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 . Epub 2020 Jun 29. 2013;23(4):247-254. Objectives: One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. All but 2 were level IV evidence. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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. sharing sensitive information, make sure youre on a federal Melone CP Jr, Beldner S, Basuk RS. POST-OPERATIVE WEEKS 22-24. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. Upper extremity injuries in snow skiers. Mean subject age was 33.9 years. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. to maintaining your privacy and will not share your personal information without
Unable to load your collection due to an error, Unable to load your delegates due to an error. Data range was reported as minimum to maximum absolute values. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. Smith RJ. 1994;25:2123. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. The anti edema management will continue for several weeks. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 8600 Rockville Pike No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Most times, they won't know until they're in the surgery if the internal brace is appropriate. *Glickel grading scale. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. There were 200 acute injuries and 93 chronic injuries. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Careers. There are some cases where the fusion is not successful and you will still have pain in . J Hand Surg Glob Online. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. eCollection 2021 Mar. Please enable it to take advantage of the complete set of features! Click the topic below to receive emails when new articles are available. 2009;34:304308. He too had the internal brace augmentation. 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. 10. Thus, the true natural history is yet unknown. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Thirty-two thumbs were treated nonoperatively and 261 operatively. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. 1999;24:7075. National Library of Medicine 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). Nonoperative treatment often failed, necessitating surgery. Am J Sports Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Disclaimer. 36. official website and that any information you provide is encrypted 37. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. 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. Mean study follow-up was 42.8 months. Catalano LW III, Cardon L, Patenaude N, et al.. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 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. 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. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. government site. Am J Orthop (Belle Mead NJ). Orthopedics. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Instability of the metacarpophalangeal joint of the thumb. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. An official website of the United States government. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 2009;61:623632. 44. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. 1989;71:383387. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. There were no cases of intraoperative ulnar nerve injury reported. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Hand Clin. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Orthop Rev. Purpose: Your ligament may need to be reattached to the bone using a bone anchor. The limitations of this systematic review are reliant on the studies analyzed. Bailie DS, Benson LS, Marymont JV. Downey DJ, Moneim MS, Omer GE Jr. 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 is currently no consensus on treatment of acute or chronic UCL injuries. J Hand Surg Am. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. UCLR case series that contained complications data were included. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. eCollection 2021 Apr. 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. An official website of the United States government. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. [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. There is currently no consensus on treatment of acute or chronic UCL injuries. Complications after this procedure may include nerve or blood vessel damage. All techniques improved clinical outcomes, including pain, motion, strength, and stability. 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. Gamekeepers thumb: a prospective study of functional bracing. Injuries to the PIP joint remain swollen for long periods of time. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. 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. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Meta-analysis of the pooled data was completed. 10. 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. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. History. and transmitted securely. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 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. Clin Orthop Relat Res. HHS Vulnerability Disclosure, Help No study directly compared the different types of graft for UCL reconstruction. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Sports Health. Acute gamekeeper's thumb. Dr. Holt will talk to you about when it is safe to return to work. They may even tear completely. 17. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 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. 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. 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. 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. Bostock S, Morris MA. 2005;87:26322638. J Hand Surg Am. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 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. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. J Bone Joint Surg Am. Please try again soon. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Unilateral injuries: 291 and bilateral injury: 1. 14 It is important to diagnose complete tears early because . 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. 20. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. unstable when the thumb is used. Sports Med Arthrosc Rev. 2005;24:217221. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Early diagnosis and treatment. Tension wire fixation of avulsion fractures in the hand. All but 2 were level IV evidence. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Bethesda, MD 20894, Web Policies Arthritis Rheum. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. Abstract. Diagnosis of displaced, 43. 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. Data is temporarily unavailable. 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. Range of motion returns much sooner, too. The grip strength and the pinch strength were 94.3% and 92.27%,. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Quantitative outcome of surgical repair. Exercises: Gradually progress to competitive throwing and sports . These exercises may be directed by a physical or occupational therapist. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 1976;58:106112. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 38. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. It runs from the outer humerus, around the radial head and attaches to the ulna. Mitsionis GI, Varitimidis SE, Sotereanos GG. Thirty-two thumbs were treated nonoperatively and 261 operatively. J Bone Joint Surg Am. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. To date, no literat. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Metacarpophalangeal joint injuries of the thumb. SYMPTOMS: The thumb may be swollen, bruised and painful. 1995;23:222226. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. official website and that any information you provide is encrypted Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. 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. 1993;21:800804. The site is secure. Proximal interphalangeal joint injuries of the hand. 2. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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. Arnold DM, Cooney WP, Wood MB. Bookshelf This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Search performed on November 17, 2011. 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. 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. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 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.19 Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. 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. Would you like email updates of new search results? better/same/worse than preoperative status). Am J Sports Med. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. If the tear is diagnosed later a ligament reconstruction might be a better option. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. The effect of thumb metacarpophalangeal. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Stener B. Skeletal injuries associated with rupture of the. 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). Riederer S, Nagy L, Buchler U. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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.