J Hand Surg Am. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. 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. 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. 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. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Epub 2014 Oct 22. The limitations of this systematic review are reliant on the studies analyzed. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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.. There is currently no consensus on treatment of acute or chronic UCL injuries. 2003;8:8185. Infection is a rare complication of hand surgery. A score of 2 was assigned if the item was completely and accurately performed and reported. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 27. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Epub 2015 Sep 22. Am J Sports Med. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Your message has been successfully sent to your colleague. Fourteen articles were included and analyzed (293 thumbs). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 1989;14:567573. Muscles. The Complications of CMC Thumb Surgery | Healthy Living In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. This site needs JavaScript to work properly. 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. At this stage, patients should be advised to wear your splint part-time. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Proximal interphalangeal joint injuries of the hand. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 21. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Continuous variable data were reported as mean SDs from the mean. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 2005;87:26322638. 2. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Wolters Kluwer Health important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Meta-analysis of the pooled data was completed. Early and late postoperative complications were recorded. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. 2018;6(4):1-7. Ulnar Collateral Ligament Repair and Reconstruction the thumb. and twist using your thumb. 1976;58:106112. your express consent. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics Part I of this two-part article focuses on common tendon and . Clinical Journal of Sport Medicine23(4):247-254, July 2013. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. A p-value of 0.05 was considered statistically significant. The .gov means its official. Rupture of the ulnar collateral ligament of the thumb - a review 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. Only prospective studies can determine this injury course. 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 . 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. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. An official website of the United States government. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Data sources: Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. 5. 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. eCollection 2021. 1999;24:275282. You will receive email when new content is published. Kaplan EB. eCollection 2021 Apr. Background: PIP Joint Injuries of the Finger - Orthogate Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Your thumb will be immobilized in a splint and should not be moved until follow up. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Ulnar Collateral Ligament (UCL) Repair | SpringerLink A score of 0 was assigned if the item was either omitted or not performed. Causes. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. [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. 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. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. 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. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.17,34 Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. Unable to load your collection due to an error, Unable to load your delegates due to an error. No study directly compared the different types of graft for UCL reconstruction. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. I was able to work while wearing the splint. Rupture of the. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. You may be trying to access this site from a secured browser on the server. 1995;23:222226. 8600 Rockville Pike **Stener lesion status reported in 6 studies (145 thumbs). Dr. Holt will talk to you about when it is safe to return to work. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries 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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Clin Orthop Relat Res. Unilateral injuries: 291 and bilateral injury: 1. Anesthesia for Hand Surgery | The Hand & Wrist Center Early diagnosis and treatment. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 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. 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%). In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. If you log out, you will be required to enter your username and password the next time you visit. What Happens If We Sit for More Than 8 Hours Per Day? 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. MeSH Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Evaluation and management of elbow injuries in the adolescent overhead athlete. *Glickel grading system. 26. 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. 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. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 45. Long-term results of ligament reconstruction. All but 2 were level IV evidence. J Hand Surg Br. Catalano LW III, Cardon L, Patenaude N, et al.. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. J Bone Joint Surg Am. doi: 10.1097/JSA.0000000000000322. J Bone Joint Surg Am. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 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. 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. Hand Clin. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Outcomes After Injury to the Thumb Ulnar Collateral Ligament Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 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

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