Clinical Journal of Sport Medicine23(4):247-254, July 2013. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 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. J Bone Joint Surg Am. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Clipboard, Search History, and several other advanced features are temporarily unavailable. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. This site needs JavaScript to work properly. Epub 2013 Nov 12. Van Dommelen BA, Zvirbulis RA. 1977;59:1421. 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. Am J Orthop (Belle Mead NJ). Wolters Kluwer Health The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). You will receive email when new content is published. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Disclaimer. A score of 2 was assigned if the item was completely and accurately performed and reported. 2000;16:345357. Am J Sports Med. 1961;43-A:541546. Posner MA, Retaillaud JL. Gamekeepers thumb: a prospective study of functional bracing. [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. J Hand Surg Br. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. If the force is too strong, the ligaments can tear. PLoS Med. 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. Keywords: Jackson M, McQueen MM. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. You may be trying to access this site from a secured browser on the server. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 13. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. The limitations of this systematic review are reliant on the studies analyzed. 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. J Bone Joint Surg Am. Kaplan EB. 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%. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Bookshelf When applicable, these parameters were compared, integrated, summated, and statistically analyzed. NR, not reported. Benson LS, Bailie DS. Part I: anatomy and diagnosis. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. For more information, please refer to our Privacy Policy. If the latter was executed only partially, a score of 1 was assigned. Orthop Rev. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.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. may email you for journal alerts and information, but is committed Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. [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. FOIA When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Clin Orthop Relat Res. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. The https:// ensures that you are connecting to the UCLR case series that contained complications data were included. 32. 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. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 31. The .gov means its official. the thumb. 1995;18:11611165. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. He too had the internal brace augmentation. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. and twist using your thumb. 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. Epub 2021 Sep 7. Rupture and displacement of the. There were 61 studies eliminated as secondary for being in a language other than English. Both purely ligamentous and bony avulsion injuries were included. The site is secure. Thus, the true natural history is yet unknown. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Federal government websites often end in .gov or .mil. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Hand Surg. 1989;14:567573. 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 . Hand Clin. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. [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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. You are being redirected to Medscape Education. Fourteen articles were included and analyzed (293 thumbs). These tears often occur as a result of a radially directed force on an extended thumb. Am J Orthop (Belle Mead NJ). 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. Stretching or even a rupture of the graft is also possible. 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. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. This article provides a review of . Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. An anatomic basis for treatment. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. There were 200 acute injuries and 93 chronic injuries. J Hand Surg Am. The torn thumb ligament is repaired or reconstructed during surgery. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. 5. Keyword Highlighting Federal government websites often end in .gov or .mil. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . A p-value of 0.05 was considered statistically significant. 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 Main results: Surgical management of chronic, 42. Injuries to the PIP joint remain swollen for long periods of time. sharing sensitive information, make sure youre on a federal Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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). A systematic review of ulnar collateral ligament reconstruction techniques. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Sakellarides HT, DeWeese JW. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Sports Health. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 1999;24:7075. 2003;8:8185. 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. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Some error has occurred while processing your request. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. eCollection 2022 May. The overall complication rate was 13.8% (11/80). Figure 46-2 Approach to the ulnar collateral ligament. The range of motion of the MP joint of the thumb following operative repair of the. This ligament prevents the thumb from pointing too far away from the hand. 1989;17:751753. PMC There is currently no consensus on treatment of acute or chronic UCL injuries. You may also begin strengthening exercises if needed. 1999;24:275282. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 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. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Descriptive statistics were calculated. 2013Lippincott Williams & Wilkins. Proximal interphalangeal joint injuries of the hand. Conclusion: CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. 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. MeSH If the tear is diagnosed later a ligament reconstruction might be a better option. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. The https:// ensures that you are connecting to the Rupture of the. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Range of motion returns much sooner, too. Early and late postoperative complications were recorded. 35. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Conflicts of interest The authors report no funding or conflicts of interest. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 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. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Would you like email updates of new search results? J Bone Joint Surg Am. A common complication following fracture of the distal radius is when the radius shortens. Patient Demographics of Thumb RCL and UCL Injuries. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 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. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 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. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. What Happens If We Sit for More Than 8 Hours Per Day? The mean patient age was 37.8 years (14.0-78.1). government site. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. 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 . There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Table 1. 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. Sports Med Arthrosc Rev. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. 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. Gamekeeper's thumb. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 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. FOIA All but 2 were level IV evidence. Search performed on November 17, 2011. The doctor won't know if the repair is . 8. 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). [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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. 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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 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. Symptoms are dependent on the cause and severity of injury to the UCL. Evaluation and management of elbow injuries in the adolescent overhead athlete. 26. and transmitted securely. 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 splint for protection or at night until twelve weeks after the operation. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Long-term results of ligament reconstruction. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Epub 2020 Jun 29. 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. 2009;34:304308. Causes. 18. Am J Sports Med. 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.. A score of 2 was assigned if the item was completely and accurately performed and reported. eCollection 2021. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 27. 1992;8:713732. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Mitsionis GI, Varitimidis SE, Sotereanos GG. UCLR case series that contained complications data were included. Orthopedics. J Hand Surg Am. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Continue to stretch before and after throwing . 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. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Various levels of pain, bruising, or edema may present at the site of damage. 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.
