Thumb dominance reported in 8 studies (168 thumbs). If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. 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. Non-Fusion. Epub 2016 Jan 13. 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. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 17. Exercises: Gradually progress to competitive throwing and sports . The effect of thumb metacarpophalangeal. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Bean CH, Tencer AF, Trumble TE. 12. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. UCLR case series that contained complications data were included. 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%). The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Muscles. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Sports Health. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Methods: Base of Thumb Fractures - Hand - Orthobullets 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. 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. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. J Hand Surg Am. Table 1. 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%). The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Anesthesia for Hand Surgery | The Hand & Wrist Center Kaplan EB. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 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. Downey DJ, Moneim MS, Omer GE Jr. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. [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. Main results: Both purely ligamentous and bony avulsion injuries were included. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 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. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed J Hand Surg Am. Click the topic below to receive emails when new articles are available. 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. 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. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Fourteen articles were included and analyzed (293 thumbs). A secondary purpose was to compare graft choice and surgical technique for reconstruction. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. What Happens If We Sit for More Than 8 Hours Per Day? [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. Complications after this procedure may include nerve or blood vessel damage. All authors independently performed the search. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Pain reduction was significantly improved in all subjects (P < 0.05). [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. *Glickel grading scale. 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. Before 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). Only prospective studies can determine this injury course. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. MCP (MetaCarpophalangeal) Collateral Ligament Sprain After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Epub 2020 Jun 29. Injuries to the PIP joint remain swollen for long periods of time. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 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. In some cases, certain risk factors make it more likely that a bone will fail to heal. **Stener lesion status reported in 6 studies (145 thumbs). Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 23. Part I: anatomy and diagnosis. MCP fusion was performed . The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. [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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Systematic review and meta-analysis. 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. 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. Ulnar Collateral Ligament Repair . The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. There were 200 acute injuries and 93 chronic injuries. A sprained thumb is a common injury among athletes. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. may email you for journal alerts and information, but is committed 34. Stener B. Skeletal injuries associated with rupture of the. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. Thumb sidedness reported in 3 studies (51 thumbs). Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Wong TC, Ip FK, Wu WC. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 13. 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 thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. This leads to what is know as a positive ulnar variance. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 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 . Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 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. He too had the internal brace augmentation. The .gov means its official. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. official website and that any information you provide is encrypted 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. 1996;25:474477. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. 1999;24:275282. Bennet Fracture. J Bone Joint Surg Am. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries This site needs JavaScript to work properly. An anatomic basis for treatment. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Clipboard, Search History, and several other advanced features are temporarily unavailable. government site. J Bone Joint Surg Am. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Complications after surgery were rare. Surgical management of chronic, 42. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Am J Sports Med. 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. 31. The site is secure. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Nonoperative treatment often failed, necessitating surgery. Louis DS, Huebner JJ Jr, Hankin FM. 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. Instability of the metacarpophalangeal joint of the thumb. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Please confirm that you would like to log out of Medscape. There is currently no consensus on treatment of acute or chronic UCL injuries. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 1999;24:7075. These exercises may be directed by a physical or occupational therapist. The limitations of this systematic review are reliant on the studies analyzed. The https:// ensures that you are connecting to the This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Sixty nine (86.3%) patients had grade 3 tears. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist If the latter was executed only partially, a score of 1 was assigned. 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. Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion Data range was reported as minimum to maximum absolute values. There is currently no consensus on treatment of acute or chronic UCL injuries. 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 . Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complications you may experience after Hand Surgery - Rebecca Ayers Sakellarides HT, DeWeese JW. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. HHS Vulnerability Disclosure, Help Wolters Kluwer Health, Inc. and/or its subsidiaries. PIP Joint Injuries of the Finger - Orthogate Thumb Ulnar Collateral Ligament repair; A Step by Step Guide When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Am J Sports Med. 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. Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Surgical techniques and a review of 70 patients. Am J Sports Med. You may search for similar articles that contain these same keywords or you may Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. 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. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Please enable it to take advantage of the complete set of features! 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. Categorical variable data were reported as frequency with percentages. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Before Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. A systematic review of ulnar collateral ligament reconstruction techniques. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Federal government websites often end in .gov or .mil. official website and that any information you provide is encrypted Chir Main. 14 It is important to diagnose complete tears early because . 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. Careers. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 1998;23:503506. Am J Orthop (Belle Mead NJ). Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 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). 1994;23:797804. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Bookshelf Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. RCL Reconstruction Thumb MPJ - The Hand Treatment Center Keywords: Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Part I of this two-part article focuses on common tendon and . Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Your thumb will be immobilized in a splint and should not be moved until follow up. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Commonly Missed Orthopedic Problems | AAFP Studies that duplicated patient populations from the same authors were excluded. 35. This article provides a review of . Orthopedics. Various levels of pain, bruising, or edema may present at the site of damage. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Jupiter JB, Sheppard JE. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. There is currently no consensus on treatment of acute or chronic UCL injuries. Meta-analysis of the pooled data was completed. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. The .gov means its official. 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. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP Wolters Kluwer Health A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. You are being redirected to Medscape Education. Gamekeeper's thumb. Search performed on November 17, 2011. An official website of the United States government. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Fourteen articles were included and analyzed (293 thumbs). Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Rupture and displacement of the. 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. No study directly compared the different types of graft for UCL reconstruction. Complications of Ulnar Collateral Ligament Repair | SpringerLink A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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. 16. Accessibility The https:// ensures that you are connecting to the MCP collateral ligament sprain is most commonly an acute injury related to trauma. Complications after surgical treatment of UCL injury are rare. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair