Complications after surgery were rare. 1987;214:113120. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Gamekeepers thumb: a prospective study of functional bracing. He too had the internal brace augmentation. Am J Sports Med. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. There is currently no consensus on treatment of acute or chronic UCL injuries. All but 2 were level IV evidence. Sports Med Arthrosc Rev. Part I of this two-part article focuses on common tendon and . 11. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Mean subject age was 33.9 years.
and transmitted securely. 2006;31:6875. 14 It is important to diagnose complete tears early because . abduction-adduction motion. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. You will receive email when new content is published. 25. 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. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. No study compared different graft types or fixation techniques. the thumb.
PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine Am J Sports Med.
AAHS - Comparison of Complications after Thumb Metacarpophalangeal 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. Data range was reported as minimum to maximum absolute values. MeSH 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%. Only prospective studies can determine this injury course. your express consent. *Glickel grading scale. 37. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. FOIA to maintaining your privacy and will not share your personal information without
Tension wire fixation of avulsion fractures in the hand. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Part II: treatment and complications. 7.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Please use this form to submit your questions or comments on how to make this article more useful to clinicians.
Complications Following Distal Radius Fractures - Mike Reinold Methods: When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Long-term results of ligament reconstruction.
Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist 1996;25:527530. Data sources: Epub 2015 Sep 22.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape 2009;61:623632. Federal government websites often end in .gov or .mil. HHS Vulnerability Disclosure, Help
Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery Conclusion: There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 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. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 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%.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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Background:
PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What UCLR case series that contained complications data were included. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 2009;6:e1000097. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. 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.
Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries Ulnar Collateral Ligament Repair and Reconstruction When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Thus, the true natural history is yet unknown. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon.
Athletes Can Return to Play in Half the Time with New Thumb Ligament Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20).
Objectives: A score of 0 was assigned if the item was either omitted or not performed. 1. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Injuries to the PIP joint remain swollen for long periods of time.
Nonunions - OrthoInfo - AAOS Am J Sports Med. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 35. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. doi: 10.1016/j.asmr.2020.12.004. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 22. 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. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped .
Ulnar Collateral Ligament (UCL) Repair | SpringerLink Click the topic below to receive emails when new articles are available. 21. Louis DS, Huebner JJ Jr, Hankin FM. **Stener lesion status reported in 6 studies (145 thumbs). Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC.
MCP (MetaCarpophalangeal) Collateral Ligament Sprain 2018;6(4):1-7. Proximal interphalangeal joint injuries of the hand. If the tear is diagnosed early a repair will be possible. Bailie DS, Benson LS, Marymont JV. J Bone Joint Surg Am. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The range of motion of the MP joint of the thumb following operative repair of the. 2000;16:345357. [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. Orthop Clin North Am. Federal government websites often end in .gov or .mil.
PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 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. Nonoperative treatment often failed, necessitating surgery. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 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. Ulnar Collateral Ligament Repair . 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Kuz JE, Husband JB, Tokar N, et al.. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Categorical variable data were reported as frequency with percentages. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment.
Commonly Missed Orthopedic Problems | AAFP Keywords: POST-OPERATIVE WEEKS 22-24. FOIA Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute.
Ulnar Collateral Ligament (UCL) Injuries of the Elbow 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. Orthop J Sports Med. 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. When assessed, most patients returned to their preinjury employment. J Hand Surg Am. Bookshelf No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Sports Health. 20. 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. 39. Early diagnosis and treatment. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 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. A systematic review of ulnar collateral ligament reconstruction techniques. 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. Only prospective studies can determine this injury course. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Main results: History. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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). 1989;17:751753. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. 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. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. 2003;8:8185. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Pichora DR, McMurtry RY, Bell MJ.
Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Results: Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Purpose. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . The torn thumb ligament is repaired or reconstructed during surgery. 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. Possible complications include: - 36.
Hand Surgery Recovery Time: Pain, Exercise & Complications sharing sensitive information, make sure youre on a federal Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). UCLR case series that contained complications data were included. Careers. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. #Injury location reported only in 3 studies. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 33. 10.
Ulnar Collateral Ligament Injuries of the Thumb - Panther Epub 2013 Nov 12. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. 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. 2005;87:26322638. 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. 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. The Orthopedic Journal of Sports Medicine. [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. 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. Please try after some time. J Hand Surg Am. Throwing status reported in 4 studies.
Outcomes after injury to the thumb ulnar collateral ligament--a Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 2022 Mar 1;30(1):e1-e8. 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. Clin J Sport Med. Evaluation and management of elbow injuries in the adolescent overhead athlete. At this stage, patients should be advised to wear your splint part-time. 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. 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. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg.
PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. Stener B. Skeletal injuries associated with rupture of the. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) This site needs JavaScript to work properly. For example, it can be removed when performing . Thumb dominance reported in 8 studies (168 thumbs). 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. J Hand Surg Br. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Causes.
The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. The .gov means its official. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb.