2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Complications after surgery were rare. The Orthopedic Journal of Sports Medicine. 27. **Stener lesion status reported in 6 studies (145 thumbs). Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Part I of this two-part article focuses on common tendon and . 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. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. Your message has been successfully sent to your colleague. This website also contains material copyrighted by 3rd parties. At this stage, patients should be advised to wear your splint part-time. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. modify the keyword list to augment your search. 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%). Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). If the latter was executed only partially, a score of 1 was assigned. Jackson M, McQueen MM. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Hand Clin. When assessed, most patients returned to their preinjury employment. Would you like email updates of new search results? Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Epub 2014 Oct 22. *Gender reported in 12 studies (218 subjects). TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Am. They may even tear completely. 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. 2006;31:6875. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Nonoperative treatment often failed, necessitating surgery. The injury involves the ulnar collateral ligament (UCL) of the thumb. Background: Jupiter JB, Sheppard JE. to maintaining your privacy and will not share your personal information without
Bailie DS, Benson LS, Marymont JV. 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. Infection is a rare complication of hand surgery. Clipboard, Search History, and several other advanced features are temporarily unavailable. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 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]). Epub 2019 Mar 21. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Sakellarides HT, DeWeese JW. The https:// ensures that you are connecting to the Mean subject age was 33.9 years. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. doi: 10.1016/j.asmr.2020.12.004. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Systematic review and meta-analysis. Benson LS, Bailie DS. 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. Complications after surgical treatment of UCL injury are rare. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. The limitations of this systematic review are reliant on the studies analyzed. 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. 1. Please enable scripts and reload this page. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. The limitations of this systematic review are reliant on the studies analyzed. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. PMC J Hand Surg Am. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . There were no cases of intraoperative ulnar nerve injury reported. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. If the force is too strong, the ligaments can tear. Search performed on November 17, 2011. Abstract. No study compared different graft types or fixation techniques. 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. Keywords: 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Federal government websites often end in .gov or .mil. 13. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 1998;23:503506. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 24. J Bone Joint Surg Am. 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. Mean study follow-up was 42.8 months. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 1989;71:383387. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Conclusion: Complications, failures, and reoperations are rare after surgical treatment of UCL injury. flexion-extension motion. The https:// ensures that you are connecting to the Wong TC, Ip FK, Wu WC. doi: 10.1097/JSA.0000000000000322. Epub 2016 Jan 13. The effect of thumb metacarpophalangeal. 1977;59:1421. Ulnar Collateral Ligament Repair . Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Epub 2015 Sep 22. 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. An official website of the United States government. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. You will receive email when new content is published. Possible complications include: - 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. Am J Sports Med. 36. Arnold DM, Cooney WP, Wood MB. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. What Happens If We Sit for More Than 8 Hours Per Day? Search for Similar Articles
Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. [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. 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. Thumb dominance reported in 8 studies (168 thumbs). Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. POST-OPERATIVE WEEKS 22-24. J Hand Surg Glob Online. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Kozin SH, Bishop AT. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Clipboard, Search History, and several other advanced features are temporarily unavailable. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 38. 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. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 1994;23:797804. Quantitative outcome of surgical repair. The .gov means its official. Van Dommelen BA, Zvirbulis RA. HHS Vulnerability Disclosure, Help 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. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Disclaimer. Objectives: 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. Clinical Journal of Sport Medicine23(4):247-254, July 2013. eCollection 2021. Wolters Kluwer Health, Inc. and/or its subsidiaries. *Glickel grading system. This damage may lead to temporary or permanent numbness or weakness. 1992;8:713732. If you log out, you will be required to enter your username and password the next time you visit. Downey DJ, Moneim MS, Omer GE Jr. may email you for journal alerts and information, but is committed
2009;61:623632. Purpose. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 15. Bookshelf Bennet Fracture. Chir Main. Wolters Kluwer Health
These exercises may be directed by a physical or occupational therapist. 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). Moher D, Liberati A, Tetzlaff J, et al.. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Upper extremity injuries in snow skiers. 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. Post-traumatic instability of the metacarpophalangeal joint of the thumb. In these patients, after failure of nonoperative treatment at anywhere from 1 month 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. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Thumb collateral ligament injuries. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Am J Sports Med. 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. 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. An anatomic basis for treatment. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 1996;25:474477. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Acta Chir Scand. Symptoms are dependent on the cause and severity of injury to the UCL. You may search for similar articles that contain these same keywords or you may
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. Highlight selected keywords in the article text. Bethesda, MD 20894, Web Policies 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). Epub 2020 Jun 29. 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 Some error has occurred while processing your request. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. [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. 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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. Disclaimer. No study directly compared the different types of graft for UCL reconstruction. Orthop J Sports Med. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 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.
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