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. the splint for protection or at night until twelve weeks after the operation. There were 200 acute injuries and 93 chronic injuries. 22. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 1976;58:106112. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Complications after surgery were rare. 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. 17. Causes. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Orthop Rev. 2013Lippincott Williams & Wilkins. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. 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. Gamekeepers thumb: a prospective study of functional bracing. 39. 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. A sprained thumb is a common injury among athletes. No study directly compared the different types of graft for UCL reconstruction. There are some cases where the fusion is not successful and you will still have pain in . Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. UCLR case series that contained complications data were included. These exercises may be directed by a physical or occupational therapist. 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. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 21. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 16. 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 . Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. A secondary purpose was to compare graft choice and surgical technique for reconstruction. The https:// ensures that you are connecting to the Bethesda, MD 20894, Web Policies 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. 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). Before When untreated, this injury may lead to decreased pinch strength, pain, instability, and. 14 It is important to diagnose complete tears early because . Click the topic below to receive emails when new articles are available. 3. You will receive email when new content is published. Pichora DR, McMurtry RY, Bell MJ. History. Epub 2014 Oct 22. Stretching or even a rupture of the graft is also possible. Tension wire fixation of avulsion fractures in the hand. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Complications after surgical treatment of UCL injury are rare. modify the keyword list to augment your search. An anatomic basis for treatment. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Eurasian J Med. 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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Clipboard, Search History, and several other advanced features are temporarily unavailable. Ulnar Collateral Ligament Repair . I was able to work while wearing the splint. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". There is currently no consensus on treatment of acute or chronic UCL injuries. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Mean study follow-up was 42.8 months. J Bone Joint Surg Am. The injury involves the ulnar collateral ligament (UCL) of the thumb. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Epub 2013 Nov 12. Please enter a Recipient Address and/or check the Send me a copy checkbox. [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. These tears often occur as a result of a radially directed force on an extended thumb. Thumb collateral ligament injuries. A p-value of 0.05 was considered statistically significant. [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]. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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%). 1961;43-A:541546. eCollection 2021 Apr. 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. An official website of the United States government. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. The .gov means its official. Search for Similar Articles I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. MCP collateral ligament sprain is most commonly an acute injury related to trauma. J Hand Surg Br. The grip strength and the pinch strength were 94.3% and 92.27%,. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. Hand Surg. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. The range of motion of the MP joint of the thumb following operative repair of the. Subject demographics are reported in Table 2. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Mean study follow-up was 42.8 months. You may search for similar articles that contain these same keywords or you may The mean patient age was 37.8 years (14.0-78.1). Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. This article provides a review of . sharing sensitive information, make sure youre on a federal 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. [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. Mean subject age was 33.9 years. The .gov means its official. 2009;34:304308. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Complications after surgery were rare. 1996;25:527530. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 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. Bean CH, Tencer AF, Trumble TE. 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. 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. Objectives: eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Only prospective studies can determine this injury course. 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. 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. Hand Clin. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. your express consent. Studies that duplicated patient populations from the same authors were excluded. Nonoperative treatment often failed, necessitating surgery. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. 1998;23:503506. Table 1. 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. Stener B. Skeletal injuries associated with rupture of the. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. You've successfully added to your alerts. Kuz JE, Husband JB, Tokar N, et al.. The anti edema management will continue for several weeks. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Early diagnosis and treatment. Systematic review and meta-analysis. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. Descriptive statistics were calculated. Wolters Kluwer Health, Inc. and/or its subsidiaries. An official website of the United States government. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Part II: treatment and complications. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Long-term results of ligament reconstruction. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. 8600 Rockville Pike There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 1. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. 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. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 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. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. If your bone is broken, a pin will be used to put it in place. Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Wolters Kluwer Health 1987;214:113120. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Your thumb will be immobilized in a splint and should not be moved until follow up. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. 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. No study compared different graft types or fixation techniques. 2000;16:345357. [30,43,44] It has been well documented that direct suture techniques fail in chronic 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. [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. Both purely ligamentous and bony avulsion injuries were included. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 14. 24. PMC 45. 4. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Fusetti C, Papaloizos M, Meyer H, et al.. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. Kaplan EB. This site needs JavaScript to work properly. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). If the force is too strong, the ligaments can tear. National Library of Medicine Acute gamekeeper's thumb. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction.

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