The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. You may also begin strengthening exercises if needed. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. 11. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 1989;17:751753. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). 13. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . The authors report no funding or conflicts of interest. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Am J Sports Med. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Early diagnosis and treatment. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 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. Disclaimer. Range of motion returns much sooner, too. Epub 2021 Jan 18. J Bone Joint Surg Am. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. the splint for protection or at night until twelve weeks after the operation. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 34. Methods: 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. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. [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. The https:// ensures that you are connecting to the 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Results: 14. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Am J Sports Med. Sixty nine (86.3%) patients had grade 3 tears. PMC All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Metacarpophalangeal joint injuries of the thumb. 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. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. 16. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Am J Sports Med. **Stener lesion status reported in 6 studies (145 thumbs). 2013;23(4):247-254. 4. 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. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. 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 more information, please refer to our Privacy Policy. Benson LS, Bailie DS. [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. 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%). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 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. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Thumb sidedness reported in 3 studies (51 thumbs). Sports Health. Riederer S, Nagy L, Buchler U. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Am J Sports Med. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Proximal interphalangeal joint injuries of the hand. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. 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. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 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. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Am J Sports Med. A broken thumb can also cause numbness or tingling. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Thumb dominance reported in 8 studies (168 thumbs). Louis DS, Huebner JJ Jr, Hankin FM. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Only prospective studies can determine this injury course. Thirty-two thumbs were treated nonoperatively and 261 operatively. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Please enable it to take advantage of the complete set of features! Please confirm that you would like to log out of Medscape. MeSH There is currently no consensus on treatment of acute or chronic UCL injuries. 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. 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. All but 2 were level IV evidence. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. [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. 1993;21:800804. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 2005;87:26322638. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 2009;61:623632. 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. No study directly compared the different types of graft for UCL reconstruction. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Keywords: 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%). Long-term results of ligament reconstruction. Doi: 10.1177/2325967118769328. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. to maintaining your privacy and will not share your personal information without
Commonly, the joint will be permanently enlarged due to the scarring of the healing process. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Clin J Sport Med. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. [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. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 1977;59:1421. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. The limitations of this systematic review are reliant on the studies analyzed. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. If the tear is diagnosed later a ligament reconstruction might be a better option. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Both purely ligamentous and bony avulsion injuries were included. 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. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. The Orthopedic Journal of Sports Medicine. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 1994;25:2123. J Bone Joint Surg Am. Hand Surg. Early and late postoperative complications were recorded. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. J Hand Surg Glob Online. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. 1961;43-A:541546. 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. 2021 Apr 15;3(2):e527-e533. 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. Accessibility This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. The injury involves the ulnar collateral ligament (UCL) of the thumb. 39. The grip strength and the pinch strength were 94.3% and 92.27%,. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 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%). Catalano LW III, Cardon L, Patenaude N, et al.. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 35. Your ligament may need to be reattached to the bone using a bone anchor. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. The mean patient age was 37.8 years (14.0-78.1). 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). 18. Diagnosis of displaced, 43. Epub 2016 Jan 13. Conflicts of interest The authors report no funding or conflicts of interest. This website also contains material copyrighted by 3rd parties. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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. Orthop Rev. Smith RJ. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Bethesda, MD 20894, Web Policies This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Clipboard, Search History, and several other advanced features are temporarily unavailable. SYMPTOMS: The thumb may be swollen, bruised and painful. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Moher D, Liberati A, Tetzlaff J, et al.. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. 2005;24:217221. Data sources: may email you for journal alerts and information, but is committed
The LUCL is located on the lateral or outside part of the elbow. Muscles. 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. 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. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Infection is a rare complication of hand surgery. 1996;25:527530. The .gov means its official. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41.
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