Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. A score of 0 was assigned if the item was either omitted or not performed. Sixty nine (86.3%) patients had grade 3 tears. Acute gamekeeper's thumb. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. The site is secure. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 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 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. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Exercises: Gradually progress to competitive throwing and sports . Search for Similar Articles The authors report no funding or conflicts of interest. J Hand Surg Am. 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 . An official website of the United States government. Evaluation and management of elbow injuries in the adolescent overhead athlete. the splint for protection or at night until twelve weeks after the operation. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Clipboard, Search History, and several other advanced features are temporarily unavailable. It runs from the outer humerus, around the radial head and attaches to the ulna. Background: To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. 10. Pain reduction was significantly improved in all subjects (P < 0.05). All authors independently performed the search. three muscles provide deforming forces at the base of the thumb. 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. 11. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery For example, it can be removed when performing . Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Objectives: Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Ulnar Collateral Ligament Repair and Reconstruction Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) Would you like email updates of new search results? 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). Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 2009;34:304308. Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP Additional Information: After surgery, you should expect some pain, swelling, and stiffness. PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois 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. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The .gov means its official. MeSH 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Figure 46-2 Approach to the ulnar collateral ligament. Purpose: The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. The torn thumb ligament is repaired or reconstructed during surgery. MCP fusion was performed . The anti edema management will continue for several weeks. Van Dommelen BA, Zvirbulis RA. 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. An official website of the United States government. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Epub 2021 Sep 7. There were 200 acute injuries and 93 chronic injuries. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Epub 2013 Nov 12. Orthop J Sports Med. 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. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Gamekeepers thumb: a prospective study of functional bracing. 38. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Instability of the metacarpophalangeal joint of the thumb. Please enable it to take advantage of the complete set of features! Rupture of the. You are being redirected to Medscape Education. For more information, please refer to our Privacy Policy. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Bailie DS, Benson LS, Marymont JV. Sports Health. 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. [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. Federal government websites often end in .gov or .mil. 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). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. J Bone Joint Surg Am. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Causes. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Stener B. Skeletal injuries associated with rupture of the. Am J Sports Med. 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%). Only prospective studies can determine this injury course. 1. Louis DS, Huebner JJ Jr, Hankin FM. Surgical techniques and a review of 70 patients. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. No study compared different graft types or fixation techniques. Subject demographics are reported in Table 2. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 2009;6:e1000097. Anesthesia for Hand Surgery | The Hand & Wrist Center Unauthorized use of these marks is strictly prohibited. 1992;8:713732. AAHS - Comparison of Complications after Thumb Metacarpophalangeal Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. The grip strength and the pinch strength were 94.3% and 92.27%,. Throwing status reported in 4 studies. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 8600 Rockville Pike 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 1989;71:383387. 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%). Melone CP Jr, Beldner S, Basuk RS. 2021 Apr 15;3(2):e527-e533. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 36. Conflicts of interest The authors report no funding or conflicts of interest. modify the keyword list to augment your search. 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). Am J Sports Med. 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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Systematic review and meta-analysis. 1987;214:113120. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Would you like email updates of new search results? PMC 37. 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. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Thumb dominance reported in 8 studies (168 thumbs). Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 1994;23:797804. Some error has occurred while processing your request. 1994;25:2123. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. 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). PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair 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. 13. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 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. 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. Jackson M, McQueen MM. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. the thumb. 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. The injury happens when you fall . Continuous variable data were reported as mean SDs from the mean. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. At this stage, patients should be advised to wear your splint part-time. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 1996;25:527530. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . A score of 2 was assigned if the item was completely and accurately performed and reported. Hand Surgery Recovery Time: Pain, Exercise & Complications 1998;23:503506. They may even tear completely. PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine Bookshelf This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to 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. 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. Main results: Abstract. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Chir Main. eCollection 2021 Mar. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. Purpose. Early and late postoperative complications were recorded. Athletes Can Return to Play in Half the Time with New Thumb Ligament Your surgeon is the person best able to help you avoid any serious recovery problems. 2. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Thumb sidedness reported in 3 studies (51 thumbs). No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Study design: 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . All but 2 were level IV evidence. Results: Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 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. 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. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Search performed on November 17, 2011. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Ulnar collateral ligament repair surgery Archives | OrthoVirginia Posner MA, Retaillaud JL. Before Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Benson LS, Bailie DS. 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. Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Am J Orthop (Belle Mead NJ). Jupiter JB, Sheppard JE. PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction This site needs JavaScript to work properly. 23. 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. Commonly Missed Orthopedic Problems | AAFP Complications after surgical treatment of UCL injury are rare. Am J Orthop (Belle Mead NJ). Arthrosc Sports Med Rehabil. Catalano LW III, Cardon L, Patenaude N, et al.. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Hand Clin. sharing sensitive information, make sure youre on a federal J Bone Joint Surg Am. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Bean CH, Tencer AF, Trumble TE. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Upper extremity injuries in snow skiers. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Educate the patient on anti edema management. Complications after this procedure may include nerve or blood vessel damage. 2005;87:26322638. Arthritis Rheum. government site. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 8600 Rockville Pike No study directly compared the different types of graft for UCL reconstruction. Ulnar collateral ligament injury of the thumb - Wikipedia
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