abduction-adduction motion. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. Meta-analysis of the pooled data was completed. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). J Bone Joint Surg Am. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 45. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Various levels of pain, bruising, or edema may present at the site of damage. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. J Hand Surg Am. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Wong TC, Ip FK, Wu WC. History. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. 6. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Careers. Mean subject age was 33.9 years. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Wolters Kluwer Health The mean patient age was 37.8 years (14.0-78.1). 1994;25:2123. 44. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Epub 2021 Sep 7. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Complications after surgical treatment of UCL injury are rare. Your surgeon is the person best able to help you avoid any serious recovery problems. J Hand Surg Br. 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. 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 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. 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. For more information, please refer to our Privacy Policy. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. J Bone Joint Surg Am. three muscles provide deforming forces at the base of the thumb. Possible complications include: - Mitsionis GI, Varitimidis SE, Sotereanos GG. Before National Library of Medicine 1995;23:222226. Ulnar Collateral Ligament Repair . Pichora DR, McMurtry RY, Bell MJ. 1994;23:797804. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 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. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. SAGE Open Med. Am J Sports Med. Keywords: Jupiter JB, Sheppard JE. 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). Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. The site is secure. 12. 1989;17:751753. #Injury location reported only in 3 studies. It runs from the outer humerus, around the radial head and attaches to the ulna. 26. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 1,5,9,10 In acute cases of complete tears involving high-level . Smith RJ. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Continuous variable data were reported as mean SDs from the mean. All rights reserved. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). A score of 2 was assigned if the item was completely and accurately performed and reported. Conclusion: 13. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Clinical Journal of Sport Medicine23(4):247-254, July 2013. National Library of Medicine UCLR case series that contained complications data were included. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Hand Clin. Sixty nine (86.3%) patients had grade 3 tears. 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*. Causes. 1989;14:567573. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 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. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). After failure of nonoperative treatment, at anywhere from 6 months 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. This site needs JavaScript to work properly. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 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. 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. 1. Melone CP Jr, Beldner S, Basuk RS. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. There is currently no consensus on treatment of acute or chronic UCL injuries. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Accessibility The mean time from reported injury date to surgery was 202.4 days (2-5969). Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. To date, no literat. Van Dommelen BA, Zvirbulis RA. Click the topic below to receive emails when new articles are available. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. J Hand Surg Am. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Clin J Sport Med. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. No study compared different graft types or fixation techniques. J Hand Surg Am. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. 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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Educate the patient on anti edema management. If the latter was executed only partially, a score of 1 was assigned. J Hand Surg Am. 2018;6(4):1-7. 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. 1998;23:503506. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The range of motion of the MP joint of the thumb following operative repair of the. 1999;24:7075. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. A broken thumb can also cause numbness or tingling. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. government site. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Unauthorized use of these marks is strictly prohibited. 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. Please enter a Recipient Address and/or check the Send me a copy checkbox. official website and that any information you provide is encrypted J Hand Surg Br. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Acute gamekeeper's thumb. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Gamekeepers thumb: a prospective study of functional bracing. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. MCP collateral ligament sprain is most commonly an acute injury related to trauma. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 18. 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. Data range was reported as minimum to maximum absolute values. 7. A score of 2 was assigned if the item was completely and accurately performed and reported. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. Complications after this procedure may include nerve or blood vessel damage. Study design: Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Epub 2019 Mar 21. Mean subject age was 33.9 years. Complications after surgical treatment of UCL injury are rare. 1987;214:113120. Meta-analysis of the pooled data was completed. Abstract. You've successfully added to your alerts. 21. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . They may even tear completely. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Arthrosc Sports Med Rehabil. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. [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. All techniques improved clinical outcomes, including pain, motion, strength, and stability. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. official website and that any information you provide is encrypted 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. No study directly compared nonoperative to operative treatment. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 14. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. Am J Sports Med. The authors report no funding or conflicts of interest. 5. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. 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. Your message has been successfully sent to your colleague. [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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Systematic review and meta-analysis. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Orthop Rev. Gamekeeper's thumb. 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. 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%). Please try after some time. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. The Orthopedic Journal of Sports Medicine. You are being redirected to Medscape Education. eCollection 2021 Mar. Continue to stretch before and after throwing . Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 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 . UCLR case series that contained complications data were included. Kozin SH, Bishop AT. MCP fusion was performed . 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Pain reduction was significantly improved in all subjects (P < 0.05). Complications after surgery were rare. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 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. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Am J Sports Med. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Results: *Glickel grading scale. Abrahamsson SO, Sollerman C, Lundborg G, et al.. [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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 33. Your thumb will be immobilized in a splint and should not be moved until follow up. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 14 It is important to diagnose complete tears early because . It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. The limitations of this systematic review are reliant on the studies analyzed. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Arnold DM, Cooney WP, Wood MB. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. J Bone Joint Surg Am. Exercises: Gradually progress to competitive throwing and sports . 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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. Weakened grip or reduced thumb range of motion may occur. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. and twist using your thumb. 3. Purpose: 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The .gov means its official. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Injury. Thus, the true natural history is yet unknown. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant.