The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Please enable scripts and reload this page. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Infection is a rare complication of hand surgery. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. You will receive email when new content is published. 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. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries Unauthorized use of these marks is strictly prohibited. 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. The Complications of CMC Thumb Surgery | Healthy Living Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. J Hand Surg Am. Systematic review and meta-analysis. 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. 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. J Hand Surg Br. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. J Hand Surg Glob Online. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 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. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Wolters Kluwer Health
Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube *Glickel grading system. 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. Complications after surgical treatment of UCL injury are rare. Gamekeeper's thumb. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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. 8600 Rockville Pike Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. *Glickel grading scale. J Bone Joint Surg Am. official website and that any information you provide is encrypted Mechanism of injury to the RCL of the MCP joint of the thumb is force . Hand Surgery Recovery Time: Pain, Exercise & Complications 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. The effect of thumb metacarpophalangeal. Bookshelf There is currently no consensus on treatment of acute or chronic UCL injuries. *Gender reported in 12 studies (218 subjects). All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). The limitations of this systematic review are reliant on the studies analyzed. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 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. 1995;23:222226. 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. All but 2 were level IV evidence. J Bone Joint Surg Am. SAGE Open Med. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Orthopedics. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 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%). Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. You've successfully added to your alerts. [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. 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). There were 61 studies eliminated as secondary for being in a language other than English. 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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair 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. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Epub 2015 Sep 22. The mean time from reported injury date to surgery was 202.4 days (2-5969). Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Exercises: Gradually progress to competitive throwing and sports . Outcomes After Injury to the Thumb Ulnar Collateral Ligament 20. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Before Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. Arthritis Rheum. Federal government websites often end in .gov or .mil. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 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. Wong TC, Ip FK, Wu WC. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. No study reported the outcomes of nonoperative management of chronic UCL injury. 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. 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. 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. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 14. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. There is currently no consensus on treatment of acute or chronic UCL injuries. Both purely ligamentous and bony avulsion injuries were included. 25. 1961;43-A:541546. official website and that any information you provide is encrypted 16. Thus, the true natural history is yet unknown. They may even tear completely. 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. Keywords: If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Conclusion: If the latter was executed only partially, a score of 1 was assigned. Am J Sports Med. Frykman G, Johansson O. Surgical repair of rupture of the, 46. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Epub 2013 Nov 12. 22. Muscles. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. 23. Rupture of the ulnar collateral ligament of the thumb - a review 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. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Dr. Holt will talk to you about when it is safe to return to work. PMC HHS Vulnerability Disclosure, Help Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Pichora DR, McMurtry RY, Bell MJ. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 18. The doctor won't know if the repair is . Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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 . Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. 1995;18:11611165. An official website of the United States government. [15,39] It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament. Ulnar Collateral Ligament Injuries of the Thumb - Panther Data sources: Catalano LW III, Cardon L, Patenaude N, et al.. 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%). HHS Vulnerability Disclosure, Help It runs from the outer humerus, around the radial head and attaches to the ulna. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Weakened grip or reduced thumb range of motion may occur. A score of 0 was assigned if the item was either omitted or not performed. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb Thumb from the common mechanism of falling on the thumb while holding a ski pole. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 19. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Nonoperative treatment often failed, necessitating surgery. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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 Abrahamsson SO, Sollerman C, Lundborg G, et al.. Epub 2021 Sep 7. These tears often occur as a result of a radially directed force on an extended thumb. Complications after this procedure may include nerve or blood vessel damage. UCL Repair of the Thumb - MSA Hand Center Your ligament may need to be reattached to the bone using a bone anchor. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Bailie DS, Benson LS, Marymont JV. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 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. 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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Commonly Missed Orthopedic Problems | AAFP Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Doi: 10.1177/2325967118769328. and twist using your thumb. If you log out, you will be required to enter your username and password the next time you visit. Clin J Sport Med. Rupture of the. 1,5,9,10 In acute cases of complete tears involving high-level . PLoS Med. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Bennet Fracture. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 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. An official website of the United States government. MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com 2013;23(4):247-254. Study design: 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Skier's thumb - Physiopedia eCollection 2022 May. A sprained thumb is a common injury among athletes. Nonsurgical Management of Ulnar Collateral Ligament Injuries PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher PIP Joint Injuries of the Finger - Orthogate Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 2005;87:26322638. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Injury. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. UCLR case series that contained complications data were included. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Clipboard, Search History, and several other advanced features are temporarily unavailable. Symptoms are dependent on the cause and severity of injury to the UCL. 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). Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. The site is secure. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. The mean patient age was 37.8 years (14.0-78.1). doi: 10.1016/j.asmr.2020.12.004. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina You are being redirected to Medscape Education. 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). Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). What Happens If We Sit for More Than 8 Hours Per Day? Evaluation and management of elbow injuries in the adolescent overhead athlete. Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Am J Sports Med. The Effect of Ulnar Collateral Ligament Repair With Internal Brace Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Results: Mean study follow-up was 42.8 months. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Accessibility There is currently no consensus on treatment of acute or chronic UCL injuries. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 12. 2009;34:304308. 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*. J Hand Surg Am. Orthop Clin North Am. 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. 44. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 2009;61:623632. The https:// ensures that you are connecting to the 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. modify the keyword list to augment your search. Metacarpophalangeal joint injuries of the thumb. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Ulnar Collateral Ligament Repair and Reconstruction
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