Some error has occurred while processing your request. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. doi: 10.1097/JSA.0000000000000322. 1995;23:222226. Categorical variable data were reported as frequency with percentages. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 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. Throwing status reported in 4 studies. Orthop Clin North Am. 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. 31. Thirty-two thumbs were treated nonoperatively and 261 operatively. National Library of Medicine Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Fourteen articles were included and analyzed (293 thumbs). All techniques improved clinical outcomes, including pain, motion, strength, and stability. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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.. MeSH Kaplan EB. Please enable scripts and reload this page. sharing sensitive information, make sure youre on a federal Thumb Collateral Ligament Injury - Hand - Orthobullets Stener B. Skeletal injuries associated with rupture of the. Wolters Kluwer Health, Inc. and/or its subsidiaries. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Mechanism of injury to the RCL of the MCP joint of the thumb is force . 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 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. 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. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Continue to stretch before and after throwing . This ligament prevents the thumb from pointing too far away from the hand. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. The authors report no funding or conflicts of interest. Background: This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . The site is secure. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) A score of 0 was assigned if the item was either omitted or not performed. 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]). Complications after surgery were rare. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher 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. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). [17,34] Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament 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. 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. All but 2 were level IV evidence. PLoS Med. SAGE Open Med. 1996;25:527530. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. J Hand Surg Glob Online. Conflicts of interest The authors report no funding or conflicts of interest. At this stage, patients should be advised to wear your splint part-time. 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 torn thumb ligament is repaired or reconstructed during surgery. Am J Orthop (Belle Mead NJ). POST-OPERATIVE WEEKS 22-24. Smith RJ. Educate the patient on anti edema management. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. 2003;8:8185. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). There is currently no consensus on treatment of acute or chronic UCL injuries. 21. MCP (MetaCarpophalangeal) Collateral Ligament Sprain Early diagnosis and treatment. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 19. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 22. Both repair and reconstruction (autograft and allograft) techniques were inclusive. PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). The doctor won't know if the repair is . 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. abduction-adduction motion. Wong TC, Ip FK, Wu WC. Methods: There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Hand Surgery Recovery Time: Pain, Exercise & Complications Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic 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. Rupture of the. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. This site needs JavaScript to work properly. Tension wire fixation of avulsion fractures in the hand. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Before Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). 2009;6:e1000097. eCollection 2021. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. The Orthopedic Journal of Sports Medicine. 11. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Symptoms are dependent on the cause and severity of injury to the UCL. 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. Epub 2014 Oct 22. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed The limitations of this systematic review are reliant on the studies analyzed. They may even tear completely. 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). Please confirm that you would like to log out of Medscape. NR, not reported. Click the topic below to receive emails when new articles are available. 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. Am J Sports Med. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Careers. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Quantitative outcome of surgical repair. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. The injury involves the ulnar collateral ligament (UCL) of the thumb. Base of Thumb Fractures - Hand - Orthobullets Moher D, Liberati A, Tetzlaff J, et al.. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 1976;58:106112. 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. Please try again soon. Highlight selected keywords in the article text. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. official website and that any information you provide is encrypted Accessibility 2013;23(4):247-254. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 14. Only prospective studies can determine this injury course. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Proximal interphalangeal joint injuries of the hand. Epub 2020 Jun 29. to maintaining your privacy and will not share your personal information without Upper extremity injuries in snow skiers. Mean subject age was 33.9 years. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine
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