Results: 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. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. [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]. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Keywords: eCollection 2021 Mar. 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. Highlight selected keywords in the article text. 2021 Apr 15;3(2):e527-e533. MeSH 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. No study directly compared nonoperative to operative treatment. Thumb from the common mechanism of falling on the thumb while holding a ski pole. UCLR case series that contained complications data were included. Pain reduction was significantly improved in all subjects (P < 0.05). Arthrosc Sports Med Rehabil. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 1993;21:800804. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 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. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. An official website of the United States government. A score of 2 was assigned if the item was completely and accurately performed and reported. Disclaimer. He too had the internal brace augmentation. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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. All rights reserved. Meta-analysis of the pooled data was completed. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. your express consent. [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. This website also contains material copyrighted by 3rd parties. Instability of the metacarpophalangeal joint of the thumb. What Happens If We Sit for More Than 8 Hours Per Day? 1999;24:7075. 45. 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. Downey DJ, Moneim MS, Omer GE Jr. 2. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. doi: 10.1016/j.asmr.2020.12.004. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Your ligament may need to be reattached to the bone using a bone anchor. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Data sources: **Stener lesion status reported in 6 studies (145 thumbs). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Purpose. 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 . Studies that duplicated patient populations from the same authors were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. This leads to what is know as a positive ulnar variance. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Complications after surgery were rare. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Metacarpophalangeal joint injuries of the thumb. Am J Orthop (Belle Mead NJ). *Glickel grading scale. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Acute gamekeeper's thumb. 12. [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. 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 Gamekeeper's thumb. There were 200 acute injuries and 93 chronic injuries. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 1977;59:1421. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 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. Epub 2021 Jan 18. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Am J Sports Med. 2018;6(4):1-7. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. This site needs JavaScript to work properly. Sakellarides HT, DeWeese JW. Doi: 10.1177/2325967118769328. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Thumb sidedness reported in 3 studies (51 thumbs). Quantitative outcome of surgical repair. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. All but 2 were level IV evidence. 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. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Objectives: 2000;16:345357. The torn thumb ligament is repaired or reconstructed during surgery. For more information, please refer to our Privacy Policy. A sprained thumb is a common injury among athletes. government site. 39. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Mean subject age was 33.9 years. 24. Disclaimer. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. abduction-adduction motion. Proximal interphalangeal joint injuries of the hand. Accessibility I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). 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). Fusetti C, Papaloizos M, Meyer H, et al.. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Educate the patient on anti edema management. 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.. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. Mitsionis GI, Varitimidis SE, Sotereanos GG. J Bone Joint Surg Am. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 1995;23:222226. Thirty-two thumbs were treated nonoperatively and 261 operatively. MCP fusion was performed . The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. 36. Louis DS, Huebner JJ Jr, Hankin FM. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. The mean time from reported injury date to surgery was 202.4 days (2-5969). Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Stener B. Skeletal injuries associated with rupture of the. No study directly compared the different types of graft for UCL reconstruction. 1961;43-A:541546. No study reported the outcomes of nonoperative management of chronic UCL injury. A systematic review of ulnar collateral ligament reconstruction techniques. 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. J Bone Joint Surg Am. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The anti edema management will continue for several weeks. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. HHS Vulnerability Disclosure, Help 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. *Glickel grading system. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 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. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. An official website of the United States government. J Hand Surg Br. This site needs JavaScript to work properly. The .gov means its official. You may be trying to access this site from a secured browser on the server. 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. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL.

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