If the force is too strong, the ligaments can tear. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery Meta-analysis of the pooled data was completed. 8600 Rockville Pike Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Acta Chir Scand. abduction-adduction motion. 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. 4. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 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 The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 16. 1994;23:797804. Accessibility ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Patient Demographics of Thumb RCL and UCL Injuries. Skier's thumb - Physiopedia 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Louis DS, Huebner JJ Jr, Hankin FM. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Additional Information: After surgery, you should expect some pain, swelling, and stiffness. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Your surgeon is the person best able to help you avoid any serious recovery problems. 35. 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. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate 2018;6(4):1-7. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 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. Abstract. 14. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 21. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 44. 2013;23(4):247-254. Data sources: CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube Keyword Highlighting Complications after surgery were rare. Epub 2019 Mar 21. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. and transmitted securely. 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.. Orthopedics. the splint for protection or at night until twelve weeks after the operation. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Thus, the true natural history is yet unknown. Thumb sidedness reported in 3 studies (51 thumbs). 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. Epub 2020 Jun 29. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. 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). Purpose: J Bone Joint Surg Am. The mean patient age was 37.8 years (14.0-78.1). official website and that any information you provide is encrypted It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. [38] Chuter et al[40] contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. If it is appropriate, then surgical consent probably happened before the surgery. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 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. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. government site. At this stage, patients should be advised to wear your splint part-time. Please confirm that you would like to log out of Medscape. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 1987;214:113120. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Continuous variable data were reported as mean SDs from the mean. 2009;61:623632. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 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. 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. 1977;59:1421. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Main results: This article provides a review of . 2003;8:8185. 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. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Please enable scripts and reload this page. 15. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Upper extremity injuries in snow skiers. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What A score of 2 was assigned if the item was completely and accurately performed and reported. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 24. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Orthop Rev. This website also contains material copyrighted by 3rd parties. Mitsionis GI, Varitimidis SE, Sotereanos GG. 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 Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 6. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Subject demographics are reported in Table 2. Quantitative outcome of surgical repair. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 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. NR, not reported. Epub 2021 Jan 18. Fourteen articles were included and analyzed (293 thumbs). 12. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Would you like email updates of new search results? The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Nonsurgical Management of Ulnar Collateral Ligament Injuries The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. 8. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. There are some cases where the fusion is not successful and you will still have pain in . 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. Unilateral injuries: 291 and bilateral injury: 1. 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%). *Glickel grading scale. Engelhardt JB, Christensen OM, Christiansen TG. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 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. Conclusions: All rights reserved. The overall complication rate was 13.8% (11/80). 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). 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). 1,5,9,10 In acute cases of complete tears involving high-level . *Gender reported in 12 studies (218 subjects). Please enable it to take advantage of the complete set of features! The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Kozin SH, Bishop AT. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 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 . Outcomes after injury to the thumb ulnar collateral ligament--a 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. These tears often occur as a result of a radially directed force on an extended 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. [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. 10. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. J Bone Joint Surg Am. A sprained thumb is a common injury among athletes. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Hand Surg. your express consent. [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. 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery.
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