At this stage, patients should be advised to wear your splint part-time. 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. Early and late postoperative complications were recorded. better/same/worse than preoperative status). 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. The range of motion of the MP joint of the thumb following operative repair of the. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. [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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Am J Sports Med. Studies that duplicated patient populations from the same authors were excluded. Clipboard, Search History, and several other advanced features are temporarily unavailable. No study directly compared nonoperative to operative treatment. Orthop Rev. [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. 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. 1993;21:800804. 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. If the tear is diagnosed later a ligament reconstruction might be a better option. 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. 25. All rights reserved. HHS Vulnerability Disclosure, Help Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 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. Injury. 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. Clin J Sport Med. 1999;24:275282. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Your surgeon is the person best able to help you avoid any serious recovery problems. [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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Mean subject age was 33.9 years. This site needs JavaScript to work properly. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 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. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Frykman G, Johansson O. Surgical repair of rupture of the, 46. *Glickel grading system. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. You've successfully added to your alerts. Part II: treatment and complications. #Injury location reported only in 3 studies. Your ligament may need to be reattached to the bone using a bone anchor. Mean subject age was 33.9 years. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 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. Am J Orthop (Belle Mead NJ). In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Fusetti C, Papaloizos M, Meyer H, et al.. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Results: Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. An anatomic basis for 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. All but 2 were level IV evidence. In these cases, a new graft may be used to perform a second reconstruction. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 2000;16:345357. 21. Fourteen articles were included and analyzed (293 thumbs). Please enable it to take advantage of the complete set of features! Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 8. 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. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Complications after surgical treatment of UCL injury are rare. This article provides a review of . 1989;71:383387. 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. The https:// ensures that you are connecting to the 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. PMC The injury involves the ulnar collateral ligament (UCL) of the thumb. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Epub 2015 Sep 22. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Instability of the metacarpophalangeal joint of the thumb. If you log out, you will be required to enter your username and password the next time you visit. Purpose: All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. You may search for similar articles that contain these same keywords or you may Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 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. National Library of Medicine Conclusions: CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Objectives: The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.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. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. 2005;87:26322638. SAGE Open Med. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. The grip strength and the pinch strength were 94.3% and 92.27%,. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Bailie DS, Benson LS, Marymont JV. Accessibility Sports Med Arthrosc Rev. 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. 12. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Range of motion returns much sooner, too. 45. Am J Orthop (Belle Mead NJ). 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. The https:// ensures that you are connecting to the Chir Main. Continuous variable data were reported as mean SDs from the mean. the thumb. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. Arthrosc Sports Med Rehabil. PLoS Med. 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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 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. Upper extremity injuries in snow skiers. Orthop J Sports Med. Part I: anatomy and diagnosis. Bookshelf The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Sixty nine (86.3%) patients had grade 3 tears. An official website of the United States government. The site is secure. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. J Bone Joint Surg Am. Evaluation and management of elbow injuries in the adolescent overhead athlete. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Acta Chir Scand. 2003;8:8185. It runs from the outer humerus, around the radial head and attaches to the ulna. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Muscles. 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. unstable when the thumb is used. 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. 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. Treatment of chronic injuries of the. 8600 Rockville Pike No study reported the outcomes of nonoperative management of chronic UCL injury. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. A secondary purpose was to compare graft choice and surgical technique for reconstruction. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . J Bone Joint Surg Am. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. and transmitted securely. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Abstract. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. doi: 10.1097/JSA.0000000000000322. Only prospective studies can determine this injury course. What Happens If We Sit for More Than 8 Hours Per Day? Federal government websites often end in .gov or .mil. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Figure 46-2 Approach to the ulnar collateral ligament. Kaplan EB. Throwing status reported in 4 studies. 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. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Complications after surgery were rare. 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. Early diagnosis and treatment. 2009;34:304308. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 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. HHS Vulnerability Disclosure, Help Benson LS, Bailie DS. Engelhardt JB, Christensen OM, Christiansen TG. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Exercises: Gradually progress to competitive throwing and sports . Melone CP Jr, Beldner S, Basuk RS. 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. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. For more information, please refer to our Privacy Policy. The overall complication rate was 13.8% (11/80). Hand Clin. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. and twist using your thumb. *Gender reported in 12 studies (218 subjects).
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