and transmitted securely. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. PLoS Med. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Ulnar collateral ligament injuries of the thumb: a comprehensive review. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. The grip strength and the pinch strength were 94.3% and 92.27%,. 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. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Search for Similar Articles 17. 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. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 2013Lippincott Williams & Wilkins. You will receive email when new content is published. Arthritis Rheum. J Hand Surg Glob Online. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery eCollection 2021 Apr. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 1999;24:275282. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Epub 2015 Sep 22. Chir Main. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Weakened grip or reduced thumb range of motion may occur. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 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. 38. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 25. Epub 2016 Jan 13. 1996;25:474477. Symptoms are dependent on the cause and severity of injury to the UCL. This website also contains material copyrighted by 3rd parties. 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. All but 2 were level IV evidence. 1989;14:567573. Sports Med Arthrosc Rev. 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. Bethesda, MD 20894, Web Policies Epub 2019 Mar 21. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. 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. You may search for similar articles that contain these same keywords or you may MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. J Bone Joint Surg Am. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Evaluation and management of elbow injuries in the adolescent overhead athlete. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Complications after surgical treatment of UCL injury are rare. 2018;6(4):1-7. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 1996;25:527530. sharing sensitive information, make sure youre on a federal 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. 2006;31:6875. 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). Please confirm that you would like to log out of Medscape. Tension wire fixation of avulsion fractures in the hand. 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. 5. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 10. Main results: the thumb. Injuries to the PIP joint remain swollen for long periods of time. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Complications after this procedure may include nerve or blood vessel damage. Federal government websites often end in .gov or .mil. The site is secure. Bethesda, MD 20894, Web Policies 2009;6:e1000097. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). HHS Vulnerability Disclosure, Help The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. UCLR case series that contained complications data were included. Background: Superficial infections tend to settle quickly with oral antibiotics and regular dressings. These exercises may be directed by a physical or occupational therapist. 2. Mitsionis GI, Varitimidis SE, Sotereanos GG. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 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. 2021 Apr 15;3(2):e527-e533. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). When assessed, most patients returned to their preinjury employment. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. flexion-extension motion. J Hand Surg Am. 33. 27. 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%). your express consent. Engelhardt JB, Christensen OM, Christiansen TG. There were 200 acute injuries and 93 chronic injuries. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Nonoperative treatment often failed, necessitating surgery. Range of motion returns much sooner, too. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. An anatomic basis for treatment. Epub 2013 Nov 12. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Fusetti C, Papaloizos M, Meyer H, et al.. 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. HHS Vulnerability Disclosure, Help Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. If it is appropriate, then surgical consent probably happened before the surgery. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Accessibility to maintaining your privacy and will not share your personal information without All techniques improved clinical outcomes, including pain, motion, strength, and stability. The mean patient age was 37.8 years (14.0-78.1). Conclusion: 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 mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 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. 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. UCLR case series that contained complications data were included. 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. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. FOIA Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). doi: 10.1016/j.asmr.2020.12.004. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. There is currently no consensus on treatment of acute or chronic UCL injuries. Data sources: Unauthorized use of these marks is strictly prohibited. 1998;23:503506. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Eurasian J Med. Metacarpophalangeal joint injuries of the thumb. 12. *Glickel grading scale. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. In some cases, certain risk factors make it more likely that a bone will fail to heal. Please enter a Recipient Address and/or check the Send me a copy checkbox. Thumb collateral ligament injuries. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Wolters Kluwer Health, Inc. and/or its subsidiaries. Am J Sports Med. Am J Sports Med. 34. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. 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). [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. 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. Please try after some time. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Surgical techniques and a review of 70 patients. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. This ligament prevents the thumb from pointing too far away from the hand. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Orthop Rev. There were 61 studies eliminated as secondary for being in a language other than English. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Sports Health. Conclusions: Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. You may also begin strengthening exercises if needed. Part I: anatomy and diagnosis. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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. Bean CH, Tencer AF, Trumble TE. Rupture of the. 1. Fourteen articles were included and analyzed (293 thumbs). Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 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. 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. Both purely ligamentous and bony avulsion injuries were included. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Kaplan EB. There were 200 acute injuries and 93 chronic injuries. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. [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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Please enable it to take advantage of the complete set of features! J Hand Surg Am. 32. Thumb dominance reported in 8 studies (168 thumbs). 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. If the force is too strong, the ligaments can tear. may email you for journal alerts and information, but is committed 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. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 37. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Studies that duplicated patient populations from the same authors were excluded. Subject demographics are reported in Table 2. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. Louis DS, Huebner JJ Jr, Hankin FM. 1961;43-A:541546. 8. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Careers. There is currently no consensus on treatment of acute or chronic UCL injuries.

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