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. 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. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Mean study follow-up was 42.8 months. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 1989;71:383387. eCollection 2021. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. The torn thumb ligament is repaired or reconstructed during surgery. The injury happens when you fall . Gamekeeper's thumb. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 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. There were 200 acute injuries and 93 chronic injuries. 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. 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. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Thus, the true natural history is yet unknown. 14. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. J Bone Joint Surg Am. Would you like email updates of new search results? 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. Epub 2020 Jun 29. Pichora DR, McMurtry RY, Bell MJ. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. 2009;61:623632. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 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.. There were 200 acute injuries and 93 chronic injuries. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 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%). Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 21. Eventually this abnormal movement will wear out the joint and it will become arthritic. Bookshelf Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Your surgeon is the person best able to help you avoid any serious recovery problems. Non-Fusion. Bethesda, MD 20894, Web Policies Nonoperative treatment often failed, necessitating surgery. Table 1. Your message has been successfully sent to your colleague. 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. There were 61 studies eliminated as secondary for being in a language other than English. 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. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 8600 Rockville Pike 2. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. eCollection 2021 Mar. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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 This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. UCLR case series that contained complications data were included. If your bone is broken, a pin will be used to put it in place. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Only prospective studies can determine this injury course. 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. Complications after surgical treatment of UCL injury are rare. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. No study directly compared the different types of graft for UCL reconstruction. Search for Similar Articles 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). 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. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Am J Sports Med. 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*. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Your thumb will be immobilized in a splint and should not be moved until follow up. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Complications after surgery were rare. 12. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 2000;16:345357. Frykman G, Johansson O. Surgical repair of rupture of the, 46. If the latter was executed only partially, a score of 1 was assigned. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Epub 2015 Sep 22. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. 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. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Kuz JE, Husband JB, Tokar N, et al.. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Sakellarides HT, DeWeese JW. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Catalano LW III, Cardon L, Patenaude N, et al.. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 1999;24:7075. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Both repair and reconstruction (autograft and allograft) techniques were inclusive. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). J Bone Joint Surg Am. Eurasian J Med. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 8. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. [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. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 2003;8:8185. This damage may lead to temporary or permanent numbness or weakness. 1996;25:474477. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Before 1996;25:527530. 2013Lippincott Williams & Wilkins. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. An official website of the United States government. 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 If the tear is diagnosed early a repair will be possible. Injury. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 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. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". J Hand Surg Am. 16. The overall complication rate was 13.8% (11/80). Additional Information: After surgery, you should expect some pain, swelling, and stiffness. If you log out, you will be required to enter your username and password the next time you visit. MeSH Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Careers. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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. 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. Epub 2014 Dec 30. Downey DJ, Moneim MS, Omer GE Jr. The .gov means its official. [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. 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. #Injury location reported only in 3 studies. 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. J Hand Surg Br. [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. 2013;23(4):247-254. Exercises: Gradually progress to competitive throwing and sports . Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Wolters Kluwer Health ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Injuries to the PIP joint remain swollen for long periods of time. 15. It runs from the outer humerus, around the radial head and attaches to the ulna. 17. Proximal interphalangeal joint injuries of the hand. Metacarpophalangeal joint injuries of the thumb. This ligament prevents the thumb from pointing too far away from the hand. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. [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;34:304308. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Abstract. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Moher D, Liberati A, Tetzlaff J, et al.. Unilateral injuries: 291 and bilateral injury: 1. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Keyword Highlighting Long-term results of ligament reconstruction. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. 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%). 22. The mean time from reported injury date to surgery was 202.4 days (2-5969). 23. **Stener lesion status reported in 6 studies (145 thumbs). 31. 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). The limitations of this systematic review are reliant on the studies analyzed. [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. Part I: anatomy and diagnosis. Conclusion: 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. [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. Diagnosis of displaced, 43. may email you for journal alerts and information, but is committed *Glickel grading scale. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Possible complications include: - J Bone Joint Surg Am. Data range was reported as minimum to maximum absolute values. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. and twist using your thumb. Bean CH, Tencer AF, Trumble TE. 44. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. flexion-extension motion. Part I of this two-part article focuses on common tendon and . Bookshelf 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. [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. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total.
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