand Surgery - Rebecca Ayers 1977;59:1421. 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%). Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. A sprained thumb is a common injury among athletes. 2003;8:8185. UCLR case series that contained complications data were included. 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 . [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Wolters Kluwer Health
A p-value of 0.05 was considered statistically significant. 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. Accessibility There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Conclusion: The doctor won't know if the repair is . 2013;23(4):247-254. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Wolters Kluwer Health, Inc. and/or its subsidiaries. Search for Similar Articles
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. Surgical management of chronic, 42. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Accessibility modify the keyword list to augment your search. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. FOIA Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Your message has been successfully sent to your colleague. Keywords:
Ulnar Collateral Ligament (UCL) Injuries of the Elbow Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). If the tear is diagnosed later a ligament reconstruction might be a better option. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint.
2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. [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. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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.
Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. SYMPTOMS: The thumb may be swollen, bruised and painful. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) 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. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. The authors report no funding or conflicts of interest. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 6. J Hand Surg Br. 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).