complications after ucl repair of thumb complications after ucl repair of thumb

It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 1993;21:800804. government site. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Hand Surg Am. The LUCL is located on the lateral or outside part of the elbow. government site. Muscles. 2009;61:623632. Before Gamekeepers thumb: a prospective study of functional bracing. 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. Chir Main. 1961;43-A:541546. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Engelhardt JB, Christensen OM, Christiansen TG. Mean subject age was 33.9 years. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Am J Sports Med. 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. All but 2 were level IV evidence. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 35. Meta-analysis of the pooled data was completed. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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%). 2005;24:217221. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 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. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 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. Mean subject age was 33.9 years. eCollection 2021 Mar. A score of 0 was assigned if the item was either omitted or not performed. Sports Health. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. 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. sharing sensitive information, make sure youre on a federal 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. 1962;124:396411. National Library of Medicine RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. Proximal interphalangeal joint injuries of the hand. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. [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. 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. Thumb sidedness reported in 3 studies (51 thumbs). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 1994;25:2123. The torn thumb ligament is repaired or reconstructed during surgery. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 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). This website also contains material copyrighted by 3rd parties. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Kuz JE, Husband JB, Tokar N, et al.. 2003;8:8185. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Wolters Kluwer Health Please enable it to take advantage of the complete set of features! Unauthorized use of these marks is strictly prohibited. To date, no literat. Fourteen articles were included and analyzed (293 thumbs). 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. A sprained thumb is a common injury among athletes. Surgical management of chronic, 42. 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. sharing sensitive information, make sure youre on a federal We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. POST-OPERATIVE WEEKS 22-24. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Conclusions: Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. The anti edema management will continue for several weeks. 33. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Jackson M, McQueen MM. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Keyword Highlighting Tension wire fixation of avulsion fractures in the hand. to maintaining your privacy and will not share your personal information without This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Subject demographics are reported in Table 2. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Upper extremity injuries in snow skiers. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Wong TC, Ip FK, Wu WC. 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. Surgical techniques and a review of 70 patients. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. An official website of the United States government. 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. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Am J Sports Med. Patient Demographics of Thumb RCL and UCL Injuries. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. HHS Vulnerability Disclosure, Help Abstract. 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.. [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. Categorical variable data were reported as frequency with percentages. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Kozin SH, Bishop AT. SYMPTOMS: The thumb may be swollen, bruised and painful. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. J Bone Joint Surg Am. 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. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Nonoperative treatment often failed, necessitating surgery. Am J Sports Med. Epub 2016 Jan 13. The overall complication rate was 13.8% (11/80). Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Infection is a rare complication of hand surgery. 1989;14:567573. 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. *Glickel grading scale. Disclaimer. If the latter was executed only partially, a score of 1 was assigned. 14. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Melone CP Jr, Beldner S, Basuk RS. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. 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. 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. Am J Sports Med. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. eCollection 2021. Smith RJ. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. [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. Arthritis Rheum. 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. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Am J Sports Med. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Exercises: Gradually progress to competitive throwing and sports . Bennet Fracture. Careers. 1989;17:751753. J Bone Joint Surg Am. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Riederer S, Nagy L, Buchler U. Causes. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Only prospective studies can determine this injury course. In some cases, certain risk factors make it more likely that a bone will fail to heal. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 32. 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. These exercises may be directed by a physical or occupational therapist. 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. If the tear is diagnosed early a repair will be possible. Bostock S, Morris MA. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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%). Data is temporarily unavailable. Hand Clin. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Fourteen articles were included and analyzed (293 thumbs). MCP fusion was performed . Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. PLoS Med. Evaluation and management of elbow injuries in the adolescent overhead athlete. An anatomic basis for treatment. The https:// ensures that you are connecting to the When assessed, most patients returned to their preinjury employment. 1995;23:222226. Range of motion returns much sooner, too. Throwing status reported in 4 studies. Bailie DS, Benson LS, Marymont JV. 5. 1994;23:797804. Frykman G, Johansson O. Surgical repair of rupture of the, 46. This article provides a review of . [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. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. An official website of the United States government. There were 61 studies eliminated as secondary for being in a language other than English. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). I was able to work while wearing the splint. Arthrosc Sports Med Rehabil. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Your thumb will be immobilized in a splint and should not be moved until follow up. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Am J Sports Med. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). 4. J Hand Surg Br. A broken thumb can also cause numbness or tingling. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 37. the splint for protection or at night until twelve weeks after the operation. Bethesda, MD 20894, Web Policies Early and late postoperative complications were recorded. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. 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. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 10. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Bookshelf Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Thumb dominance reported in 8 studies (168 thumbs). Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Sports Med Arthrosc Rev. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). 39. The .gov means its official. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 3. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. 44. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. No study directly compared nonoperative to operative treatment. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). J Hand Surg Am. The mean time from reported injury date to surgery was 202.4 days (2-5969). Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. History. 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. Injuries to the PIP joint remain swollen for long periods of time. 2013Lippincott Williams & Wilkins. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. The .gov means its official. Metacarpophalangeal joint injuries of the thumb. may email you for journal alerts and information, but is committed The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 26. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. NR, not reported. There were no cases of intraoperative ulnar nerve injury reported. Before Please use this form to submit your questions or comments on how to make this article more useful to clinicians.