Am J Sports Med. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Melone CP Jr, Beldner S, Basuk RS. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Commonly Missed Orthopedic Problems | AAFP eCollection 2021. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Rupture of the. 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. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Fourteen articles were included and analyzed (293 thumbs). doi: 10.1097/JSA.0000000000000322. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine 1994;25:2123. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. The Effect of Ulnar Collateral Ligament Repair With Internal Brace Hand Surgery Recovery Time: Pain, Exercise & Complications 2009;6:e1000097. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. The mean patient age was 37.8 years (14.0-78.1). 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. Please enable it to take advantage of the complete set of features! SAGE Open Med. 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. Complications Following Distal Radius Fractures - Mike Reinold When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. UCLR case series that contained complications data were included. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Subject demographics are reported in Table 2. 16. 12. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. Bethesda, MD 20894, Web Policies An official website of the United States government. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . This site needs JavaScript to work properly. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair 45. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube Early and late postoperative complications were recorded. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. *Glickel grading scale. Categorical variable data were reported as frequency with percentages. 15. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 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. 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. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Hand Clin. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 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. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Your message has been successfully sent to your colleague. Fusetti C, Papaloizos M, Meyer H, et al.. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Thumb Collateral Ligament Injury - Hand - Orthobullets *Gender reported in 12 studies (218 subjects). PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Thirty-two thumbs were treated nonoperatively and 261 operatively. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 39. [38] Chuter et al[40] 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. 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]). Ulnar Collateral Ligament Injuries of the Thumb - Panther Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Data is temporarily unavailable. J Hand Surg Am. Muscles. J Hand Surg Am. 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). Jackson M, McQueen MM. Catalano LW III, Cardon L, Patenaude N, et al.. The injury involves the ulnar collateral ligament (UCL) of the thumb. 1996;25:527530. Epub 2015 Sep 22. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Wolters Kluwer Health *Glickel grading system. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. J Bone Joint Surg Am. If the tear is diagnosed later a ligament reconstruction might be a better option. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. Complications you may experience after Hand Surgery - Rebecca Ayers Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. eCollection 2021 Mar. Complications after this procedure may include nerve or blood vessel damage. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. There is currently no consensus on treatment of acute or chronic UCL injuries. 34. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 14. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. The site is secure. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. 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. 1992;8:713732. If your bone is broken, a pin will be used to put it in place. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Throwing status reported in 4 studies. A broken thumb can also cause numbness or tingling. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Before Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Injury. Epub 2014 Oct 22. Sixty nine (86.3%) patients had grade 3 tears. Meta-analysis of the pooled data was completed. Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary A score of 2 was assigned if the item was completely and accurately performed and reported. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. The anti edema management will continue for several weeks. 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.15,39 It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.15 In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.15. [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. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery J Bone Joint Surg Am. 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). Complications after surgery were rare. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Purpose: Continue to stretch before and after throwing . Hand Surg. Complications after surgical treatment of UCL injury are rare. Am J Sports Med. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 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. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation.