Eventually this abnormal movement will wear out the joint and it will become arthritic. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. An anatomic basis for treatment. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Am J Sports Med. Kozin SH, Bishop AT. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. 1989;71:383387. 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. 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 chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 2003;8:8185. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. MeSH and transmitted securely. The LUCL is located on the lateral or outside part of the elbow. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Rupture of the ulnar collateral ligament of the thumb - a review Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Complications after surgical treatment of UCL injury are rare. Acta Chir Scand. 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. 1962;124:396411. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. Objectives: The site is secure. 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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. 2009;61:623632. 27. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). SAGE Open Med. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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). Metacarpophalangeal joint injuries of the thumb. The site is secure. Nonoperative treatment often failed, necessitating surgery. 1999;24:275282. Treatment for thumb collateral ligament injury - KW orthopaedics The authors report no funding or conflicts of interest. Federal government websites often end in .gov or .mil. Riederer S, Nagy L, Buchler U. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 1987;214:113120. Am J Orthop (Belle Mead NJ). Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Complications after surgery were rare. Federal government websites often end in .gov or .mil. You may be trying to access this site from a secured browser on the server. 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. sharing sensitive information, make sure youre on a federal The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Clin J Sport Med. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics 1995;23:222226. 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. Jupiter JB, Sheppard JE. 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. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 2018;6(4):1-7. Ulnar Collateral Ligament (UCL) Injuries of the Elbow [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 38. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Background: Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Clipboard, Search History, and several other advanced features are temporarily unavailable. Kuz JE, Husband JB, Tokar N, et al.. 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%.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. J Bone Joint Surg Am. Nonunions - OrthoInfo - AAOS ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Educate the patient on anti edema management. Fourteen articles were included and analyzed (293 thumbs). Please enter a Recipient Address and/or check the Send me a copy checkbox. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. [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. Orthop Clin North Am. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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. Am J Sports Med. For example, it can be removed when performing . 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). Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Hand Surg. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 44. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Mean subject age was 33.9 years. eCollection 2021 Apr. Categorical variable data were reported as frequency with percentages. Bennet Fracture. Bean CH, Tencer AF, Trumble TE. PMC Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Bookshelf These exercises may be directed by a physical or occupational therapist. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. In these patients, after failure of nonoperative treatment at anywhere from 1 month 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. 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . 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. flexion-extension motion. 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. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Continuous variable data were reported as mean SDs from the mean. 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. Outcomes after injury to the thumb ulnar collateral ligament--a Keywords: 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Careers. 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%. These tears often occur as a result of a radially directed force on an extended thumb. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher The mean time from reported injury date to surgery was 202.4 days (2-5969). The UCL is also known as the medial collateral ligament or "Tommy John Ligament". 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. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Search for Similar Articles Accessibility Epub 2021 Jan 18. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. All authors independently performed the search. The .gov means its official. Your thumb will be immobilized in a splint and should not be moved until follow up. J Hand Surg Glob Online. A systematic review of ulnar collateral ligament reconstruction techniques. 7. J Bone Joint Surg Am. [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. Ulnar collateral ligament injury of the thumb - Wikipedia Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 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. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Methods: Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube 5. Patient Demographics of Thumb RCL and UCL Injuries.
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