Infection is a rare complication of hand surgery. Search for Similar Articles 8. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. If the force is too strong, the ligaments can tear. 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. Complications after surgical treatment of UCL injury are rare. Throwing status reported in 4 studies. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. The site is secure. 2022 Mar 1;30(1):e1-e8. Am J Sports Med. FOIA official website and that any information you provide is encrypted This website also contains material copyrighted by 3rd parties. 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. If you log out, you will be required to enter your username and password the next time you visit. Posner MA, Retaillaud JL. National Library of Medicine Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 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. Complications you may experience after Hand Surgery - Rebecca Ayers 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery government site. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. 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. sharing sensitive information, make sure youre on a federal 34. Search performed on November 17, 2011. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. This site needs JavaScript to work properly. Stretching or even a rupture of the graft is also possible. Treatment for thumb collateral ligament injury - KW orthopaedics A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Doi: 10.1177/2325967118769328. 1996;25:527530. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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. 2021 Apr 15;3(2):e527-e533. RCL Reconstruction Thumb MPJ - The Hand Treatment Center eCollection 2021. Thumb dominance reported in 8 studies (168 thumbs). Federal government websites often end in .gov or .mil. Am J Sports Med. and transmitted securely. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 1961;43-A:541546. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Sports Med Arthrosc Rev. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. MeSH The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. 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. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. The mean patient age was 37.8 years (14.0-78.1). This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Outcomes After Injury to the Thumb Ulnar Collateral Ligament No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Thumb from the common mechanism of falling on the thumb while holding a ski pole. They may even tear completely. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. He too had the internal brace augmentation. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. [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. 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%). No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Muscles. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Please enable scripts and reload this page. Results: 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. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. An official website of the United States government. A broken thumb can also cause numbness or tingling. Part I: anatomy and diagnosis. to maintaining your privacy and will not share your personal information without This damage may lead to temporary or permanent numbness or weakness. doi: 10.1016/j.asmr.2020.12.004. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. J Hand Surg Am. Epub 2014 Dec 30. Hand Surg. Injury. No study directly compared nonoperative to operative treatment. Dr. Holt will talk to you about when it is safe to return to work. [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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Figure 46-2 Approach to the ulnar collateral ligament. 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. 31. Stener B. Skeletal injuries associated with rupture of the. 13. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Fusetti C, Papaloizos M, Meyer H, et al.. 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 is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Wong TC, Ip FK, Wu WC. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Arthrosc Sports Med Rehabil. 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%). All rights reserved. Tension wire fixation of avulsion fractures in the hand. 21. UCL Repair of the Thumb - MSA Hand Center 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Bennet Fracture. Objectives: Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. PMC After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. MCP fusion was performed . ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 1994;23:797804. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Meta-analysis of the pooled data was completed. A p-value of 0.05 was considered statistically significant. 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%). In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. and transmitted securely. Unable to load your collection due to an error, Unable to load your delegates due to an error. There is currently no consensus on treatment of acute or chronic UCL injuries. Acute gamekeeper's 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. For example, it can be removed when performing . The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Ulnar Collateral Ligament (UCL) Repair | SpringerLink The authors report no funding or conflicts of interest. Highlight selected keywords in the article text. Eventually this abnormal movement will wear out the joint and it will become arthritic. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. Clin Orthop Relat Res. Ulnar collateral ligament injuries of the thumb: a comprehensive review. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. 2003;8:8185. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Please enter a Recipient Address and/or check the Send me a copy checkbox. Careers. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. 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. 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 . Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. When assessed, most patients returned to their preinjury employment. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. You may be trying to access this site from a secured browser on the server. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Epub 2021 Sep 7. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 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. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 38. You've successfully added to your alerts. 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. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. 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. NR, not reported. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 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. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Accessibility PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction 1996;25:474477. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). The overall complication rate was 13.8% (11/80). It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. These tears often occur as a result of a radially directed force on an extended thumb. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What 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. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. Please enable it to take advantage of the complete set of features! I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Complications after surgery were rare.

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