Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Tension wire fixation of avulsion fractures in the hand. eCollection 2022 May. 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. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Fusetti C, Papaloizos M, Meyer H, et al.. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Conclusions: 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 . Injury. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Hand Surgery Recovery Time: Pain, Exercise & Complications The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Continue to stretch before and after throwing . 1989;17:751753. 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. 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. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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 . Acute gamekeeper's thumb. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Upper extremity injuries in snow skiers. Data is temporarily unavailable. Kuz JE, Husband JB, Tokar N, et al.. 25. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. J Bone Joint Surg Am. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. National Library of Medicine 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. may email you for journal alerts and information, but is committed 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 Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. [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. to maintaining your privacy and will not share your personal information without The injury happens when you fall . If the latter was executed only partially, a score of 1 was assigned. A common complication following fracture of the distal radius is when the radius shortens. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Surgical management of chronic, 42. your express consent. Thumb collateral ligament injuries. MCP fusion was performed . There were 61 studies eliminated as secondary for being in a language other than English. Arthritis Rheum. [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. Only prospective studies can determine this injury course. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Ulnar collateral ligament repair surgery Archives | OrthoVirginia Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 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. The grip strength and the pinch strength were 94.3% and 92.27%,. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . The mean time from reported injury date to surgery was 202.4 days (2-5969). Acta Chir Scand. Complications Following Distal Radius Fractures - Mike Reinold Am J Sports Med. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Orthop Clin North Am. 12. NR, not reported. Meta-analysis of the pooled data was completed. Melone CP Jr, Beldner S, Basuk RS. 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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Stener B. Skeletal injuries associated with rupture of the. Quantitative outcome of surgical repair. 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. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape [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. Please try again soon. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Complications after surgery were rare. Thus, the true natural history is yet unknown. Van Dommelen BA, Zvirbulis RA. 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. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. Epub 2020 Jun 29. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. Athletes Can Return to Play in Half the Time with New Thumb Ligament Unauthorized use of these marks is strictly prohibited. Instability of the metacarpophalangeal joint of the thumb. 11. 38. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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. Purpose: 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Your surgeon will discuss these options with you. Before Complications of Ulnar Collateral Ligament Repair | SpringerLink doi: 10.1097/JSA.0000000000000322. 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. 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. 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. 1977;59:1421. 2000;16:345357. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. HHS Vulnerability Disclosure, Help Part I: anatomy and diagnosis. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Early diagnosis and treatment. 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. 1989;14:567573. You may also begin strengthening exercises if needed. Posner MA, Retaillaud JL. Treatment of chronic injuries of the. 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. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Bethesda, MD 20894, Web Policies sharing sensitive information, make sure youre on a federal Search performed on November 17, 2011. This website also contains material copyrighted by 3rd parties. Disclaimer. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 8600 Rockville Pike All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 1995;23:222226. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What [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]. Stretching or even a rupture of the graft is also possible. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. Educate the patient on anti edema management. and transmitted securely. Clin J Sport Med. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. There are some cases where the fusion is not successful and you will still have pain in . Orthopedics. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. Sports Med Arthrosc Rev. Am J Sports Med. J Hand Surg Br. The Complications of CMC Thumb Surgery | Healthy Living Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Proximal interphalangeal joint injuries of the hand. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 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. Please enable scripts and reload this page. Your ligament may need to be reattached to the bone using a bone anchor. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 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. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Abstract. 2009;6:e1000097. 2005;24:217221. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. PIP Joint Injuries of the Finger - Orthogate 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. 18. Abrahamsson SO, Sollerman C, Lundborg G, et al.. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Nonoperative treatment often failed, necessitating surgery. Both purely ligamentous and bony avulsion injuries were included. Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion SAGE Open Med. PDF UVA HAND CENTER - THERAPY - University of Virginia School of 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 1992;8:713732. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. government site. [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. Gamekeeper's thumb. 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. 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. Sports Health. Ulnar collateral ligament injury of the thumb - Wikipedia 1993;21:800804. Anesthesia for Hand Surgery | The Hand & Wrist Center 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). 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. 1996;25:474477. Downey DJ, Moneim MS, Omer GE Jr. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. A broken thumb can also cause numbness or tingling. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. Before The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Thumb Ulnar Collateral Ligament repair; A Step by Step Guide PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Evaluation and management of elbow injuries in the adolescent overhead athlete. History. Part I of this two-part article focuses on common tendon and . 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. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 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. Please enable it to take advantage of the complete set of features! All rights reserved. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia 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. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 4. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. All but 2 were level IV evidence. 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality).