and transmitted securely. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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). A broken thumb can also cause numbness or tingling. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Accessibility There are some cases where the fusion is not successful and you will still have pain in . Complications after surgical treatment of UCL injury are rare. 1. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Mean subject age was 33.9 years. Please try after some time. Data is temporarily unavailable. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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. 35. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Keyword Highlighting Hand Clin. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. J Bone Joint Surg Am. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 19. 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. Early and late postoperative complications were recorded. Fusetti C, Papaloizos M, Meyer H, et al.. Moher D, Liberati A, Tetzlaff J, et al.. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. NR, not reported. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Hand Clin. Catalano LW III, Cardon L, Patenaude N, et al.. 37. 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. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. official website and that any information you provide is encrypted 2. Jackson M, McQueen MM. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 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%). Thus, the true natural history is yet unknown. better/same/worse than preoperative status). Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. In these patients, after failure of nonoperative treatment at anywhere from 1 month 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. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Benson LS, Bailie DS. Stener B. Skeletal injuries associated with rupture of the. Part I: anatomy and diagnosis. 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. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. I was able to work while wearing the splint. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Non-Fusion. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Evaluation and management of elbow injuries in the adolescent overhead athlete. Thumb collateral ligament injuries. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Only prospective studies can determine this injury course. Arnold DM, Cooney WP, Wood MB. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Early diagnosis and treatment. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Proximal interphalangeal joint injuries of the hand. J Hand Surg Br. 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. J Bone Joint Surg Am. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . UCLR case series that contained complications data were included. Part I of this two-part article focuses on common tendon and . National Library of Medicine Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Pichora DR, McMurtry RY, Bell MJ. Epub 2020 Jun 29. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 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. 38. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. A secondary purpose was to compare graft choice and surgical technique for reconstruction. may email you for journal alerts and information, but is committed There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 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.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.15 In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.15. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. 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. Bostock S, Morris MA. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. sharing sensitive information, make sure youre on a federal Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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 goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. 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%). After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Muscles. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Am J Sports Med. your express consent. A score of 0 was assigned if the item was either omitted or not performed. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 1994;25:2123. 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. 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. Categorical variable data were reported as frequency with percentages. Kuz JE, Husband JB, Tokar N, et al.. 4. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Would you like email updates of new search results? Treatment of chronic injuries of the. 1992;8:713732. Possible complications include: - Long-term results of ligament reconstruction. 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. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. Keywords: [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. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. This website also contains material copyrighted by 3rd parties. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 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. 17. Dr. Holt will talk to you about when it is safe to return to work. Federal government websites often end in .gov or .mil. 8600 Rockville Pike What are the symptoms of GameKeeper's Thumb? FOIA Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Rupture of the. 1999;24:7075. Surgical techniques and a review of 70 patients. 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. 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%). There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 2021 Apr 15;3(2):e527-e533. POST-OPERATIVE WEEKS 22-24. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. It runs from the outer humerus, around the radial head and attaches to the ulna. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". flexion-extension motion. J Hand Surg Am. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. [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. This site needs JavaScript to work properly. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Bethesda, MD 20894, Web Policies The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. No study directly compared the different types of graft for UCL reconstruction. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. These exercises may be directed by a physical or occupational therapist. The https:// ensures that you are connecting to the UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Your ligament may need to be reattached to the bone using a bone anchor. There is currently no consensus on treatment of acute or chronic UCL injuries. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Thumb sidedness reported in 3 studies (51 thumbs). 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 2018;6(4):1-7. You've successfully added to your alerts. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Unilateral injuries: 291 and bilateral injury: 1. MCP fusion was performed . 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]). 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. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Louis DS, Huebner JJ Jr, Hankin FM. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 14. 2013Lippincott Williams & Wilkins. 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. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 1,5,9,10 In acute cases of complete tears involving high-level . Am J Orthop (Belle Mead NJ). No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Please enable scripts and reload this page. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Part II: treatment and complications. 3. 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. J Bone Joint Surg Am. Only prospective studies can determine this injury course. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Subject demographics are reported in Table 2. You may search for similar articles that contain these same keywords or you may I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. Complications after surgical treatment of UCL injury are rare. HHS Vulnerability Disclosure, Help Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. 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). 1961;43-A:541546. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. MeSH Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 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. [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. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Conclusions: When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 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. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 2005;24:217221. 2000;16:345357. Epub 2014 Oct 22. A p-value of 0.05 was considered statistically significant. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Am. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. The range of motion of the MP joint of the thumb following operative repair of the. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. 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. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Nonoperative treatment often failed, necessitating surgery. Objectives: 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. 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 Hand Surg. Meta-analysis of the pooled data was completed. Nonoperative treatment often failed, necessitating surgery. 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 Collateral Ligament Repair . Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Riederer S, Nagy L, Buchler U. 31. To date, no literat. Conclusion: 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. J Hand Surg Br. There were no cases of intraoperative ulnar nerve injury reported. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. Arthritis Rheum. 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. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. Am J Sports Med. You are being redirected to Medscape Education. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. An anatomic basis for treatment. 1989;17:751753. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Kozin SH, Bishop AT. Careers. Thirty-two thumbs were treated nonoperatively and 261 operatively. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Ulnar collateral ligament injuries of the thumb: a comprehensive review. The site is secure. If your bone is broken, a pin will be used to put it in place. If the tear is diagnosed later a ligament reconstruction might be a better option. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. There were 200 acute injuries and 93 chronic injuries. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. History. 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 Mean subject age was 33.9 years. 10. The overall complication rate was 13.8% (11/80). PLoS Med. Sports Health. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex.