Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. The grip strength and the pinch strength were 94.3% and 92.27%,. Conclusion: J Bone Joint Surg Am. Am J Sports Med. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Bailie DS, Benson LS, Marymont JV. 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. J Hand Surg Am. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 18. For more information, please refer to our Privacy Policy. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Downey DJ, Moneim MS, Omer GE Jr. [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. Possible complications include: - Careers. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Fourteen articles were included and analyzed (293 thumbs). TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Table 1. 1989;71:383387. 1993;21:800804. Mechanism of injury to the RCL of the MCP joint of the thumb is force . The authors report no funding or conflicts of interest. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Studies that duplicated patient populations from the same authors were excluded. Only prospective studies can determine this injury course. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 7. Clipboard, Search History, and several other advanced features are temporarily unavailable. Arnold DM, Cooney WP, Wood MB. 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. Catalano LW III, Cardon L, Patenaude N, et al.. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. 25. 1995;23:222226. The .gov means its official. Results: #Injury location reported only in 3 studies. Orthop Clin North Am. Before 1999;24:275282. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Descriptive statistics were calculated. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Only prospective studies can determine this injury course. There were 200 acute injuries and 93 chronic injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. Kozin SH, Bishop AT. 37. Weakened grip or reduced thumb range of motion may occur. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Engelhardt JB, Christensen OM, Christiansen TG. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Wolters Kluwer Health, Inc. and/or its subsidiaries. Complications after this procedure may include nerve or blood vessel damage. Am J Sports Med. 20. 11. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. J Hand Surg Am. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 2. 21. 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. 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. This site needs JavaScript to work properly. 2003;8:8185. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. If the force is too strong, the ligaments can tear. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 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. 2018;6(4):1-7. 2009;34:304308. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. PLoS Med. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Bethesda, MD 20894, Web Policies Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Rupture of the. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). modify the keyword list to augment your search. This leads to what is know as a positive ulnar variance. Chir Main. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. J Hand Surg Br. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Melone CP Jr, Beldner S, Basuk RS. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. SYMPTOMS: The thumb may be swollen, bruised and painful. Please enable it to take advantage of the complete set of features! All authors independently performed the search. A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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. 2000;16:345357. three muscles provide deforming forces at the base of the thumb. The effect of thumb metacarpophalangeal. No study compared different graft types or fixation techniques. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. 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 . Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 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. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Epub 2013 Nov 12. 1994;25:2123. 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. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Throwing status reported in 4 studies. Gamekeepers thumb: a prospective study of functional bracing. Your surgeon is the person best able to help you avoid any serious recovery problems. Arthrosc Sports Med Rehabil. What Happens If We Sit for More Than 8 Hours Per Day? 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. No study directly compared nonoperative to operative treatment. SAGE Open Med. 2022 Mar 1;30(1):e1-e8. 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. 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. 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. 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. Data is temporarily unavailable. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Thirty-two thumbs were treated nonoperatively and 261 operatively. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Some error has occurred while processing your request. 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. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. All but 2 were level IV evidence. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Clin Orthop Relat Res. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 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 . J Bone Joint Surg Am. eCollection 2021 Mar. Tension wire fixation of avulsion fractures in the hand. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. 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. 2021 Apr 15;3(2):e527-e533. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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. The torn thumb ligament is repaired or reconstructed during surgery. [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]. Please enter a Recipient Address and/or check the Send me a copy checkbox. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Benson LS, Bailie DS. Treatment of chronic injuries of the. 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). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 8. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. and twist using your thumb. [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. If the tear is diagnosed early a repair will be possible. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Continuous variable data were reported as mean SDs from the mean. A common complication following fracture of the distal radius is when the radius shortens. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 1987;214:113120. 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. MCP fusion was performed . Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. 23. 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. 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. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. At this stage, patients should be advised to wear your splint part-time. 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. Please try again soon. Injuries to the PIP joint remain swollen for long periods of time. Unable to load your collection due to an error, Unable to load your delegates due to an error. 34. 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). 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. Subject demographics are reported in Table 2. Thirty-two thumbs were treated nonoperatively and 261 operatively. FOIA Injury. It runs from the outer humerus, around the radial head and attaches to the ulna. 33. An official website of the United States government. Louis DS, Huebner JJ Jr, Hankin FM. 31. 3. your express consent. 8600 Rockville Pike Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. National Library of Medicine Kaplan EB. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Keyword Highlighting