2009;6:e1000097. Thumb sidedness reported in 3 studies (51 thumbs). Nonoperative treatment often failed, necessitating surgery. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 21. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). [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. 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. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Careers. Stener B. Skeletal injuries associated with rupture of the. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. [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. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Accessibility Descriptive statistics were calculated. Before If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Pain reduction was significantly improved in all subjects (P < 0.05). A sprained thumb is a common injury among athletes. 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. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Wong TC, Ip FK, Wu WC. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. to maintaining your privacy and will not share your personal information without
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. Would you like email updates of new search results? Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Louis DS, Huebner JJ Jr, Hankin FM. PMC NR, not reported. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. You may be trying to access this site from a secured browser on the server. [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. 8600 Rockville Pike Proximal interphalangeal joint injuries of the hand. Search performed on November 17, 2011. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. eCollection 2021. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Only prospective studies can determine this injury course. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 26. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. If you log out, you will be required to enter your username and password the next time you visit. 32. 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.. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Please enter a Recipient Address and/or check the Send me a copy checkbox. Mean subject age was 33.9 years. Upper extremity injuries in snow skiers. [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. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 2021 Apr 15;3(2):e527-e533. J Hand Surg Br. 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. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 7. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 2022 Mar 1;30(1):e1-e8. Surgical management of chronic, 42. Arthritis Rheum. [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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. the splint for protection or at night until twelve weeks after the operation. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. unstable when the thumb is used. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 18. Am J Sports Med. Downey DJ, Moneim MS, Omer GE Jr. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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. 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. 45. Mitsionis GI, Varitimidis SE, Sotereanos GG. Instability of the metacarpophalangeal joint of the thumb. Federal government websites often end in .gov or .mil. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 1989;14:567573. 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 2009;34:304308. Hand Clin. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. eCollection 2022 May. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. J Bone Joint Surg Am. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Wolters Kluwer Health
6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . The torn thumb ligament is repaired or reconstructed during surgery. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 1994;23:797804. 2006;31:6875. 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. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. 1998;23:503506. Systematic review and meta-analysis. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Figure 46-2 Approach to the ulnar collateral ligament. 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]). I was able to work while wearing the splint. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 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. official website and that any information you provide is encrypted modify the keyword list to augment your search. official website and that any information you provide is encrypted History. Continue to stretch before and after throwing . No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Before 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. 1977;59:1421. [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. 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). 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%). Meta-analysis of the pooled data was completed. 22. If the latter was executed only partially, a score of 1 was assigned. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. What are the symptoms of GameKeeper's Thumb? Wolters Kluwer Health, Inc. and/or its subsidiaries. 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. Diagnosis of displaced, 43. Gamekeeper's thumb. 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. SYMPTOMS: The thumb may be swollen, bruised and painful. 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. 1992;8:713732. Unauthorized use of these marks is strictly prohibited. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Disclaimer. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Some error has occurred while processing your request. 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. 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. Bookshelf Subject demographics are reported in Table 2. 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 If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . 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. 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. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Only prospective studies can determine this injury course. Am J Orthop (Belle Mead NJ). The authors report no funding or conflicts of interest. Please try after some time. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Injuries to the PIP joint remain swollen for long periods of time. 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . Exercises: Gradually progress to competitive throwing and sports . Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. 19. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Conflicts of interest The authors report no funding or conflicts of interest. FOIA 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. Careers. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. The site is secure. Orthop Rev. 37. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Mean study follow-up was 42.8 months. sharing sensitive information, make sure youre on a federal 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*. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Purpose: Search for Similar Articles
Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Van Dommelen BA, Zvirbulis RA. You may search for similar articles that contain these same keywords or you may
6. The .gov means its official. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. Complications after surgery were rare. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 11. Mean study follow-up was 42.8 months. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Thirty-two thumbs were treated nonoperatively and 261 operatively. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Jackson M, McQueen MM. and twist using your thumb. Complications after this procedure may include nerve or blood vessel damage.
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