complications after ucl repair of thumb complications after ucl repair of thumb

All authors independently performed the search. Early diagnosis and treatment. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 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. 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. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Upper extremity injuries in snow skiers. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Kozin SH, Bishop AT. Abrahamsson SO, Sollerman C, Lundborg G, et al.. 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. Complications after surgical treatment of UCL injury are rare. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Fusetti C, Papaloizos M, Meyer H, et al.. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb The doctor won't know if the repair is . PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape 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. Rupture and displacement of the. 33. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery 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. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). There were 200 acute injuries and 93 chronic injuries. Ulnar collateral ligament injury of the thumb - Wikipedia Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Surgical management of chronic, 42. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Federal government websites often end in .gov or .mil. your express consent. Sports Med Arthrosc Rev. 1994;23:797804. Most times, they won't know until they're in the surgery if the internal brace is appropriate. 22. You may be trying to access this site from a secured browser on the server. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. The .gov means its official. J Bone Joint Surg Am. Categorical variable data were reported as frequency with percentages. Downey DJ, Moneim MS, Omer GE Jr. 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. Chir Main. Part II: treatment and complications. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Thumb collateral ligament injuries. Disclaimer. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. 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%). Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. FOIA 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. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? What are the symptoms of GameKeeper's Thumb? *Glickel grading system. *Gender reported in 12 studies (218 subjects). Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. 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. Unauthorized use of these marks is strictly prohibited. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Please try again soon. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Results: Thumb Collateral Ligament Injury - Hand - Orthobullets PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. [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. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Early and late postoperative complications were recorded. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). #Injury location reported only in 3 studies. Long-term results of ligament reconstruction. Complications after surgical treatment of UCL injury are rare. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. If the force is too strong, the ligaments can tear. 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. Pain reduction was significantly improved in all subjects (P < 0.05). Am J Orthop (Belle Mead NJ). A score of 2 was assigned if the item was completely and accurately performed and reported. 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. Weakened grip or reduced thumb range of motion may occur. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. 7. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Conflicts of interest The authors report no funding or conflicts of interest. 2013;23(4):247-254. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. eCollection 2021 Mar. 2009;34:304308. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries [38] Chuter et al[40] 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. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Epub 2014 Oct 22. Sixty nine (86.3%) patients had grade 3 tears. UCL Repair of the Thumb - MSA Hand Center Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Keywords: 8. Thirty-two thumbs were treated nonoperatively and 261 operatively. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 36. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. There were no cases of intraoperative ulnar nerve injury reported. Possible complications include: - eCollection 2022 May. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 32. 5. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . You may search for similar articles that contain these same keywords or you may Treatment of chronic injuries of the. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Tension wire fixation of avulsion fractures in the hand. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 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%. 2005;87:26322638. eCollection 2021 Apr. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Clipboard, Search History, and several other advanced features are temporarily unavailable. 16. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Please confirm that you would like to log out of Medscape. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. UCLR case series that contained complications data were included. Range of motion returns much sooner, too. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Am J Sports Med. J Hand Surg Am. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Louis DS, Huebner JJ Jr, Hankin FM. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Data range was reported as minimum to maximum absolute values. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Wolters Kluwer Health 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. flexion-extension motion. Base of Thumb Fractures - Hand - Orthobullets The https:// ensures that you are connecting to the Please enable it to take advantage of the complete set of features! Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) Kuz JE, Husband JB, Tokar N, et al.. Am J Sports Med. 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. 23. 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. Careers. 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. Hand Clin. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Complications Following Distal Radius Fractures - Mike Reinold Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. J Hand Surg Am. Midterm clinical outcomes of collateral ligament repair of the thumb 2009;6:e1000097. Your surgeon is the person best able to help you avoid any serious recovery problems. Posner MA, Retaillaud JL. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. *Glickel grading scale. Am J Sports Med. National Library of Medicine The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury 12. 6. Study design: Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 1961;43-A:541546. [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. 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. [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. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Abstract. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 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. government site. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. doi: 10.1097/JSA.0000000000000322. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. J Bone Joint Surg Am. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. 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 . If your bone is broken, a pin will be used to put it in place. 34. Engelhardt JB, Christensen OM, Christiansen TG. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Both repair and reconstruction (autograft and allograft) techniques were inclusive. There were 61 studies eliminated as secondary for being in a language other than English. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Meta-analysis of the pooled data was completed. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 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. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). 38. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. The mean time from reported injury date to surgery was 202.4 days (2-5969). 1996;25:527530. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 44. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist All but 2 were level IV evidence. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb Nonsurgical Management of Ulnar Collateral Ligament Injuries 1994;25:2123. Complications after surgery were rare. J Hand Surg Glob Online. [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]. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 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). The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 1998;23:503506. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 1995;18:11611165. the splint for protection or at night until twelve weeks after the operation. Accessibility Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Ulnar Collateral Ligament (UCL) Repair | SpringerLink Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Bookshelf Your message has been successfully sent to your colleague. 1999;24:7075. Van Dommelen BA, Zvirbulis RA. If the latter was executed only partially, a score of 1 was assigned. Epub 2019 Mar 21. Thumb sidedness reported in 3 studies (51 thumbs). Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape 21. Fourteen articles were included and analyzed (293 thumbs). Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Symptoms are dependent on the cause and severity of injury to the UCL. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 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. to maintaining your privacy and will not share your personal information without 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. Sports Health. A broken thumb can also cause numbness or tingling. 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. Please try after some time. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Epub 2021 Jan 18. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Arthrosc Sports Med Rehabil. 26. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Data is temporarily unavailable. 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. Riederer S, Nagy L, Buchler U. 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. abduction-adduction motion. Muscles. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 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. 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. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Jupiter JB, Sheppard JE. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. History. sharing sensitive information, make sure youre on a federal [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. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. 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. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. There is currently no consensus on treatment of acute or chronic UCL injuries. 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.