Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). There were 200 acute injuries and 93 chronic injuries. 8600 Rockville Pike Fourteen articles were included and analyzed (293 thumbs). Early and late postoperative complications were recorded. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . Thirty-two thumbs were treated nonoperatively and 261 operatively. 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. Am J Sports Med. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Diagnosis of displaced, 43. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 1995;18:11611165. #Injury location reported only in 3 studies. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.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.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. 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. eCollection 2021. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Eurasian J Med. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. [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. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Am J Sports Med. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 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. All but 2 were level IV evidence. 11. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 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. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. It runs from the outer humerus, around the radial head and attaches to the ulna. You may also begin strengthening exercises if needed. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. If your bone is broken, a pin will be used to put it in place. official website and that any information you provide is encrypted Sports Health. A score of 2 was assigned if the item was completely and accurately performed and reported. your express consent. 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). 1989;14:567573. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. 1,5,9,10 In acute cases of complete tears involving high-level . Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. There is currently no consensus on treatment of acute or chronic UCL injuries. 2005;24:217221. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. A sprained thumb is a common injury among athletes. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Careers. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%.16 Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. Results: The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. *Glickel grading scale. Data range was reported as minimum to maximum absolute values. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. 25. Please enable it to take advantage of the complete set of features! Disclaimer. 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. 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. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Would you like email updates of new search results? 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. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Arthritis Rheum. 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. Before TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 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. Most times, they won't know until they're in the surgery if the internal brace is appropriate. FOIA The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Doi: 10.1177/2325967118769328. Background: Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. [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. Injury. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Orthopedics. This article provides a review of . The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 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. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2013Lippincott Williams & Wilkins. 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 . 1999;24:7075. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Your surgeon is the person best able to help you avoid any serious recovery problems. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 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. 2. The limitations of this systematic review are reliant on the studies analyzed. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. the thumb. doi: 10.1016/j.asmr.2020.12.004. Table 1. 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. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Hand Surg. Please try after some time. 2006;31:6875. 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. 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. 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). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. to maintaining your privacy and will not share your personal information without The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Clinical Journal of Sport Medicine23(4):247-254, July 2013. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%. 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. Bookshelf Van Dommelen BA, Zvirbulis RA. Accessibility You've successfully added to your alerts. 12. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Complications after surgery were rare. The .gov means its official. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. 14. 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. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. There were 61 studies eliminated as secondary for being in a language other than English. Thirty-two thumbs were treated nonoperatively and 261 operatively. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 18. [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]. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 35. 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. The mean patient age was 37.8 years (14.0-78.1). Figure 46-2 Approach to the ulnar collateral ligament. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Ulnar Collateral Ligament Repair . Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. *Gender reported in 12 studies (218 subjects). 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. 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. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Complications after surgical treatment of UCL injury are rare. 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. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Part I: anatomy and diagnosis. Posner MA, Retaillaud JL. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. If it is appropriate, then surgical consent probably happened before the surgery. Am J Sports Med. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. For more information, please refer to our Privacy Policy. 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. No study reported the outcomes of nonoperative management of chronic UCL injury. If you log out, you will be required to enter your username and password the next time you visit. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Proximal interphalangeal joint injuries of the hand. Smith RJ. HHS Vulnerability Disclosure, Help The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Proximal interphalangeal joint injuries of the hand. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 .