The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). and transmitted securely. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. three muscles provide deforming forces at the base of the thumb. Am J Orthop (Belle Mead NJ). 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. Please enable scripts and reload this page. Part I: anatomy and diagnosis. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 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. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. 13. Throwing status reported in 4 studies. 1999;24:275282. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Search for Similar Articles 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 . 1987;214:113120. Anesthesia for Hand Surgery | The Hand & Wrist Center UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic All techniques improved clinical outcomes, including pain, motion, strength, and stability. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. and transmitted securely. If the force is too strong, the ligaments can tear. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. The limitations of this systematic review are reliant on the studies analyzed. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . eCollection 2021. The anti edema management will continue for several weeks. Acute gamekeeper's thumb. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. If it is appropriate, then surgical consent probably happened before the surgery. Clin J Sport Med. All authors independently performed the search. Conclusions: 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. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. 36. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 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. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). [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. 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. Wong TC, Ip FK, Wu WC. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Only prospective studies can determine this injury course. Surgical techniques and a review of 70 patients. J Hand Surg Am. Am J Sports Med. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Moher D, Liberati A, Tetzlaff J, et al.. Complications after surgical treatment of UCL injury are rare. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Part I of this two-part article focuses on common tendon and . Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Purpose. Before Clipboard, Search History, and several other advanced features are temporarily unavailable. 1994;23:797804. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. Unilateral injuries: 291 and bilateral injury: 1. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Unable to load your collection due to an error, Unable to load your delegates due to an error. You are being redirected to Medscape Education. 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). doi: 10.1016/j.asmr.2020.12.004. Orthop J Sports Med. Epub 2019 Mar 21. Fourteen articles were included and analyzed (293 thumbs). Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. 32. A score of 2 was assigned if the item was completely and accurately performed and reported. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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. Sakellarides HT, DeWeese JW. 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. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 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. J Hand Surg Glob Online. Wolters Kluwer Health, Inc. and/or its subsidiaries. A score of 2 was assigned if the item was completely and accurately performed and reported. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 8600 Rockville Pike 17. Hand Clin. doi: 10.1097/JSA.0000000000000322. Posner MA, Retaillaud JL. Systematic review and meta-analysis. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Bostock S, Morris MA. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 22. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Please confirm that you would like to log out of Medscape. There were 200 acute injuries and 93 chronic injuries. [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. Epub 2015 Sep 22. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 1995;18:11611165. 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. 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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. AAHS - Comparison of Complications after Thumb Metacarpophalangeal All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 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 Surgery Recovery Time: Pain, Exercise & Complications Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Complications after surgery were rare. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. UCLR case series that contained complications data were included. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Mean study follow-up was 42.8 months. Complications Following Distal Radius Fractures - Mike Reinold 27. 5. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Complications after surgery were rare. 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%. 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 Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. The effect of thumb metacarpophalangeal. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Bethesda, MD 20894, Web Policies Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics A score of 0 was assigned if the item was either omitted or not performed. Muscles. Bean CH, Tencer AF, Trumble TE. 37. 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. 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. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). 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. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. There were 61 studies eliminated as secondary for being in a language other than English. The LUCL is located on the lateral or outside part of the elbow. Possible complications include: - Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 21. 2022 Mar 1;30(1):e1-e8. 1976;58:106112. Treatment of chronic injuries of the. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. 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. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. National Library of Medicine A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Am J Sports Med. Infection is a rare complication of hand surgery. government site. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Upper extremity injuries in snow skiers. The grip strength and the pinch strength were 94.3% and 92.27%,. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Post-traumatic instability of the metacarpophalangeal joint of the thumb. SYMPTOMS: The thumb may be swollen, bruised and painful. Gamekeepers thumb: a prospective study of functional bracing. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Epub 2021 Jan 18. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. MeSH 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. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Nonunions - OrthoInfo - AAOS The limitations of this systematic review are reliant on the studies analyzed. Your surgeon will discuss these options with you. Injuries to the PIP joint remain swollen for long periods of time. Injury. 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. Eurasian J Med. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Your message has been successfully sent to your colleague. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. A common complication following fracture of the distal radius is when the radius shortens. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Clin Orthop Relat Res. 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. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Main results: 6. [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. PIP Joint Injuries of the Finger - Orthogate Thumb collateral ligament injuries. 2009;61:623632. 2021 Apr 15;3(2):e527-e533. Mean study follow-up was 42.8 months. J Hand Surg Am. 26. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Thirty-two thumbs were treated nonoperatively and 261 operatively. 2013Lippincott Williams & Wilkins. Tension wire fixation of avulsion fractures in the hand. Base of Thumb Fractures - Hand - Orthobullets Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 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. 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. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Methods: 2009;34:304308. 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. 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. Conclusion: An official website of the United States government. [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. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery better/same/worse than preoperative status). PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Clinical Journal of Sport Medicine23(4):247-254, July 2013. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb.