Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. UCLR case series that contained complications data were included. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Accessibility Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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. eCollection 2022 May. 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 . There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. abduction-adduction motion. Bennet Fracture. 1976;58:106112. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Injury. In some cases, certain risk factors make it more likely that a bone will fail to heal. 2013;23(4):247-254. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. You've successfully added to your alerts. Some error has occurred while processing your request. 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. A common complication following fracture of the distal radius is when the radius shortens. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Complications Following Distal Radius Fractures - Mike Reinold 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 dominance reported in 8 studies (168 thumbs). Am J Sports Med. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) 44. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. The anti edema management will continue for several weeks. and twist using your thumb. Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion 1992;8:713732. AAHS - Comparison of Complications after Thumb Metacarpophalangeal Through a small incision along the side of the thumb joint, we will see where the ligament was torn. These tears often occur as a result of a radially directed force on an extended thumb. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 19. 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. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube 24. doi: 10.1097/JSA.0000000000000322. Thumb sidedness reported in 3 studies (51 thumbs). eCollection 2021. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Clin J Sport Med. Please enable scripts and reload this page. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. #Injury location reported only in 3 studies. Am J Sports Med. Epub 2013 Nov 12. The Complications of CMC Thumb Surgery | Healthy Living The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.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.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. This site needs JavaScript to work properly. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Before 23. 1,5,9,10 In acute cases of complete tears involving high-level . Symptoms are dependent on the cause and severity of injury to the UCL. 1998;23:503506. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Rupture of the ulnar collateral ligament of the thumb - a review Kuz JE, Husband JB, Tokar N, et al.. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair HHS Vulnerability Disclosure, Help Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery A score of 0 was assigned if the item was either omitted or not performed. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 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. Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary 35. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Descriptive statistics were calculated. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Various levels of pain, bruising, or edema may present at the site of damage. PMC The limitations of this systematic review are reliant on the studies analyzed. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. 14 It is important to diagnose complete tears early because . Thumb Collateral Ligament Injury - Hand - Orthobullets Post-traumatic instability of the metacarpophalangeal joint of the thumb. All rights reserved. This article provides a review of . Infection is a rare complication of hand surgery. J Hand Surg Br. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. [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. MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com The mean patient age was 37.8 years (14.0-78.1). Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). Careers. FOIA An official website of the United States government. 2013Lippincott Williams & Wilkins. Sports Health. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. This website also contains material copyrighted by 3rd parties. 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. Treatment for thumb collateral ligament injury - KW orthopaedics Data sources: FOIA Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. RCL Reconstruction Thumb MPJ - The Hand Treatment Center Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Epub 2021 Jan 18. the thumb. J Bone Joint Surg Am. 10. Conflicts of interest The authors report no funding or conflicts of interest. 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. Melone CP Jr, Beldner S, Basuk RS. Nonoperative treatment often failed, necessitating surgery. [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. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Background: Arnold DM, Cooney WP, Wood MB. The https:// ensures that you are connecting to the 22. 8. No study directly compared the different types of graft for UCL reconstruction. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. 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, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Clipboard, Search History, and several other advanced features are temporarily unavailable. Main results: Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Nonsurgical Management of Ulnar Collateral Ligament Injuries Search for Similar Articles
important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. The site is secure. 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. This ligament prevents the thumb from pointing too far away from the hand. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Study design: A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Subject demographics are reported in Table 2. official website and that any information you provide is encrypted 39. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Conclusions: Keyword Highlighting
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.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.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. 13. All but 2 were level IV evidence. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Systematic review and meta-analysis. 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. Bean CH, Tencer AF, Trumble TE. Posner MA, Retaillaud JL. 1987;214:113120. [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. Figure 46-2 Approach to the ulnar collateral ligament. All authors independently performed the search. 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). [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. Thus, the true natural history is yet unknown. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Mean study follow-up was 42.8 months. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. **Stener lesion status reported in 6 studies (145 thumbs). No study compared different graft types or fixation techniques. A p-value of 0.05 was considered statistically significant. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. unstable when the thumb is used. NR, not reported. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Please try after some time. 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. Part II: treatment and complications. three muscles provide deforming forces at the base of the thumb. Part I of this two-part article focuses on common tendon and . 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. There are some cases where the fusion is not successful and you will still have pain in . There is currently no consensus on treatment of acute or chronic UCL injuries. Search performed on November 17, 2011. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Stretching or even a rupture of the graft is also possible. Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent 7. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 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%). Riederer S, Nagy L, Buchler U. A score of 2 was assigned if the item was completely and accurately performed and reported. Jupiter JB, Sheppard JE. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands.