Your message has been successfully sent to your colleague. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 39. 2018;6(4):1-7. Kozin SH, Bishop AT. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Please enable it to take advantage of the complete set of features! Complications after surgical treatment of UCL injury are rare. [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. For more information, please refer to our Privacy Policy. 25. 1999;24:7075. A sprained thumb is a common injury among athletes. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Subject demographics are reported in Table 2. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 8600 Rockville Pike 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. HHS Vulnerability Disclosure, Help 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. UCLR case series that contained complications data were included. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. J Hand Surg Am. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. It runs from the outer humerus, around the radial head and attaches to the ulna. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Additional Information: After surgery, you should expect some pain, swelling, and stiffness. The https:// ensures that you are connecting to the Wong TC, Ip FK, Wu WC. 15. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. 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. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. The .gov means its official. Continuous variable data were reported as mean SDs from the mean. J Bone Joint Surg Am. 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. Epub 2021 Sep 7. Metacarpophalangeal joint injuries of the thumb. doi: 10.1016/j.asmr.2020.12.004. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 20. There were no cases of intraoperative ulnar nerve injury reported. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Arthritis Rheum. 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. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. 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 . J Bone Joint Surg Am. and transmitted securely. The authors report no funding or conflicts of interest. FOIA A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Objectives: MeSH 1999;24:275282. Mean study follow-up was 42.8 months. 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 Conflicts of interest The authors report no funding or conflicts of interest. Bethesda, MD 20894, Web Policies The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 1994;23:797804. 6. This site needs JavaScript to work properly. 33. 37. 36. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 12. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Various levels of pain, bruising, or edema may present at the site of damage. Treatment of chronic injuries of the. 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. Studies that duplicated patient populations from the same authors were excluded. 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%). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Complications after surgery were rare. 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. This ligament prevents the thumb from pointing too far away from the hand. 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). Keywords: 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. 2013;23(4):247-254. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 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. Some error has occurred while processing your request. #Injury location reported only in 3 studies. 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 . Data range was reported as minimum to maximum absolute values. Nonoperative treatment often failed, necessitating surgery. Nonoperative treatment often failed, necessitating surgery. 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%). Thumb sidedness reported in 3 studies (51 thumbs). 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. Bean CH, Tencer AF, Trumble TE. There were 61 studies eliminated as secondary for being in a language other than English. 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. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. The anti edema management will continue for several weeks. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. eCollection 2021 Mar. Hand Clin. Benson LS, Bailie DS. 1994;25:2123. 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. Injury. 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 Accessibility It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Hand Clin. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 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. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. unstable when the thumb is used. 2005;87:26322638. Your surgeon will discuss these options with you. 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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 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. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. They may even tear completely. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Fourteen articles were included and analyzed (293 thumbs). 2022 Mar 1;30(1):e1-e8. Table 1. Mean subject age was 33.9 years. National Library of Medicine The Orthopedic Journal of Sports Medicine. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 3. Tension wire fixation of avulsion fractures in the hand. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Epub 2014 Oct 22. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). If the tear is diagnosed early a repair will be possible. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 44. 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). The overall complication rate was 13.8% (11/80). This damage may lead to temporary or permanent numbness or weakness. J Hand Surg Am. *Gender reported in 12 studies (218 subjects). Am J Sports Med. The mean patient age was 37.8 years (14.0-78.1). Melone CP Jr, Beldner S, Basuk RS. Acta Chir Scand. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Ulnar Collateral Ligament Repair . Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. The effect of thumb metacarpophalangeal. The https:// ensures that you are connecting to the The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2013Lippincott Williams & Wilkins. 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. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 1996;25:474477. Instability of the metacarpophalangeal joint of the thumb. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 10. These exercises may be directed by a physical or occupational therapist. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. A common complication following fracture of the distal radius is when the radius shortens. better/same/worse than preoperative status). 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. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Wolters Kluwer Health [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. Data sources: official website and that any information you provide is encrypted If your bone is broken, a pin will be used to put it in place. 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. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. [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.