A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. 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. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Bailie DS, Benson LS, Marymont JV. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. J Hand Surg Am. 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. Possible complications include: - It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Conclusions: SAGE Open Med. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 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. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. There were no cases of intraoperative ulnar nerve injury reported. Sixty nine (86.3%) patients had grade 3 tears. Various levels of pain, bruising, or edema may present at the site of damage. 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. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Mean study follow-up was 42.8 months. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Causes. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 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. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Part I of this two-part article focuses on common tendon and . The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 1989;71:383387. If you log out, you will be required to enter your username and password the next time you visit. 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. In these cases, a new graft may be used to perform a second reconstruction. The mean patient age was 37.8 years (14.0-78.1). A score of 0 was assigned if the item was either omitted or not performed. Categorical variable data were reported as frequency with percentages. modify the keyword list to augment your search. The grip strength and the pinch strength were 94.3% and 92.27%,. Evaluation and management of elbow injuries in the adolescent overhead athlete. doi: 10.1097/JSA.0000000000000322. 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. 31. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Mean subject age was 33.9 years. 1998;23:503506. You will receive email when new content is published. 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 are dependent on the cause and severity of injury to the UCL. Diagnosis of displaced, 43. National Library of Medicine 19. 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 overall complication rate after primary thumb RCL and UCL repair was 13.8%. If the latter was executed only partially, a score of 1 was assigned. eCollection 2022 May. 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]). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Eurasian J Med. The .gov means its official. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Jackson M, McQueen MM. J Bone Joint Surg Am. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. When assessed, most patients returned to their preinjury employment. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Subject demographics are reported in Table 2. A score of 0 was assigned if the item was either omitted or not performed. 24. All but 2 were level IV evidence. 1999;24:275282. Educate the patient on anti edema management. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. The injury happens when you fall . Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. [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. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Clin J Sport Med. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. This site needs JavaScript to work properly. 2018;6(4):1-7. Am J Sports Med. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 1995;18:11611165. There are some cases where the fusion is not successful and you will still have pain in . 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. Please try again soon. 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. Highlight selected keywords in the article text. MeSH Orthop J Sports Med. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Your surgeon is the person best able to help you avoid any serious recovery problems. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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). Click the topic below to receive emails when new articles are available. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. The LUCL is located on the lateral or outside part of the elbow. Metacarpophalangeal joint injuries of the thumb. Arthrosc Sports Med Rehabil. Data range was reported as minimum to maximum absolute values. unstable when the thumb is used. No study directly compared the different types of graft for UCL reconstruction. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) SYMPTOMS: The thumb may be swollen, bruised and painful. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . Frykman G, Johansson O. Surgical repair of rupture of the, 46. All rights reserved. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. 16. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Thumb collateral ligament injuries. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. If the latter was executed only partially, a score of 1 was assigned. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Some error has occurred while processing your request. Am J Sports Med. 23. 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. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Am 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. Sports Health. 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. 25. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 1999;24:7075. 1989;17:751753. 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. 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). Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. government site. For example, it can be removed when performing . Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. Objectives: 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. 4. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%. Am J Sports Med. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Long-term results of ligament reconstruction. 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). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Stretching or even a rupture of the graft is also possible. **Stener lesion status reported in 6 studies (145 thumbs). 36. Non-Fusion. Infection is a rare complication of hand surgery. J Bone Joint Surg Am. J Hand Surg Am. Orthop Rev. 18. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 2009;34:304308. There is currently no consensus on treatment of acute or chronic UCL injuries. Mechanism of injury to the RCL of the MCP joint of the thumb is force . An anatomic basis for treatment. What are the symptoms of GameKeeper's Thumb? Study design: All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 1994;23:797804. Rupture of the. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 2021 Apr 15;3(2):e527-e533. [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. Am J Sports Med. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). J Hand Surg Am. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). UCLR case series that contained complications data were included. There is currently no consensus on treatment of acute or chronic UCL injuries. 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 . 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. Bookshelf The .gov means its official. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used. 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 1996;25:474477. Unilateral injuries: 291 and bilateral injury: 1. 2009;61:623632. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 6. In some cases, certain risk factors make it more likely that a bone will fail to heal. 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. Before Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. This leads to what is know as a positive ulnar variance. Main results: 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. The torn thumb ligament is repaired or reconstructed during surgery. POST-OPERATIVE WEEKS 22-24. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. If the force is too strong, the ligaments can tear. Meta-analysis of the pooled data was completed. Riederer S, Nagy L, Buchler U. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 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. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The site is secure. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Careers. Tension wire fixation of avulsion fractures in the hand. Clin Orthop Relat Res. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. 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. Melone CP Jr, Beldner S, Basuk RS. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 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. Dr. Holt will talk to you about when it is safe to return to work. Muscles. J Hand Surg Br. your express consent. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 1989;14:567573. Ulnar Collateral Ligament Repair . eCollection 2021 Mar. Proximal interphalangeal joint injuries of the hand. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. The limitations of this systematic review are reliant on the studies analyzed. No study directly compared nonoperative to operative treatment. All but 2 were level IV evidence. Upper extremity injuries in snow skiers. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 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. Please enable it to take advantage of the complete set of features! 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. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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. 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. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. 3. Bostock S, Morris MA. Epub 2016 Jan 13. 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. Your ligament may need to be reattached to the bone using a bone anchor. official website and that any information you provide is encrypted This ligament prevents the thumb from pointing too far away from the hand. 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. Meta-analysis of the pooled data was completed. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 1993;21:800804. 22. Part I: anatomy and diagnosis. Unauthorized use of these marks is strictly prohibited. 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. Hand Clin. There were 200 acute injuries and 93 chronic injuries. 8. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Part II: treatment and complications. Bookshelf 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. 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Louis DS, Huebner JJ Jr, Hankin FM. [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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Data is temporarily unavailable. Your surgeon will discuss these options with you. FOIA The site is secure. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 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). Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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.
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