Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). The LUCL is located on the lateral or outside part of the elbow. 2003;8:8185. 24. 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. Bethesda, MD 20894, Web Policies 2013Lippincott Williams & Wilkins. 25. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. the splint for protection or at night until twelve weeks after the operation. Thumb Collateral Ligament Injury - Hand - Orthobullets 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. Part I of this two-part article focuses on common tendon and . Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Would you like email updates of new search results? MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Subject demographics are reported in Table 2. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. This article provides a review of . Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Smith RJ. your express consent. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 1994;23:797804. 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. 1999;24:275282. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 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. government site. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". 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. Your ligament may need to be reattached to the bone using a bone anchor. Categorical variable data were reported as frequency with percentages. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. This damage may lead to temporary or permanent numbness or weakness. No study directly compared nonoperative to operative treatment. 17. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 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 . 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). Purpose. Only prospective studies can determine this injury course. In these cases, a new graft may be used to perform a second reconstruction. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Search performed on November 17, 2011. 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. doi: 10.1097/JSA.0000000000000322. Patient Demographics of Thumb RCL and UCL Injuries. 6. At this stage, patients should be advised to wear your splint part-time. Nonunions - OrthoInfo - AAOS Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 2006;31:6875. 2018;6(4):1-7. Thirty-two thumbs were treated nonoperatively and 261 operatively. modify the keyword list to augment your search. There were 200 acute injuries and 93 chronic injuries. 1998;23:503506. If the tear is diagnosed later a ligament reconstruction might be a better option. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 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. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. There were no cases of intraoperative ulnar nerve injury reported. Ulnar Collateral Ligament Repair and Reconstruction PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Meta-analysis of the pooled data was completed. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. #Injury location reported only in 3 studies. The torn thumb ligament is repaired or reconstructed during surgery. 2021 Apr 15;3(2):e527-e533. The grip strength and the pinch strength were 94.3% and 92.27%,. Federal government websites often end in .gov or .mil. Acta Chir Scand. The range of motion of the MP joint of the thumb following operative repair of the. He too had the internal brace augmentation. Bostock S, Morris MA. 1996;25:474477. [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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Mitsionis GI, Varitimidis SE, Sotereanos GG. What are the symptoms of GameKeeper's Thumb? 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. J Bone Joint Surg Am. The effect of thumb metacarpophalangeal. Wolters Kluwer Health
Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 2009;6:e1000097. Before Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Am J Sports Med. 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%). Bookshelf 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 . 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Fourteen articles were included and analyzed (293 thumbs). 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%. Sports Med Arthrosc Rev. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Sakellarides HT, DeWeese JW. official website and that any information you provide is encrypted Ulnar collateral ligament injuries of the thumb: a comprehensive review. Results: [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 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%). better/same/worse than preoperative status). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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 Finger Injuries: Part I. Tendons and Ligaments | AAFP Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. The limitations of this systematic review are reliant on the studies analyzed. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Downey DJ, Moneim MS, Omer GE Jr. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Mean subject age was 33.9 years. PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Please enable it to take advantage of the complete set of features! Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 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. 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. Please try after some time. [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. 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. The anti edema management will continue for several weeks. For example, it can be removed when performing . Treatment for thumb collateral ligament injury - KW orthopaedics Fourteen articles were included and analyzed (293 thumbs). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. to maintaining your privacy and will not share your personal information without
Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) There were 61 studies eliminated as secondary for being in a language other than English. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. UCL injuries: Defining risk and improving treatment - Mayo Clinic There were 200 acute injuries and 93 chronic injuries. J Hand Surg Am. Instability of the metacarpophalangeal joint of the thumb. Data sources: Only prospective studies can determine this injury course. Epub 2020 Jun 29. UCL Repair of the Thumb - MSA Hand Center Conflicts of interest The authors report no funding or conflicts of interest. 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. 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. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. Your thumb will be immobilized in a splint and should not be moved until follow up. This ligament prevents the thumb from pointing too far away from the hand. Outcomes After Injury to the Thumb Ulnar Collateral Ligament UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina 37. A broken thumb can also cause numbness or tingling. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. A score of 0 was assigned if the item was either omitted or not performed. 5. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What Clipboard, Search History, and several other advanced features are temporarily unavailable. Rupture and displacement of the. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Treatment of chronic injuries of the. eCollection 2021. Orthop Clin North Am. Proximal interphalangeal joint injuries of the hand. 8600 Rockville Pike J Hand Surg Br. A score of 2 was assigned if the item was completely and accurately performed and reported. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. The authors report no funding or conflicts of interest. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. There is currently no consensus on treatment of acute or chronic UCL injuries.
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