If you log out, you will be required to enter your username and password the next time you visit. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. No study directly compared the different types of graft for UCL reconstruction. [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. SYMPTOMS: The thumb may be swollen, bruised and painful. 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. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. The mean time from reported injury date to surgery was 202.4 days (2-5969). 2009;34:304308. the splint for protection or at night until twelve weeks after the operation. 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. 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%). Accessibility You've successfully added to your alerts. eCollection 2021. 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%). Orthopedics. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. 1992;8:713732. Careers. government site. 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. Part II: treatment and complications. Please try after some time. A score of 2 was assigned if the item was completely and accurately performed and reported. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. This site needs JavaScript to work properly. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 2005;87:26322638. Epub 2021 Jan 18. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Am J Sports Med. Categorical variable data were reported as frequency with percentages. 1977;59:1421. National Library of Medicine Thumb from the common mechanism of falling on the thumb while holding a ski pole. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. [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. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. I was able to work while wearing the splint. Your ligament may need to be reattached to the bone using a bone anchor. Orthop Clin North Am. For more information, please refer to our Privacy Policy. 8. Main results: Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. 26. The limitations of this systematic review are reliant on the studies analyzed. All rights reserved. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Evaluation and management of elbow injuries in the adolescent overhead athlete. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 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*. 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. 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. 37. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Am J Sports Med. J Hand Surg Am. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Subject demographics are reported in Table 2. J Bone Joint Surg Am. 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%). Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 8600 Rockville Pike 11. Meta-analysis of the pooled data was completed. Am J Sports Med. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Highlight selected keywords in the article text. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). You may search for similar articles that contain these same keywords or you may What are the symptoms of GameKeeper's Thumb? Epub 2016 Jan 13. It runs from the outer humerus, around the radial head and attaches to the ulna. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Quantitative outcome of surgical repair. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). National Library of Medicine Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. [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. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. 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%. Dr. Holt will talk to you about when it is safe to return to work. Table 1. What Happens If We Sit for More Than 8 Hours Per Day? Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Smith RJ. Arthritis Rheum. Epub 2014 Oct 22. Thus, the true natural history is yet unknown. eCollection 2022 May. 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. Clin J Sport Med. SAGE Open Med. You may be trying to access this site from a secured browser on the server. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 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. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Moher D, Liberati A, Tetzlaff J, et al.. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Please enable it to take advantage of the complete set of features! Epub 2021 Sep 7. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 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.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.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. Jackson M, McQueen MM. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. The mean patient age was 37.8 years (14.0-78.1). After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Injuries to the PIP joint remain swollen for long periods of time. Sixty nine (86.3%) patients had grade 3 tears. 2021 Apr 15;3(2):e527-e533. 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. J Bone Joint Surg Am. Meta-analysis of the pooled data was completed. 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. 17. PMC 33. Engelhardt JB, Christensen OM, Christiansen TG. 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. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Early diagnosis and treatment. Instability of the metacarpophalangeal joint of the thumb. 15. This website also contains material copyrighted by 3rd parties. Please try again soon. 31. 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. The limitations of this systematic review are reliant on the studies analyzed. 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. 27. 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. Early and late postoperative complications were recorded. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Careers. 18. Both repair and reconstruction (autograft and allograft) techniques were inclusive. There are some cases where the fusion is not successful and you will still have pain in . 1. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. MCP fusion was performed . A common complication following fracture of the distal radius is when the radius shortens. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). 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. 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. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. may email you for journal alerts and information, but is committed A broken thumb can also cause numbness or tingling. 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. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Hand Clin. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Disclaimer. unstable when the thumb is used. 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. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 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. 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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 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). *Glickel grading scale. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Epub 2013 Nov 12. Doi: 10.1177/2325967118769328. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Ulnar collateral ligament injuries of the thumb: a comprehensive review. UCLR case series that contained complications data were included. HHS Vulnerability Disclosure, Help Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Chir Main. 1996;25:527530. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. The doctor won't know if the repair is . Study design: The .gov means its official. Complications after surgical treatment of UCL injury are rare. J Bone Joint Surg Am. A secondary purpose was to compare graft choice and surgical technique for reconstruction. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Only prospective studies can determine this injury course. Abstract. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 23. NR, not reported. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Rupture and displacement of the. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 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). Bostock S, Morris MA. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. If the tear is diagnosed later a ligament reconstruction might be a better option. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Sports Health. Acta Chir Scand. doi: 10.1016/j.asmr.2020.12.004. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 1994;25:2123. Before Van Dommelen BA, Zvirbulis RA. The LUCL is located on the lateral or outside part of the elbow. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Throwing status reported in 4 studies. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Continue to stretch before and after throwing . 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. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Thumb dominance reported in 8 studies (168 thumbs). FOIA Some error has occurred while processing your request. Ulnar Collateral Ligament Repair . Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). This leads to what is know as a positive ulnar variance. 1976;58:106112. 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. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Riederer S, Nagy L, Buchler U. 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. A systematic review of ulnar collateral ligament reconstruction techniques. Bethesda, MD 20894, Web Policies Complications after surgery were rare. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 2009;6:e1000097. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Possible complications include: - 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. 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. You will receive email when new content is published. These exercises may be directed by a physical or occupational therapist. and twist using your thumb. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Mean study follow-up was 42.8 months. There is currently no consensus on treatment of acute or chronic UCL injuries. They may even tear completely. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options.