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. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). 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. 2. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 1987;214:113120. 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. Your message has been successfully sent to your colleague. Doi: 10.1177/2325967118769328. three muscles provide deforming forces at the base of the thumb. Search for Similar Articles Would you like email updates of new search results? 5. Background: Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 4. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Mean subject age was 33.9 years. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Federal government websites often end in .gov or .mil. You may be trying to access this site from a secured browser on the server. Bailie DS, Benson LS, Marymont JV. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Am J Sports Med. 2013;23(4):247-254. 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. 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%). Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. [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. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 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. Kaplan EB. The injury happens when you fall . Engelhardt JB, Christensen OM, Christiansen TG. Bennet Fracture. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 1995;18:11611165. Data is temporarily unavailable. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 23. 1999;24:7075. Am J Sports Med. Click the topic below to receive emails when new articles are available. Meta-analysis of the pooled data was completed. This site needs JavaScript to work properly. 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). abduction-adduction motion. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. [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. 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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. and transmitted securely. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Part I of this two-part article focuses on common tendon and . Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. If it is appropriate, then surgical consent probably happened before the surgery. The https:// ensures that you are connecting to the Both purely ligamentous and bony avulsion injuries were included. [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. If your bone is broken, a pin will be used to put it in place. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 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. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Early and late postoperative complications were recorded. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. There is currently no consensus on treatment of acute or chronic UCL injuries. You've successfully added to your alerts. UCLR case series that contained complications data were included. HHS Vulnerability Disclosure, Help 1989;14:567573. Federal government websites often end in .gov or .mil. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Possible complications include: - 35. 10. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Your surgeon is the person best able to help you avoid any serious recovery problems. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Your surgeon will discuss these options with you. An official website of the United States government. 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. Thumb dominance reported in 8 studies (168 thumbs). For example, it can be removed when performing . Arnold DM, Cooney WP, Wood MB. All techniques improved clinical outcomes, including pain, motion, strength, and stability. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Orthop J Sports Med. 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. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 1,5,9,10 In acute cases of complete tears involving high-level . Sixty nine (86.3%) patients had grade 3 tears. Your ligament may need to be reattached to the bone using a bone anchor. Continue to stretch before and after throwing . 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. 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.. Hand Clin. 18. A common complication following fracture of the distal radius is when the radius shortens. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Throwing status reported in 4 studies. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. The https:// ensures that you are connecting to the These exercises may be directed by a physical or occupational therapist. Causes. Nonoperative treatment often failed, necessitating surgery. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Most times, they won't know until they're in the surgery if the internal brace is appropriate. J Bone Joint Surg Am. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. The mean patient age was 37.8 years (14.0-78.1). Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. If the latter was executed only partially, a score of 1 was assigned. Purpose: Search performed on November 17, 2011. 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. Wolters Kluwer Health, Inc. and/or its subsidiaries. Arthrosc Sports Med Rehabil. flexion-extension motion. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 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. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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). Upper extremity injuries in snow skiers. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Results: Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. In some cases, certain risk factors make it more likely that a bone will fail to heal. 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 Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. 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. History. J Hand Surg Am. 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. 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. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Eventually this abnormal movement will wear out the joint and it will become arthritic. Jackson M, McQueen MM. NR, not reported. 2000;16:345357. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 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. 34. Injury. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 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. No study compared different graft types or fixation techniques. Thus, the true natural history is yet unknown. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. National Library of Medicine 2009;6:e1000097. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. At this stage, patients should be advised to wear your splint part-time. Continuous variable data were reported as mean SDs from the mean. Downey DJ, Moneim MS, Omer GE Jr. Smith RJ. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 1. 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. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. FOIA 14 It is important to diagnose complete tears early because . 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. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). The Orthopedic Journal of Sports Medicine. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 24. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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. 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. modify the keyword list to augment your search. 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. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. Complications after surgery were rare. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2009;34:304308. and transmitted securely. Eurasian J Med. 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. Louis DS, Huebner JJ Jr, Hankin FM. 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 . Quantitative outcome of surgical repair. 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.
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