The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Careers. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Pichora DR, McMurtry RY, Bell MJ. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. PMC [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. Complications after surgery were rare. 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. Metacarpophalangeal joint injuries of the thumb. 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. Injury. Symptoms are dependent on the cause and severity of injury to the UCL. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. 1996;25:527530. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 8. Objectives: 1,5,9,10 In acute cases of complete tears involving high-level . There are some cases where the fusion is not successful and you will still have pain in . 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%). the splint for protection or at night until twelve weeks after the operation. J Hand Surg Br. 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 2013Lippincott Williams & Wilkins. 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. 2000;16:345357. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. If the force is too strong, the ligaments can tear. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Epub 2020 Jun 29. 1994;25:2123. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Bethesda, MD 20894, Web Policies 1995;18:11611165. 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. sharing sensitive information, make sure youre on a federal Mean study follow-up was 42.8 months. 25. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Am J Sports Med. Proximal interphalangeal joint injuries of the hand. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Meta-analysis of the pooled data was completed. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 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. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 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. Fusetti C, Papaloizos M, Meyer H, et al.. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 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. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Thirty-two thumbs were treated nonoperatively and 261 operatively. Part I: anatomy and diagnosis. J Bone Joint Surg Am. HHS Vulnerability Disclosure, Help When assessed, most patients returned to their preinjury employment. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 35. 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. Systematic review and meta-analysis. 31. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. 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. It runs from the outer humerus, around the radial head and attaches to the ulna. Sports Health. 1993;21:800804. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Continuous variable data were reported as mean SDs from the mean. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 10. 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. This damage may lead to temporary or permanent numbness or weakness. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. This leads to what is know as a positive ulnar variance. 2. Part II: treatment and complications. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Please enable it to take advantage of the complete set of features! Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Unauthorized use of these marks is strictly prohibited. Federal government websites often end in .gov or .mil. [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. 1962;124:396411. 7. If it is appropriate, then surgical consent probably happened before the surgery. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation 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. 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Your message has been successfully sent to your colleague. 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. 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%). Infection is a rare complication of hand surgery. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Epub 2015 Sep 22. 1992;8:713732. Diagnosis of displaced, 43. Bean CH, Tencer AF, Trumble TE. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. 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. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. 20. 2009;34:304308. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. 22. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 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. Range of motion returns much sooner, too. 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. FOIA Eventually this abnormal movement will wear out the joint and it will become arthritic. SYMPTOMS: The thumb may be swollen, bruised and painful. 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. Purpose. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 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. No study compared different graft types or fixation techniques. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 1994;23:797804. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. If you log out, you will be required to enter your username and password the next time you visit. Am J Orthop (Belle Mead NJ). The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). A broken thumb can also cause numbness or tingling. They may even tear completely. Early and late postoperative complications were recorded. Kuz JE, Husband JB, Tokar N, et al.. Data range was reported as minimum to maximum absolute values. This ligament prevents the thumb from pointing too far away from 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. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. Most times, they won't know until they're in the surgery if the internal brace is appropriate. and transmitted securely. [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. 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. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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. Hand Clin. Search for Similar Articles J Hand Surg Am. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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.
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