15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Infection is a rare complication of hand surgery. 35. 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. J Bone Joint Surg Am. 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. 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 Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. What are the symptoms of GameKeeper's Thumb? NR, not reported. The mean time from reported injury date to surgery was 202.4 days (2-5969). 31. 26. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. If the latter was executed only partially, a score of 1 was assigned. 1989;14:567573. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. 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. This article provides a review of . 10. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Treatment for thumb collateral ligament injury - KW orthopaedics 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. Bethesda, MD 20894, Web Policies The range of motion of the MP joint of the thumb following operative repair of the. Epub 2014 Oct 22. 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. Complications of Ulnar Collateral Ligament Repair | SpringerLink eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Background: 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. Subject demographics are reported in Table 2. I was able to work while wearing the splint. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 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. You are being redirected to Medscape Education. 8. Complications after surgical treatment of UCL injury are rare. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Kuz JE, Husband JB, Tokar N, et al.. SYMPTOMS: The thumb may be swollen, bruised and painful. Bailie DS, Benson LS, Marymont JV. 2. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.30 The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles.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. Conclusion: Exercises: Gradually progress to competitive throwing and sports . If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Nonoperative treatment often failed, necessitating surgery. 2022 Mar 1;30(1):e1-e8. Proximal interphalangeal joint injuries of the hand. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. If it is appropriate, then surgical consent probably happened before the surgery. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. *Gender reported in 12 studies (218 subjects). 1977;59:1421. Ulnar Collateral Ligament Repair and Reconstruction Thumb Ulnar Collateral Ligament repair; A Step by Step Guide 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. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Unable to load your collection due to an error, Unable to load your delegates due to an error. The limitations of this systematic review are reliant on the studies analyzed. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery eCollection 2021 Apr. 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%). Pichora DR, McMurtry RY, Bell MJ. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois Meta-analysis of the pooled data was completed. 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%). 2021 Apr 15;3(2):e527-e533. 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 . Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Weakened grip or reduced thumb range of motion may occur. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). J Bone Joint Surg Am. official website and that any information you provide is encrypted FOIA Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The site is secure. 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. 1976;58:106112. Purpose. [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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. National Library of Medicine All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Keyword Highlighting J Hand Surg Br. 21. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. MCP (MetaCarpophalangeal) Collateral Ligament Sprain 38. abduction-adduction motion. Smith RJ. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. This ligament prevents the thumb from pointing too far away from the hand. 1962;124:396411. There were 200 acute injuries and 93 chronic injuries. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Ulnar Collateral Ligament Repair . Am J Sports Med. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. All authors independently performed the search. Mean subject age was 33.9 years. At this stage, patients should be advised to wear your splint part-time. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. A score of 2 was assigned if the item was completely and accurately performed and reported. Injuries to the PIP joint remain swollen for long periods of time. 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. 2000;16:345357. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Kozin SH, Bishop AT. Methods: Posner MA, Retaillaud JL. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 18. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Mean subject age was 33.9 years. There were 61 studies eliminated as secondary for being in a language other than English. Mean study follow-up was 42.8 months. Search for Similar Articles UCL injuries: Defining risk and improving treatment - Mayo Clinic 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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 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). MeSH Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia 1989;17:751753. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 1995;18:11611165. An official website of the United States government. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thumb Collateral Ligament Injury - Hand - Orthobullets Superficial infections tend to settle quickly with oral antibiotics and regular dressings. The https:// ensures that you are connecting to the [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].