If the force is too strong, the ligaments can tear. A score of 0 was assigned if the item was either omitted or not performed. He too had the internal brace augmentation. 2009;6:e1000097. abduction-adduction motion. Acta Chir Scand. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Please enable it to take advantage of the complete set of features! Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Epub 2021 Jan 18. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Metacarpophalangeal joint injuries of the thumb. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Bethesda, MD 20894, Web Policies No study reported the outcomes of nonoperative management of chronic UCL injury. 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%). Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 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.. You may also begin strengthening exercises if needed. I was able to work while wearing the splint. Complications after surgery were rare. SAGE Open Med. 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. 14. 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%). Thus, the true natural history is yet unknown. Methods: NR, not reported. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Continue to stretch before and after throwing . A systematic review of ulnar collateral ligament reconstruction techniques. Table 1. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. MeSH 39. The injury happens when you fall . 1989;71:383387. sharing sensitive information, make sure youre on a federal There were 200 acute injuries and 93 chronic injuries. 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. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 1. 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. 3. Complications after surgery were rare. Abstract. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Data range was reported as minimum to maximum absolute values. Catalano LW III, Cardon L, Patenaude N, et al.. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 22. Wolters Kluwer Health
45. 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. 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*. 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. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Unauthorized use of these marks is strictly prohibited. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 38. Descriptive statistics were calculated. #Injury location reported only in 3 studies. HHS Vulnerability Disclosure, Help Epub 2014 Dec 30. J Hand Surg Glob Online. PMC Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Am J Sports Med. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 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. Would you like email updates of new search results? A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). If your bone is broken, a pin will be used to put it in place. Surgical management of chronic, 42. Am J Sports Med. 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. Your surgeon will discuss these options with you. Injuries to the PIP joint remain swollen for long periods of time. You may search for similar articles that contain these same keywords or you may
2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 2021 Apr 15;3(2):e527-e533. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. doi: 10.1097/JSA.0000000000000322. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Disclaimer. Smith RJ. doi: 10.1016/j.asmr.2020.12.004. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. They may even tear completely. An official website of the United States government. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. All but 2 were level IV evidence. Bookshelf There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. 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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. 26. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Mean study follow-up was 42.8 months. Orthopedics. 23. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Accessibility Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Disclaimer. HHS Vulnerability Disclosure, Help [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. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 4. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Please confirm that you would like to log out of Medscape. [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. Epub 2016 Jan 13. Kaplan EB. 11. Federal government websites often end in .gov or .mil. 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 site needs JavaScript to work properly. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Hand Surg. There were no cases of intraoperative ulnar nerve injury reported. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Acute gamekeeper's thumb. The authors report no funding or conflicts of interest. Please try after some time. Wolters Kluwer Health, Inc. and/or its subsidiaries. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Am J Orthop (Belle Mead NJ). Proximal interphalangeal joint injuries of the hand. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 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. *Glickel grading scale. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Accessibility 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. This damage may lead to temporary or permanent numbness or weakness. Mean study follow-up was 42.8 months. Arthrosc Sports Med Rehabil. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. Bethesda, MD 20894, Web Policies the thumb. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 37. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Non-Fusion. 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. The https:// ensures that you are connecting to the 7. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 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. 21. When assessed, most patients returned to their preinjury employment. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. The doctor won't know if the repair is . If the latter was executed only partially, a score of 1 was assigned. Gamekeepers thumb: a prospective study of functional bracing. A broken thumb can also cause numbness or tingling. to maintaining your privacy and will not share your personal information without