unstable when the thumb is used. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Purpose. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Complications of Ulnar Collateral Ligament Repair | SpringerLink Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. A common complication following fracture of the distal radius is when the radius shortens. 14 It is important to diagnose complete tears early because . Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed If your bone is broken, a pin will be used to put it in place. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 and twist using your thumb. Bailie DS, Benson LS, Marymont JV. 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.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.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Arnold DM, Cooney WP, Wood MB. Evaluation and management of elbow injuries in the adolescent overhead athlete. 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 These tears often occur as a result of a radially directed force on an extended thumb. AAHS - Comparison of Complications after Thumb Metacarpophalangeal 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. Injuries to the PIP joint remain swollen for long periods of time. Data sources: MCP collateral ligament sprain is most commonly an acute injury related to trauma. Conclusions: No study directly compared the different types of graft for UCL reconstruction. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. I was able to work while wearing the splint. 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. Jackson M, McQueen MM. The .gov means its official. 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. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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. Am J Sports Med. Am J Sports Med. Methods: Your surgeon will discuss these options with you. Complications you may experience after Hand Surgery - Rebecca Ayers There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 1993;21:800804. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Ulnar Collateral Ligament Repair and Reconstruction 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. Nonoperative treatment often failed, necessitating surgery. Some error has occurred while processing your request. official website and that any information you provide is encrypted 2005;87:26322638. Early diagnosis and treatment. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Epub 2014 Dec 30. Search for Similar Articles No study reported the outcomes of nonoperative management of chronic UCL injury. [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. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Am J Sports Med. 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. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 35. A score of 2 was assigned if the item was completely and accurately performed and reported. There were no cases of intraoperative ulnar nerve injury reported. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Unauthorized use of these marks is strictly prohibited. Would you like email updates of new search results? Thus, the true natural history is yet unknown. There were 200 acute injuries and 93 chronic injuries. Am J Sports Med. 45. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Unable to load your collection due to an error, Unable to load your delegates due to an error. A p-value of 0.05 was considered statistically significant. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Am J Sports Med. Bethesda, MD 20894, Web Policies Complications after this procedure may include nerve or blood vessel damage. Federal government websites often end in .gov or .mil. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. 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. Diagnosis of displaced, 43. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. NR, not reported. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Kozin SH, Bishop AT. Epub 2019 Mar 21. Conflicts of interest The authors report no funding or conflicts of interest. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 2006;31:6875. 31. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Mean subject age was 33.9 years. Outcomes after injury to the thumb ulnar collateral ligament--a The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Instability of the metacarpophalangeal joint of the thumb. Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent Anesthesia for Hand Surgery | The Hand & Wrist Center Thumb Collateral Ligament Injury - Hand - Orthobullets Possible complications include: - PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Downey DJ, Moneim MS, Omer GE Jr. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Your surgeon is the person best able to help you avoid any serious recovery problems. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 11. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 19. They may even tear completely. sharing sensitive information, make sure youre on a federal Catalano LW III, Cardon L, Patenaude N, et al.. Stretching or even a rupture of the graft is also possible. Outcomes After Injury to the Thumb Ulnar Collateral Ligament Wolters Kluwer Health, Inc. and/or its subsidiaries. The effect of thumb metacarpophalangeal. 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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. You will receive email when new content is published. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb Acute gamekeeper's thumb. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. The Orthopedic Journal of Sports Medicine. 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. MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com 1976;58:106112. For more information, please refer to our Privacy Policy. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. There is currently no consensus on treatment of acute or chronic UCL injuries. Thumb sidedness reported in 3 studies (51 thumbs). This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 1989;14:567573. Am J Orthop (Belle Mead NJ). Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 1995;18:11611165. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Melone CP Jr, Beldner S, Basuk RS. Thumb collateral ligament injuries. This website also contains material copyrighted by 3rd parties. 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%). 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%. 33. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Ulnar Collateral Ligament Repair . 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. the splint for protection or at night until twelve weeks after the operation. 34. MeSH eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. [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. Stener B. Skeletal injuries associated with rupture of the. You may search for similar articles that contain these same keywords or you may 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Nonsurgical Management of Ulnar Collateral Ligament Injuries Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Treatment for thumb collateral ligament injury - KW orthopaedics 4. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Orthop Rev. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Exercises: Gradually progress to competitive throwing and sports . 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. Systematic review and meta-analysis. 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. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 1995;23:222226. Your thumb will be immobilized in a splint and should not be moved until follow up. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Engelhardt JB, Christensen OM, Christiansen TG. If the latter was executed only partially, a score of 1 was assigned. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic 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. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Fourteen articles were included and analyzed (293 thumbs). [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. Clin Orthop Relat Res. 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. #Injury location reported only in 3 studies. Ulnar Collateral Ligament Injuries of the Thumb - Panther Clin J Sport Med. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 1994;25:2123. 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). MeSH Please try after some time. Base of Thumb Fractures - Hand - Orthobullets Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Disclaimer. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 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. Studies that duplicated patient populations from the same authors were excluded. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. J Hand Surg Br. Only prospective studies can determine this injury course. 2009;34:304308. flexion-extension motion. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. Figure 46-2 Approach to the ulnar collateral ligament. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. UCLR case series that contained complications data were included. Benson LS, Bailie DS. 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. 8. The Effect of Ulnar Collateral Ligament Repair With Internal Brace 2. 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. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. You've successfully added to your alerts. The torn thumb ligament is repaired or reconstructed during surgery. The mean time from reported injury date to surgery was 202.4 days (2-5969). 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. eCollection 2021 Apr. The injury involves the ulnar collateral ligament (UCL) of the thumb. If the force is too strong, the ligaments can tear. When assessed, most patients returned to their preinjury employment. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Orthopedics. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Careers. There were 61 studies eliminated as secondary for being in a language other than English. 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. Acta Chir Scand. Pain reduction was significantly improved in all subjects (P < 0.05). Keyword Highlighting Both purely ligamentous and bony avulsion injuries were included. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Arthritis Rheum. Complications after surgery were rare. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Bostock S, Morris MA. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Please enable scripts and reload this page.
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