and transmitted securely. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 1995;23:222226. 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. Treatment of chronic injuries of the. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. 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. Careers. Orthop Rev. #Injury location reported only in 3 studies. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 35. Federal government websites often end in .gov or .mil. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. The authors report no funding or conflicts of interest. SYMPTOMS: The thumb may be swollen, bruised and painful. Bailie DS, Benson LS, Marymont JV. 25. Dr. Holt will talk to you about when it is safe to return to work. All rights reserved. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. A score of 0 was assigned if the item was either omitted or not performed. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 1994;23:797804. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Mean subject age was 33.9 years. Catalano LW III, Cardon L, Patenaude N, et al.. Am J Sports Med. Thus, the true natural history is yet unknown. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. *Gender reported in 12 studies (218 subjects). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Rupture and displacement of the. 1977;59:1421. FOIA Hand Clin. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. J Hand Surg Am. 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. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. Part II: treatment and complications. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 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. Careers. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. 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. There were 61 studies eliminated as secondary for being in a language other than English. Am J Sports Med. Symptoms are dependent on the cause and severity of injury to the UCL. Complications after surgical treatment of UCL injury are rare. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Search for Similar Articles
2005;24:217221. Only prospective studies can determine this injury course. Keywords: may email you for journal alerts and information, but is committed
Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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. For example, it can be removed when performing . Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 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. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Thumb from the common mechanism of falling on the thumb while holding a ski pole. An anatomic basis for treatment. Wolters Kluwer Health, Inc. and/or its subsidiaries. Federal government websites often end in .gov or .mil. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. If the force is too strong, the ligaments can tear. Arthritis Rheum. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Thumb collateral ligament injuries. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 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. The LUCL is located on the lateral or outside part of the elbow. 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. 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. Mean study follow-up was 42.8 months. 31. 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. Systematic review and meta-analysis. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Studies that duplicated patient populations from the same authors were excluded. J Hand Surg Br. 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. 34. All techniques improved clinical outcomes, including pain, motion, strength, and stability. 4. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. This website also contains material copyrighted by 3rd parties. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 11. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. unstable when the thumb is used. Infection is a rare complication of hand surgery. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. If the tear is diagnosed later a ligament reconstruction might be a better option. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. The site is secure. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. [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. 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. No study directly compared the different types of graft for UCL reconstruction. Non-Fusion. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 1998;23:503506. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. In some cases, certain risk factors make it more likely that a bone will fail to heal. Surgical techniques and a review of 70 patients. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. J Bone Joint Surg Am. A common complication following fracture of the distal radius is when the radius shortens. sharing sensitive information, make sure youre on a federal For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. PMC Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. The anti edema management will continue for several weeks. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Orthopedics. Continuous variable data were reported as mean SDs from the mean. *Glickel grading system. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Am J Sports Med. 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.