An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. Your surgeon is the person best able to help you avoid any serious recovery problems. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Purpose: [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. Am J Orthop (Belle Mead NJ). 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. 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. 1993;21:800804. 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. Thumb dominance reported in 8 studies (168 thumbs). Bailie DS, Benson LS, Marymont JV. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Accessibility Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. 1996;25:474477. Only prospective studies can determine this injury course. 38. Kaplan EB. MeSH Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Sakellarides HT, DeWeese JW. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Hand Surg. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Keywords: However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. The effect of thumb metacarpophalangeal. Pichora DR, McMurtry RY, Bell MJ. Proximal interphalangeal joint injuries of the hand. I was able to work while wearing the splint. 23. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Downey DJ, Moneim MS, Omer GE Jr. 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. The grip strength and the pinch strength were 94.3% and 92.27%,. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. There were no cases of intraoperative ulnar nerve injury reported. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. A score of 2 was assigned if the item was completely and accurately performed and reported. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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). Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 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. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Results: Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 39. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. 11. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Infection is a rare complication of hand surgery. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 5. Keyword Highlighting
POST-OPERATIVE WEEKS 22-24. 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%. Table 1. Clipboard, Search History, and several other advanced features are temporarily unavailable. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Engelhardt JB, Christensen OM, Christiansen TG. Wong TC, Ip FK, Wu WC. The LUCL is located on the lateral or outside part of the elbow. 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. The overall complication rate was 13.8% (11/80). Am J Sports Med. Stener B. Skeletal injuries associated with rupture of the. Epub 2021 Sep 7. 1. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 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. Thumb sidedness reported in 3 studies (51 thumbs). Thus, the true natural history is yet unknown. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. No study directly compared nonoperative to operative treatment. Hand Clin. J Hand Surg Br. 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. 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. 2005;87:26322638. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Figure 46-2 Approach to the ulnar collateral ligament. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 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. 22. [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. 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. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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 ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). The doctor won't know if the repair is . eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Your thumb will be immobilized in a splint and should not be moved until follow up. An official website of the United States government. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Gamekeeper's thumb. Bennet Fracture. SAGE Open Med. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Evaluation and management of elbow injuries in the adolescent overhead athlete. National Library of Medicine 2018;6(4):1-7. Federal government websites often end in .gov or .mil. eCollection 2021. 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. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. J Hand Surg Am. Please enter a Recipient Address and/or check the Send me a copy checkbox. Diagnosis of displaced, 43. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). [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. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Gamekeepers thumb: a prospective study of functional bracing. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 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. 10. Complications after surgery were rare. J Bone Joint Surg Am. Bostock S, Morris MA. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. 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. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). All techniques improved clinical outcomes, including pain, motion, strength, and stability. 2009;34:304308. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. For more information, please refer to our Privacy Policy. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. The site is secure. Nonoperative treatment often failed, necessitating surgery. There is currently no consensus on treatment of acute or chronic UCL injuries. UCLR case series that contained complications data were included. The mean patient age was 37.8 years (14.0-78.1). 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 . Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 1999;24:7075. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Please enable scripts and reload this page. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 2. 25. Thirty-two thumbs were treated nonoperatively and 261 operatively. Symptoms are dependent on the cause and severity of injury to the UCL. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. A secondary purpose was to compare graft choice and surgical technique for reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Study design: [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped .