*Glickel grading scale. POST-OPERATIVE WEEKS 22-24. Part II: treatment and complications. Epub 2014 Oct 22. 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. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Arthritis Rheum. 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. Before Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Acute gamekeeper's thumb. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 5. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. A score of 0 was assigned if the item was either omitted or not performed. Pain reduction was significantly improved in all subjects (P < 0.05). [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 2022 Mar 1;30(1):e1-e8. Downey DJ, Moneim MS, Omer GE Jr. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Would you like email updates of new search results? Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. FOIA 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. The site is secure. Mean subject age was 33.9 years. 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. Conflicts of interest The authors report no funding or conflicts of interest. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. government site. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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]). *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. No study reported the outcomes of nonoperative management of chronic UCL injury. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 7. Exercises: Gradually progress to competitive throwing and sports . 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. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. 44. HHS Vulnerability Disclosure, Help Evaluation and management of elbow injuries in the adolescent overhead athlete. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). abduction-adduction motion. There were 61 studies eliminated as secondary for being in a language other than English. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Please enable it to take advantage of the complete set of features! Tension wire fixation of avulsion fractures in the hand. Am J Sports Med. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. official website and that any information you provide is encrypted If you log out, you will be required to enter your username and password the next time you visit. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 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. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. This ligament prevents the thumb from pointing too far away from the hand. A systematic review of ulnar collateral ligament reconstruction techniques. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Eventually this abnormal movement will wear out the joint and it will become arthritic. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. government site. 31. 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. All but 2 were level IV evidence. The range of motion of the MP joint of the thumb following operative repair of the. Am J Sports Med. 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%. Epub 2021 Sep 7. three muscles provide deforming forces at the base of the thumb. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. 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. Studies that duplicated patient populations from the same authors were excluded. To date, no literat. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). to maintaining your privacy and will not share your personal information without 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). [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. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. The site is secure. Subject demographics are reported in Table 2. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. Melone CP Jr, Beldner S, Basuk RS. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Wolters Kluwer Health, Inc. and/or its subsidiaries. Dr. Holt will talk to you about when it is safe to return to work. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Instability of the metacarpophalangeal joint of the thumb. Complications after surgery were rare. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 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 . Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 10. *Glickel grading system. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. 1987;214:113120. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Clin Orthop Relat Res. Sixty nine (86.3%) patients had grade 3 tears. Range of motion returns much sooner, too. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 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%). Abstract. Jackson M, McQueen MM. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. 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. Early and late postoperative complications were recorded. 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). Clipboard, Search History, and several other advanced features are temporarily unavailable. What are the symptoms of GameKeeper's Thumb? Unauthorized use of these marks is strictly prohibited. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. [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. [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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. J Bone Joint Surg Am. J Hand Surg Am. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. A score of 2 was assigned if the item was completely and accurately performed and reported. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. 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. MeSH Am J Sports Med. 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). Causes. An official website of the United States government. Epub 2015 Sep 22. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Sports Health. 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. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. Complications after this procedure may include nerve or blood vessel damage. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Unable to load your collection due to an error, Unable to load your delegates due to an error. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". 19. Rupture of the. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. If the tear is diagnosed early a repair will be possible. Frykman G, Johansson O. Surgical repair of rupture of the, 46. The .gov means its official. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum).
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