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. Rupture of the. and twist using your thumb. 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". may email you for journal alerts and information, but is committed Engelhardt JB, Christensen OM, Christiansen TG. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 33. 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. 36. Objectives: All techniques improved clinical outcomes, including pain, motion, strength, and stability. 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. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 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. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Thus, the true natural history is yet unknown. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1995;18:11611165. Keyword Highlighting American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. Mean study follow-up was 42.8 months. Part I: anatomy and diagnosis. There were no cases of intraoperative ulnar nerve injury reported. Federal government websites often end in .gov or .mil. Epub 2014 Dec 30. 1,5,9,10 In acute cases of complete tears involving high-level . When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. J Hand Surg Am. The https:// ensures that you are connecting to the Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Proximal interphalangeal joint injuries of the hand. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. J Hand Surg Am. 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. 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 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. Bennet Fracture. Disclaimer. Thumb from the common mechanism of falling on the thumb while holding a ski pole. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Docs Struggle to Keep Up With the Flood of New Medical Knowledge. 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. 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. 2018;6(4):1-7. Descriptive statistics were calculated. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 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. You may search for similar articles that contain these same keywords or you may The https:// ensures that you are connecting to the 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Ulnar Collateral Ligament Repair . All but 2 were level IV evidence. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 1994;25:2123. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 19. 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. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. The limitations of this systematic review are reliant on the studies analyzed. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 2021 Apr 15;3(2):e527-e533. Clin J Sport Med. The range of motion of the MP joint of the thumb following operative repair of the. 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. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 23. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. 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. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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. If the latter was executed only partially, a score of 1 was assigned. This ligament prevents the thumb from pointing too far away from the hand. [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. Data sources: Possible complications include: - Please enable it to take advantage of the complete set of features! Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. HHS Vulnerability Disclosure, Help [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. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 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. [31] The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. the splint for protection or at night until twelve weeks after the operation. Eventually this abnormal movement will wear out the joint and it will become arthritic. Thumb sidedness reported in 3 studies (51 thumbs). Early diagnosis and treatment. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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%). doi: 10.1097/JSA.0000000000000322. 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. 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. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. J Bone Joint Surg Am. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. The .gov means its official. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Fusetti C, Papaloizos M, Meyer H, et al.. No study compared different graft types or fixation techniques. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. You are being redirected to Medscape Education. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 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. 1995;23:222226. Bethesda, MD 20894, Web Policies There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 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).
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