Keyword Highlighting SYMPTOMS: The thumb may be swollen, bruised and painful. 35. There were no cases of intraoperative ulnar nerve injury reported. doi: 10.1097/JSA.0000000000000322. Sports Med Arthrosc Rev. Rupture of the ulnar collateral ligament of the thumb - a review 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. 1961;43-A:541546. 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. There were 61 studies eliminated as secondary for being in a language other than English. 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). The range of motion of the MP joint of the thumb following operative repair of the. This site needs JavaScript to work properly. Part I of this two-part article focuses on common tendon and . Range of motion returns much sooner, too. The doctor won't know if the repair is . There are some cases where the fusion is not successful and you will still have pain in . Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries 38. 45. Complications of Ulnar Collateral Ligament Repair | SpringerLink Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). [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. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 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. Outcomes after injury to the thumb ulnar collateral ligament--a 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. government site. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina 8600 Rockville Pike the thumb. Thumb dominance reported in 8 studies (168 thumbs). Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia Thus, the true natural history is yet unknown. 2018;6(4):1-7. Keywords: There is currently no consensus on treatment of acute or chronic UCL injuries. J Hand Surg Br. 19. Bethesda, MD 20894, Web Policies Additional Information: After surgery, you should expect some pain, swelling, and stiffness. 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. Please confirm that you would like to log out of Medscape. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. AAHS - Comparison of Complications after Thumb Metacarpophalangeal Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Your ligament may need to be reattached to the bone using a bone anchor. 14. 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. Unauthorized use of these marks is strictly prohibited. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 2006;31:6875. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher They may even tear completely. Mean study follow-up was 42.8 months. Accessibility PLoS Med. What are the symptoms of GameKeeper's Thumb? 1996;25:527530. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 3. 15. Riederer S, Nagy L, Buchler U. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. Rupture of the. Commonly Missed Orthopedic Problems | AAFP 1996;25:474477. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Abstract. Complications after surgical treatment of UCL injury are rare. Before 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). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. eCollection 2021. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Background: Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. 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. Am J Orthop (Belle Mead NJ). This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Bean CH, Tencer AF, Trumble TE. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 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. To date, no literat. There were 200 acute injuries and 93 chronic injuries. Surgical management of chronic, 42. Orthop Rev. A secondary purpose was to compare graft choice and surgical technique for reconstruction. PMC [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Only prospective studies can determine this injury course. Infection is a rare complication of hand surgery. The torn thumb ligament is repaired or reconstructed during surgery. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Evaluation and management of elbow injuries in the adolescent overhead athlete. Tension wire fixation of avulsion fractures in the hand. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Smith RJ. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb Mean subject age was 33.9 years. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. #Injury location reported only in 3 studies. 1999;24:7075. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. The mean patient age was 37.8 years (14.0-78.1). Complications after surgery were rare. 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. Search performed on November 17, 2011. 2013Lippincott Williams & Wilkins. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. eCollection 2022 May. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 27. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). 12. All authors independently performed the search. MeSH Clipboard, Search History, and several other advanced features are temporarily unavailable. Federal government websites often end in .gov or .mil. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.