Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 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 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. The mean time from reported injury date to surgery was 202.4 days (2-5969). The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. The https:// ensures that you are connecting to the FOIA 2005;87:26322638. J Hand Surg Glob Online. 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 Fourteen articles were included and analyzed (293 thumbs). and transmitted securely. 19. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol.
Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Click the topic below to receive emails when new articles are available. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. 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. Dr. Holt will talk to you about when it is safe to return to work. official website and that any information you provide is encrypted Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. If the latter was executed only partially, a score of 1 was assigned. 2009;34:304308. Your thumb will be immobilized in a splint and should not be moved until follow up. unstable when the thumb is used. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 1995;23:222226. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 21. Orthopedics.
Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed Please enable it to take advantage of the complete set of features! The limitations of this systematic review are reliant on the studies analyzed. 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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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. 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. 13. This article provides a review of . Symptoms are dependent on the cause and severity of injury to the UCL. An official website of the United States government. Hand Clin.
The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Outcomes after injury to the thumb ulnar collateral ligament--a Mean study follow-up was 42.8 months. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 16. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. Highlight selected keywords in the article text.
The diagnosis is best established clinically, though MRI is the imaging modality of choice. 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. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. History. You may also begin strengthening exercises if needed. Doi: 10.1177/2325967118769328. 1996;25:474477. Instability of the metacarpophalangeal joint of the thumb. Unilateral injuries: 291 and bilateral injury: 1. Accessibility 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. PMC
Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. If your bone is broken, a pin will be used to put it in place. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Arthrosc Sports Med Rehabil. This website also contains material copyrighted by 3rd parties. Kaplan EB. 1,5,9,10 In acute cases of complete tears involving high-level . 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. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 2021 Apr 15;3(2):e527-e533. Sports Health. If it is appropriate, then surgical consent probably happened before the surgery. 25.
Ulnar Collateral Ligament Injuries of the Thumb - Orthogate All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. doi: 10.1016/j.asmr.2020.12.004. J Bone Joint Surg Am. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Clipboard, Search History, and several other advanced features are temporarily unavailable. Meta-analysis of the pooled data was completed.
PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb 23. 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. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Stener B. Skeletal injuries associated with rupture of the. UCLR case series that contained complications data were included. 12.
Ulnar Collateral Ligament Injuries of the Thumb - Panther 8600 Rockville Pike 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. Eventually this abnormal movement will wear out the joint and it will become arthritic. Data is temporarily unavailable. No study directly compared the different types of graft for UCL reconstruction. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Bailie DS, Benson LS, Marymont JV.
MCP (MetaCarpophalangeal) Collateral Ligament Sprain This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. Proximal interphalangeal joint injuries of the hand. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement.
PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months.
Outcomes After Injury to the Thumb Ulnar Collateral Ligament Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Methods: Injuries to the PIP joint remain swollen for long periods of time. Nonoperative treatment often failed, necessitating surgery. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). There were no cases of intraoperative ulnar nerve injury reported. 1987;214:113120. There were 200 acute injuries and 93 chronic injuries. Catalano LW III, Cardon L, Patenaude N, et al.. There are some cases where the fusion is not successful and you will still have pain in .
RCL Reconstruction Thumb MPJ - The Hand Treatment Center The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). This ligament prevents the thumb from pointing too far away from the hand. [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.
Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist 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. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm).
Commonly Missed Orthopedic Problems | AAFP Hand Injuries - Finger Tip Injuries, Jersey Finger, PIP Dislocations 2013;23(4):247-254. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Clipboard, Search History, and several other advanced features are temporarily unavailable. Thus, the true natural history is yet unknown. 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. government site. 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]). SAGE Open Med. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Early and late postoperative complications were recorded. [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. 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. 27. Please confirm that you would like to log out of Medscape. A secondary purpose was to compare graft choice and surgical technique for reconstruction.