J Bone Joint Surg Am. Posner MA, Retaillaud JL. PMC This article provides a review of . Stretching or even a rupture of the graft is also possible. Thumb dominance reported in 8 studies (168 thumbs). 2006;31:6875. Various levels of pain, bruising, or edema may present at the site of damage. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. 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. 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. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Most times, they won't know until they're in the surgery if the internal brace is appropriate. 14. Sakellarides HT, DeWeese JW. 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*. 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. Nonoperative treatment often failed, necessitating surgery. NR, not reported. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. Unable to load your collection due to an error, Unable to load your delegates due to an error. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Symptoms are dependent on the cause and severity of injury to the UCL. MeSH Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Bailie DS, Benson LS, Marymont JV. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 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. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 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. Please confirm that you would like to log out of Medscape. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. [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. Results: Am J Sports Med. Injuries to the PIP joint remain swollen for long periods of time. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Data sources: Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. doi: 10.1097/JSA.0000000000000322. Quantitative outcome of surgical repair. eCollection 2021 Apr. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 25. Purpose: 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). Mechanism of injury to the RCL of the MCP joint of the thumb is force . 1994;25:2123. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Sports Med Arthrosc Rev. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Rupture of the. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. These exercises may be directed by a physical or occupational therapist. Diagnosis of displaced, 43. This site needs JavaScript to work properly. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Conclusion: All rights reserved. Acute gamekeeper's thumb. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). They may even tear completely. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The site is secure. An official website of the United States government. Metacarpophalangeal joint injuries of the thumb. 10. Am J Sports Med. To date, no literat. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Doi: 10.1177/2325967118769328. Please enable it to take advantage of the complete set of features! When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Treatment of chronic injuries of the. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Mitsionis GI, Varitimidis SE, Sotereanos GG. 1998;23:503506. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. Accessibility 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. Surgical management of chronic, 42. Abrahamsson SO, Sollerman C, Lundborg G, et al.. The effect of thumb metacarpophalangeal. Only prospective studies can determine this injury course. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. If it is appropriate, then surgical consent probably happened before the surgery. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). Hand Clin. 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 https:// ensures that you are connecting to the Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. flexion-extension motion. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 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.