The site is secure. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Eventually this abnormal movement will wear out the joint and it will become arthritic. 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. All rights reserved. 37. A sprained thumb is a common injury among athletes. 5. modify the keyword list to augment your search. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 2003;8:8185. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. You may be trying to access this site from a secured browser on the server. 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. You've successfully added to your alerts. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. SYMPTOMS: The thumb may be swollen, bruised and painful. Bean CH, Tencer AF, Trumble TE. There were 200 acute injuries and 93 chronic injuries. may email you for journal alerts and information, but is committed For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Complications after this procedure may include nerve or blood vessel damage. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Thumb dominance reported in 8 studies (168 thumbs). There is currently no consensus on treatment of acute or chronic UCL injuries. *Gender reported in 12 studies (218 subjects). Your ligament may need to be reattached to the bone using a bone anchor. Please try again soon. 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. 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. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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. Surgical management of chronic, 42. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 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%. The injury happens when you fall . Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Bookshelf Stretching or even a rupture of the graft is also possible. Sports Med Arthrosc Rev. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Nonoperative treatment often failed, necessitating surgery. Am J Orthop (Belle Mead NJ). 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.. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 1962;124:396411. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. HHS Vulnerability Disclosure, Help If your bone is broken, a pin will be used to put it in place. 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]). 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. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 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. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. 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. Thus, the true natural history is yet unknown. Bethesda, MD 20894, Web Policies UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. The doctor won't know if the repair is . All but 2 were level IV evidence. 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%). 21. A score of 0 was assigned if the item was either omitted or not performed. MeSH 1992;8:713732. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Federal government websites often end in .gov or .mil. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Epub 2021 Sep 7. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Accessibility Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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 addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Data range was reported as minimum to maximum absolute values. 44. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. There were 200 acute injuries and 93 chronic injuries. Upper extremity injuries in snow skiers. Clipboard, Search History, and several other advanced features are temporarily unavailable. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. There were no cases of intraoperative ulnar nerve injury reported. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Data is temporarily unavailable. 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%). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Posner MA, Retaillaud JL. 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. Melone CP Jr, Beldner S, Basuk RS. This damage may lead to temporary or permanent numbness or weakness. If it is appropriate, then surgical consent probably happened before the surgery. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 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. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Downey DJ, Moneim MS, Omer GE Jr. 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. Fusetti C, Papaloizos M, Meyer H, et al.. 22. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 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. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Am J Sports Med. Data sources: 2013;23(4):247-254. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Instability of the metacarpophalangeal joint of the thumb. 33. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. J Bone Joint Surg Am. 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). If the latter was executed only partially, a score of 1 was assigned. Thumb collateral ligament injuries. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. Am J Sports Med. 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. Sports Health. 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. 1989;17:751753. Please enable scripts and reload this page. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Rupture of the. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Keywords: 1976;58:106112. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. The grip strength and the pinch strength were 94.3% and 92.27%,. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. J Hand Surg Am. There were 61 studies eliminated as secondary for being in a language other than English. [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. 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. Hand Clin. Various levels of pain, bruising, or edema may present at the site of damage. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Dr. Holt will talk to you about when it is safe to return to work. A secondary purpose was to compare graft choice and surgical technique for reconstruction. [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]. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Arthritis Rheum. Your surgeon will discuss these options with you. Your message has been successfully sent to your colleague. [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. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 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. 24. The limitations of this systematic review are reliant on the studies analyzed. 10. Epub 2014 Oct 22. 2018;6(4):1-7. Early diagnosis and treatment. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 1. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Epub 2015 Sep 22. Epub 2020 Jun 29. The Orthopedic Journal of Sports Medicine. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. If the tear is diagnosed early a repair will be possible. 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. 23. MeSH 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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. J Hand Surg Br. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Chir Main. Continuous variable data were reported as mean SDs from the mean. No study compared different graft types or fixation techniques. Proximal interphalangeal joint injuries of the hand. 2005;87:26322638. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 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. 1999;24:7075. Would you like email updates of new search results? No study directly compared the different types of graft for UCL 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). 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. Possible complications include: - 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.