Downey DJ, Moneim MS, Omer GE Jr. 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. Melone CP Jr, Beldner S, Basuk RS. 1962;124:396411. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. 1995;23:222226. eCollection 2021. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 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. Thumb sidedness reported in 3 studies (51 thumbs). 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. Various levels of pain, bruising, or edema may present at the site of damage. 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. Epub 2021 Sep 7. 36. Data is temporarily unavailable. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Injury. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. 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. Disclaimer. Unable to load your collection due to an error, Unable to load your delegates due to an error. Your thumb will be immobilized in a splint and should not be moved until follow up. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 33. 1994;23:797804. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 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. HHS Vulnerability Disclosure, Help Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 20. 22. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. [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. A systematic review of ulnar collateral ligament reconstruction techniques. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. J Hand Surg Br. 44. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. Disclaimer. Meta-analysis of the pooled data was completed. POST-OPERATIVE WEEKS 22-24. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. SYMPTOMS: The thumb may be swollen, bruised and painful. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery You may be trying to access this site from a secured browser on the server. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). A broken thumb can also cause numbness or tingling. If the latter was executed only partially, a score of 1 was assigned. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. 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. SAGE Open Med. 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%). 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. The https:// ensures that you are connecting to the The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Upper extremity injuries in snow skiers. Arthritis Rheum. An anatomic basis for treatment. All but 2 were level IV evidence. 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. [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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Bostock S, Morris MA. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Nonoperative treatment often failed, necessitating surgery. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Stener B. Skeletal injuries associated with rupture of the. A sprained thumb is a common injury among athletes. Am J Orthop (Belle Mead NJ). Please confirm that you would like to log out of Medscape. FOIA 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. Am J Sports Med. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 34. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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%). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Federal government websites often end in .gov or .mil. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Bailie DS, Benson LS, Marymont JV. 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. 18. 13. Sixty nine (86.3%) patients had grade 3 tears. 45. 1. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. National Library of Medicine Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Complications after surgical treatment of UCL injury are rare. Fourteen articles were included and analyzed (293 thumbs). The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Arthrosc Sports Med Rehabil. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. 2000;16:345357. 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. 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. Wolters Kluwer Health TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 6. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Louis DS, Huebner JJ Jr, Hankin FM. The .gov means its official. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. Dr. Holt will talk to you about when it is safe to return to work. What are the symptoms of GameKeeper's Thumb? 1998;23:503506. Federal government websites often end in .gov or .mil. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Throwing status reported in 4 studies. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Please try after some time. J Bone Joint Surg Am. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 1994;25:2123. Click the topic below to receive emails when new articles are available. sharing sensitive information, make sure youre on a federal Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Epub 2020 Jun 29. The mean patient age was 37.8 years (14.0-78.1). You may search for similar articles that contain these same keywords or you may The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. You've successfully added to your alerts. Pichora DR, McMurtry RY, Bell MJ. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Eventually this abnormal movement will wear out the joint and it will become arthritic. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Mean subject age was 33.9 years. Possible complications include: - Epub 2014 Oct 22. Ulnar Collateral Ligament Repair . 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 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. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 14. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. 1961;43-A:541546. Highlight selected keywords in the article text. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. doi: 10.1097/JSA.0000000000000322. 2005;87:26322638. This site needs JavaScript to work properly. eCollection 2021 Mar. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. 15. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 3. 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. If the tear is diagnosed later a ligament reconstruction might be a better option. J Hand Surg Br. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. You are being redirected to Medscape Education. Unauthorized use of these marks is strictly prohibited. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 2022 Mar 1;30(1):e1-e8. Early and late postoperative complications were recorded. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. Hand Clin. There were no cases of intraoperative ulnar nerve injury reported. Your surgeon will discuss these options with you. J Bone Joint Surg Am. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Causes. 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%. Systematic review and meta-analysis. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Complications after surgical treatment of UCL injury are rare. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Am J Orthop (Belle Mead NJ). Only prospective studies can determine this injury course. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. 16. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Search performed on November 17, 2011. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. #Injury location reported only in 3 studies. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Smith RJ. 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 . UCLR case series that contained complications data were included. 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. 2006;31:6875. The .gov means its official. Epub 2013 Nov 12. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. J Bone Joint Surg Am. government site. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Your surgeon is the person best able to help you avoid any serious recovery problems. Fourteen articles were included and analyzed (293 thumbs). Epub 2016 Jan 13. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Please enable scripts and reload this page. 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. abduction-adduction motion. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 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. your express consent. Conflicts of interest The authors report no funding or conflicts of interest. Posner MA, Retaillaud JL. Conclusion: Abstract. HHS Vulnerability Disclosure, Help three muscles provide deforming forces at the base of the thumb. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 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. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. The limitations of this systematic review are reliant on the studies analyzed. Before 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 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. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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. Orthop J Sports Med. All authors independently performed the search. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Gamekeepers thumb: a prospective study of functional bracing. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Am J Sports Med. Acute gamekeeper's thumb. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. PMC Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. and twist using your thumb. 1987;214:113120. 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). J Hand Surg Am. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. J Hand Surg Glob Online. 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. eCollection 2021 Apr. Data sources: 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries.