45. Moher D, Liberati A, Tetzlaff J, et al.. It runs from the outer humerus, around the radial head and attaches to the ulna. Gamekeepers thumb: a prospective study of functional bracing. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Sakellarides HT, DeWeese JW. unstable when the thumb is used. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. MeSH Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Surgical management of chronic, 42. Catalano LW III, Cardon L, Patenaude N, et al.. A score of 2 was assigned if the item was completely and accurately performed and reported. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. 2022 Mar 1;30(1):e1-e8. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. 36. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Conclusions: In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. 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. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Mean subject age was 33.9 years. Am J Sports Med. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 17. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Continue to stretch before and after throwing . 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. [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]. Early diagnosis and treatment. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Various levels of pain, bruising, or edema may present at the site of damage. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. Patient Demographics of Thumb RCL and UCL Injuries. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. 2018;6(4):1-7. 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. J Bone Joint Surg Am. 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%). [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 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. 34. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Long-term results of ligament reconstruction. The injury involves the ulnar collateral ligament (UCL) of the thumb. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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. 2009;34:304308. Injury. Acta Chir Scand. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. 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. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Meta-analysis of the pooled data was completed. 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. Epub 2014 Oct 22. Thumb collateral ligament injuries. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. An official website of the United States government. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 1989;71:383387. National Library of Medicine Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Data sources: 2003;8:8185. [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. the thumb. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 10. 5. Tension wire fixation of avulsion fractures in the hand. National Library of Medicine Only prospective studies can determine this injury course. 2000;16:345357. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Engelhardt JB, Christensen OM, Christiansen TG. Keyword Highlighting 2021 Apr 15;3(2):e527-e533. 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 . Pichora DR, McMurtry RY, Bell MJ. 2009;61:623632. Infection is a rare complication of hand surgery. SYMPTOMS: The thumb may be swollen, bruised and painful. Hand Surg. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. The grip strength and the pinch strength were 94.3% and 92.27%,. Conclusion: 7. J Bone Joint Surg Am. What Happens If We Sit for More Than 8 Hours Per Day? The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. 1,5,9,10 In acute cases of complete tears involving high-level . SAGE Open Med. 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. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . 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. Abrahamsson SO, Sollerman C, Lundborg G, et al.. 27. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. If the latter was executed only partially, a score of 1 was assigned. 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. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). *Gender reported in 12 studies (218 subjects). Downey DJ, Moneim MS, Omer GE Jr. Rupture and displacement of the. 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%). If the force is too strong, the ligaments can tear. 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 . 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 UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Disclaimer. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Your ligament may need to be reattached to the bone using a bone anchor. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Am J Sports Med. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 1962;124:396411. Accessibility Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. This site needs JavaScript to work properly. A systematic review of ulnar collateral ligament reconstruction techniques. There were 200 acute injuries and 93 chronic injuries. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Complications after surgical treatment of UCL injury are rare. 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%). 1961;43-A:541546. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. 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. 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 . When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. NR, not reported. Doi: 10.1177/2325967118769328. Continuous variable data were reported as mean SDs from the mean. Instability of the metacarpophalangeal joint of the thumb. The site is secure. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 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. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. J Hand Surg Br. 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. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Educate the patient on anti edema management. 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. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. A score of 0 was assigned if the item was either omitted or not performed. Arthritis Rheum. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. He too had the internal brace augmentation. 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. Federal government websites often end in .gov or .mil. Wong TC, Ip FK, Wu WC. 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. The Orthopedic Journal of Sports Medicine. Stretching or even a rupture of the graft is also possible. 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. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. flexion-extension motion. Upper extremity injuries in snow skiers. The https:// ensures that you are connecting to the may email you for journal alerts and information, but is committed Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand.
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