2006;31:6875. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Metacarpophalangeal joint injuries of the thumb. Injury. 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. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Epub 2021 Jan 18. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Complications after surgery were rare. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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%). Accessibility 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. For example, it can be removed when performing . Rupture of the. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Sakellarides HT, DeWeese JW. 26. What are the symptoms of GameKeeper's Thumb? PMC 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. 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. If the tear is diagnosed early a repair will be possible. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 14 It is important to diagnose complete tears early because . The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 24. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). unstable when the thumb is used. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 2018;6(4):1-7. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Sixty nine (86.3%) patients had grade 3 tears. This ligament prevents the thumb from pointing too far away from the hand. Instability of the metacarpophalangeal joint of the thumb. Part I of this two-part article focuses on common tendon and . Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. It runs from the outer humerus, around the radial head and attaches to the ulna. MeSH Mean study follow-up was 42.8 months. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. 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. Am J Sports Med. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Data range was reported as minimum to maximum absolute values. Am J Orthop (Belle Mead NJ). If the latter was executed only partially, a score of 1 was assigned. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. Both repair and reconstruction (autograft and allograft) techniques were inclusive. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Wong TC, Ip FK, Wu WC. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Bethesda, MD 20894, Web Policies All authors independently performed the search. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. 12. 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. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Orthop Clin North Am. An official website of the United States government. Abstract. Upper extremity injuries in snow skiers. Table 1. Clin J Sport Med. Nonoperative treatment often failed, necessitating surgery. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Only prospective studies can determine this injury course. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and 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. 13. There were 200 acute injuries and 93 chronic injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. Categorical variable data were reported as frequency with percentages. If it is appropriate, then surgical consent probably happened before the surgery. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. [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. better/same/worse than preoperative status). and twist using your thumb. Conclusion: 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. There were no cases of intraoperative ulnar nerve injury reported. Pichora DR, McMurtry RY, Bell MJ. 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 modify the keyword list to augment your search. 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. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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 . 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. Throwing status reported in 4 studies. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. The injury involves the ulnar collateral ligament (UCL) of the thumb. official website and that any information you provide is encrypted Wolters Kluwer Health Complications after surgical treatment of UCL injury are rare. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Complications after surgical treatment of UCL injury are rare. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Eurasian J Med. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Please enable scripts and reload this page. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. National Library of Medicine [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. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 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. Causes. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. If you log out, you will be required to enter your username and password the next time you visit. 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. Benson LS, Bailie DS. 27. Bailie DS, Benson LS, Marymont JV. Various levels of pain, bruising, or edema may present at the site of damage. SYMPTOMS: The thumb may be swollen, bruised and painful. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 2009;34:304308. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 1976;58:106112. 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 . In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. Purpose. POST-OPERATIVE WEEKS 22-24. Thumb from the common mechanism of falling on the thumb while holding a ski pole. The .gov means its official. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. You've successfully added to your alerts. A sprained thumb is a common injury among athletes. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Descriptive statistics were calculated. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Kozin SH, Bishop AT. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 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. Range of motion returns much sooner, too. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. MCP collateral ligament sprain is most commonly an acute injury related to trauma. abduction-adduction motion. Am J Sports Med. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Keywords: This leads to what is know as a positive ulnar variance. He too had the internal brace augmentation. The site is secure. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The https:// ensures that you are connecting to the Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Part II: treatment and complications. Epub 2019 Mar 21. Ulnar Collateral Ligament Repair . 17. J Bone Joint Surg Am. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Complications after this procedure may include nerve or blood vessel damage. 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. Data is temporarily unavailable. 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. Hand Surg. Epub 2016 Jan 13. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 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). Data sources: Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. 1996;25:474477. The grip strength and the pinch strength were 94.3% and 92.27%,. 4. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 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. eCollection 2021. Unauthorized use of these marks is strictly prohibited. 34. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. If the force is too strong, the ligaments can tear. Thirty-two thumbs were treated nonoperatively and 261 operatively. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Gamekeeper's thumb. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 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. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. These exercises may be directed by a physical or occupational therapist. Highlight selected keywords in the article text. 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. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Sports Health. Both purely ligamentous and bony avulsion injuries were included. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. All but 2 were level IV evidence. Thumb sidedness reported in 3 studies (51 thumbs). Epub 2013 Nov 12. The injury happens when you fall . For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Methods: No study compared different graft types or fixation techniques. The mean patient age was 37.8 years (14.0-78.1). The doctor won't know if the repair is . The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. three muscles provide deforming forces at the base of the thumb. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. doi: 10.1016/j.asmr.2020.12.004. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 1998;23:503506. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. 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. Am J Orthop (Belle Mead NJ). the splint for protection or at night until twelve weeks after the operation. If the tear is diagnosed later a ligament reconstruction might be a better option. J Hand Surg Am. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Please confirm that you would like to log out of Medscape. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Thumb dominance reported in 8 studies (168 thumbs). Only prospective studies can determine this injury course.