Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 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. Thumb dominance reported in 8 studies (168 thumbs). Docs Struggle to Keep Up With the Flood of New Medical Knowledge. 1996;25:527530. NR, not reported. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. J Bone Joint Surg Am. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Please confirm that you would like to log out of Medscape. Figure 46-2 Approach to the ulnar collateral ligament. Orthopedics. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. unstable when the thumb is used. J Bone Joint Surg Am. Bailie DS, Benson LS, Marymont JV. Wolters Kluwer Health, Inc. and/or its subsidiaries. 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 . For more information, please refer to our Privacy Policy. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Am J Sports Med. The injury involves the ulnar collateral ligament (UCL) of the thumb. Dr. Holt will talk to you about when it is safe to return to work. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. All but 2 were level IV evidence. Diagnosis of displaced, 43. 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. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. Data range was reported as minimum to maximum absolute values. [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. Catalano LW III, Cardon L, Patenaude N, et al.. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Possible complications include: - Careers. Your message has been successfully sent to your colleague. What Happens If We Sit for More Than 8 Hours Per Day? He too had the internal brace augmentation. 2009;34:304308. J Bone Joint Surg Am. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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. Part I of this two-part article focuses on common tendon and . Thirty-two thumbs were treated nonoperatively and 261 operatively. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further 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. 1989;17:751753. Gamekeeper's thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Clin J Sport Med. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Conclusions: Complications after this procedure may include nerve or blood vessel damage. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Search for Similar Articles Conclusion: flexion-extension motion. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. 8. 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. 1995;18:11611165. Clin Orthop Relat Res. If the latter was executed only partially, a score of 1 was assigned. Thus, the true natural history is yet unknown. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. eCollection 2021 Apr. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. HHS Vulnerability Disclosure, Help All but 2 were level IV evidence. Data sources: Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Thus, the true natural history is yet unknown. Objectives: 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. Keyword Highlighting Pichora DR, McMurtry RY, Bell MJ. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Jupiter JB, Sheppard JE. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Fourteen articles were included and analyzed (293 thumbs). Epub 2013 Nov 12. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. All techniques improved clinical outcomes, including pain, motion, strength, and stability. This ligament prevents the thumb from pointing too far away from the hand. If the tear is diagnosed early a repair will be possible. Range of motion returns much sooner, too. sharing sensitive information, make sure youre on a federal Search performed on November 17, 2011. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Highlight selected keywords in the article text. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 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. Symptoms are dependent on the cause and severity of injury to the UCL. There were no cases of intraoperative ulnar nerve injury reported. 1989;71:383387. The limitations of this systematic review are reliant on the studies analyzed. Weakened grip or reduced thumb range of motion may occur. If you log out, you will be required to enter your username and password the next time you visit. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. to maintaining your privacy and will not share your personal information without Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 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. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Riederer S, Nagy L, Buchler U. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 2013;23(4):247-254. Educate the patient on anti edema management. Smith RJ. This leads to what is know as a positive ulnar variance. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 18. This site needs JavaScript to work properly. The site is secure. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . At this stage, patients should be advised to wear your splint part-time. 19. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. They may even tear completely. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 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. The anti edema management will continue for several weeks. The grip strength and the pinch strength were 94.3% and 92.27%,. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). PMC Bethesda, MD 20894, Web Policies TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 2006;31:6875. 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. The limitations of this systematic review are reliant on the studies analyzed. 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. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. Gamekeepers thumb: a prospective study of functional bracing. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1962;124:396411. Your surgeon is the person best able to help you avoid any serious recovery problems. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. 8600 Rockville Pike The Orthopedic Journal of Sports Medicine. 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%). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 1994;25:2123. Downey DJ, Moneim MS, Omer GE Jr. To date, no literat. 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. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Subject demographics are reported in Table 2. 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 . Results: Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. There were 61 studies eliminated as secondary for being in a language other than English. 1995;23:222226. For example, it can be removed when performing . Both purely ligamentous and bony avulsion injuries were included. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 2009;61:623632. Proximal interphalangeal joint injuries of the hand. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Sports Health. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. An official website of the United States government. Pain reduction was significantly improved in all subjects (P < 0.05). The torn thumb ligament is repaired or reconstructed during surgery. Please try after some time. Keywords: Doi: 10.1177/2325967118769328. Frykman G, Johansson O. Surgical repair of rupture of the, 46. There is currently no consensus on treatment of acute or chronic UCL injuries. 1999;24:7075. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Kuz JE, Husband JB, Tokar N, et al.. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. government site. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. #Injury location reported only in 3 studies. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 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. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Sixty nine (86.3%) patients had grade 3 tears. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Causes. doi: 10.1016/j.asmr.2020.12.004. J Hand Surg Br. If the force is too strong, the ligaments can tear. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 2000;16:345357. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Federal government websites often end in .gov or .mil. Bennet Fracture. MCP fusion was performed . Am J Sports Med. Infection is a rare complication of hand surgery. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. The LUCL is located on the lateral or outside part of the elbow. 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. Various levels of pain, bruising, or edema may present at the site of damage. 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%). The https:// ensures that you are connecting to the Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1996;25:474477. Hand Clin. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Please try again soon. abduction-adduction motion. 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. Patient Demographics of Thumb RCL and UCL Injuries. POST-OPERATIVE WEEKS 22-24. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. A common complication following fracture of the distal radius is when the radius shortens. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction.
