He too had the internal brace augmentation. There were 200 acute injuries and 93 chronic injuries. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent AAHS - Comparison of Complications after Thumb Metacarpophalangeal official website and that any information you provide is encrypted PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. In some cases, certain risk factors make it more likely that a bone will fail to heal. 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. If the force is too strong, the ligaments can tear. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. For more information, please refer to our Privacy Policy. 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%). You may search for similar articles that contain these same keywords or you may The torn thumb ligament is repaired or reconstructed during surgery. Jupiter JB, Sheppard JE. Mean subject age was 33.9 years. Engelhardt JB, Christensen OM, Christiansen TG. There is currently no consensus on treatment of acute or chronic UCL injuries. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Thus, the true natural history is yet unknown. flexion-extension motion. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. A score of 2 was assigned if the item was completely and accurately performed and reported. You are being redirected to Medscape Education. Wong TC, Ip FK, Wu WC. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. eCollection 2021 Apr. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. Sports Health. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). 1995;18:11611165. Arthritis Rheum. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. Accessibility 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. Skier's thumb - Physiopedia The .gov means its official. Clinical Journal of Sport Medicine23(4):247-254, July 2013. There are some cases where the fusion is not successful and you will still have pain in . Epub 2014 Oct 22. 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). J Bone Joint Surg Am. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Orthopedics. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 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. 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. 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. Treatment of chronic injuries of the. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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 splint for protection or at night until twelve weeks after the operation. Bennet Fracture. 39. Fusetti C, Papaloizos M, Meyer H, et al.. Ulnar collateral ligament injuries of the thumb: a comprehensive review. You may be trying to access this site from a secured browser on the server. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Before Mean subject age was 33.9 years. Arthrosc Sports Med Rehabil. Long-term results of ligament reconstruction. 2013Lippincott Williams & Wilkins. Would you like email updates of new search results? The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Bookshelf Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. J Bone Joint Surg Am. MeSH Kaplan EB. Ulnar Collateral Ligament Repair and Reconstruction eCollection 2022 May. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Acta Chir Scand. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. This website also contains material copyrighted by 3rd parties. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. PLoS Med. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 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. 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. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 1992;8:713732. J Bone Joint Surg Am. and twist using your thumb. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 23. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. The grip strength and the pinch strength were 94.3% and 92.27%,. abduction-adduction motion. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Exercises: Gradually progress to competitive throwing and sports . 2005;24:217221. 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. Athletes Can Return to Play in Half the Time with New Thumb Ligament There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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%). 1. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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. Table 1. After failure of nonoperative treatment, at anywhere from 6 months 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. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. This site needs JavaScript to work properly. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 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%. Epub 2015 Sep 22. Complications after surgical treatment of UCL injury are rare. 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. 2. Symptoms are dependent on the cause and severity of injury to the UCL. National Library of Medicine Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 18. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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%). UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 1999;24:7075. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Part I of this two-part article focuses on common tendon and . Chir Main. 8600 Rockville Pike Thirty-two thumbs were treated nonoperatively and 261 operatively. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 10. 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Would you like email updates of new search results? Doi: 10.1177/2325967118769328. 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. Proximal interphalangeal joint injuries of the hand. Posner MA, Retaillaud JL. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Conflicts of interest The authors report no funding or conflicts of interest. Pain reduction was significantly improved in all subjects (P < 0.05). A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries UCLR case series that contained complications data were included. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Complications after surgery were rare. Bethesda, MD 20894, Web Policies [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The injury happens when you fall . Data sources: If the tear is diagnosed later a ligament reconstruction might be a better option. Diagnosis of displaced, 43. 1987;214:113120. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Methods: sharing sensitive information, make sure youre on a federal After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 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. No study reported the outcomes of nonoperative management of chronic UCL injury. A score of 0 was assigned if the item was either omitted or not performed. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Pichora DR, McMurtry RY, Bell MJ. Fourteen articles were included and analyzed (293 thumbs). Dr. Holt will talk to you about when it is safe to return to work. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Am J Sports Med. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Data range was reported as minimum to maximum absolute values. 1989;71:383387. Hand Surgery Recovery Time: Pain, Exercise & Complications Possible complications include: - Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. 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.