Nonsurgical Management of Ulnar Collateral Ligament Injuries When assessed, most patients returned to their preinjury employment. Fourteen articles were included and analyzed (293 thumbs). Sports Health. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. There were no cases of intraoperative ulnar nerve injury reported. Arthrosc Sports Med Rehabil. better/same/worse than preoperative status). Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Symptoms are dependent on the cause and severity of injury to the UCL. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. government site. eCollection 2022 May. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher J Bone Joint Surg Am. Your surgeon will discuss these options with you. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. 36. 10. Thumb sidedness reported in 3 studies (51 thumbs). Unilateral injuries: 291 and bilateral injury: 1. 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. 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. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Figure 46-2 Approach to the ulnar collateral ligament. *Glickel grading system. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. [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. Rupture of the ulnar collateral ligament of the thumb - a review An official website of the United States government. Data sources: Doi: 10.1177/2325967118769328. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Tension wire fixation of avulsion fractures in the hand. UCLR case series that contained complications data were included. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Unauthorized use of these marks is strictly prohibited. Nonoperative treatment often failed, necessitating surgery. Objectives: Ulnar Collateral Ligament Repair . [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. A systematic review of ulnar collateral ligament reconstruction techniques. The doctor won't know if the repair is . Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Your surgeon is the person best able to help you avoid any serious recovery problems. 1. [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. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 1961;43-A:541546. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What Thumb from the common mechanism of falling on the thumb while holding a ski pole. official website and that any information you provide is encrypted Various levels of pain, bruising, or edema may present at the site of damage. 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). 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia J Hand Surg Am. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 45. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Injury. 2009;34:304308. Chir Main. Purpose: Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Sports Med Arthrosc Rev. Purpose. PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine 21. Thus, the true natural history is yet unknown. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 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. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Please confirm that you would like to log out of Medscape. Clin J Sport Med. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 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%.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. 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. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Epub 2020 Jun 29. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. to maintaining your privacy and will not share your personal information without A sprained thumb is a common injury among athletes. Disclaimer. Before If your bone is broken, a pin will be used to put it in place. 5. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 1989;17:751753. 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. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. In some cases, certain risk factors make it more likely that a bone will fail to heal. eCollection 2021 Apr. Exercises: Gradually progress to competitive throwing and sports . The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 24. Table 1. Only prospective studies can determine this injury course. Orthopedics. Anesthesia for Hand Surgery | The Hand & Wrist Center SYMPTOMS: The thumb may be swollen, bruised and painful. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 2006;31:6875. 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. Am J Orthop (Belle Mead NJ). Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 17. Thirty-two thumbs were treated nonoperatively and 261 operatively. official website and that any information you provide is encrypted 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 1,5,9,10 In acute cases of complete tears involving high-level . Midterm clinical outcomes of collateral ligament repair of the thumb Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. National Library of Medicine You are being redirected to Medscape Education. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 2013Lippincott Williams & Wilkins. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Pain reduction was significantly improved in all subjects (P < 0.05). There were 200 acute injuries and 93 chronic injuries. Would you like email updates of new search results? Infection is a rare complication of hand surgery. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Complications after surgery were rare. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Please enter a Recipient Address and/or check the Send me a copy checkbox. National Library of Medicine Meta-analysis of the pooled data was completed. 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 LUCL is located on the lateral or outside part of the elbow. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Part I of this two-part article focuses on common tendon and . Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Eventually this abnormal movement will wear out the joint and it will become arthritic. 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . These exercises may be directed by a physical or occupational therapist. Ulnar Collateral Ligament Repair and Reconstruction 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. You may search for similar articles that contain these same keywords or you may A score of 0 was assigned if the item was either omitted or not performed. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Mean study follow-up was 42.8 months. FOIA PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Unable to load your collection due to an error, Unable to load your delegates due to an error. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. There were 200 acute injuries and 93 chronic injuries. 2005;24:217221. 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. I was able to work while wearing the splint. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. The effect of thumb metacarpophalangeal. Riederer S, Nagy L, Buchler U. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 1976;58:106112. 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. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Studies that duplicated patient populations from the same authors were excluded. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. 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. Epub 2014 Dec 30. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). An official website of the United States government. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 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. Careers. 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]). Before Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Careers. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 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. History. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. There is currently no consensus on treatment of acute or chronic UCL injuries. Please enable it to take advantage of the complete set of features! MeSH Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. The .gov means its official. FOIA Please try again soon. 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%. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. All but 2 were level IV evidence. The limitations of this systematic review are reliant on the studies analyzed. 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. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. NR, not reported. The https:// ensures that you are connecting to the Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent PMC Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). flexion-extension motion. Bailie DS, Benson LS, Marymont JV. Pichora DR, McMurtry RY, Bell MJ. Arnold DM, Cooney WP, Wood MB. The limitations of this systematic review are reliant on the studies analyzed. 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. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Conclusions: 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. All authors independently performed the search. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. PIP Joint Injuries of the Finger - Orthogate [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Am J Sports Med. Meta-analysis of the pooled data was completed. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. There is currently no consensus on treatment of acute or chronic UCL injuries. 13. 25. Rupture of the. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Outcomes after injury to the thumb ulnar collateral ligament--a Surgical techniques and a review of 70 patients. 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 . 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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Mitsionis GI, Varitimidis SE, Sotereanos GG. Methods: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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 Orthopedic Journal of Sports Medicine. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Gamekeeper's thumb. Descriptive statistics were calculated. 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%). These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. It runs from the outer humerus, around the radial head and attaches to the ulna. Eurasian J Med. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. There were 61 studies eliminated as secondary for being in a language other than English. This ligament prevents the thumb from pointing too far away from the hand. Keyword Highlighting 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). Ulnar collateral ligament injury of the thumb - Wikipedia may email you for journal alerts and information, but is committed Bostock S, Morris MA. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Search performed on November 17, 2011. There is currently no consensus on treatment of acute or chronic UCL injuries. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Diagnosis of displaced, 43. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. He too had the internal brace augmentation. 11. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). A secondary purpose was to compare graft choice and surgical technique for reconstruction. 15. 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. 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. HHS Vulnerability Disclosure, Help Only prospective studies can determine this injury course. 12. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina 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. Clin Orthop Relat Res. 6. 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. MCP (MetaCarpophalangeal) Collateral Ligament Sprain
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