Meta-analysis of the pooled data was completed. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. No study directly compared the different types of graft for UCL reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Orthop J Sports Med. Careers. 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. 8600 Rockville Pike No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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. 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). 7. You've successfully added to your alerts. Meta-analysis of the pooled data was completed. UCLR case series that contained complications data were included. 2018;6(4):1-7. 14 It is important to diagnose complete tears early because . All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Am J Sports Med. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. History. Epub 2015 Sep 22. J Bone Joint Surg Am. 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 [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Unauthorized use of these marks is strictly prohibited. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. A score of 2 was assigned if the item was completely and accurately performed and reported. Thirty-two thumbs were treated nonoperatively and 261 operatively. [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. [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. Gamekeeper's thumb. 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. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. For more information, please refer to our Privacy Policy. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . There is currently no consensus on treatment of acute or chronic UCL injuries. Downey DJ, Moneim MS, Omer GE Jr. Thumb collateral ligament injuries. 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. Wolters Kluwer Health, Inc. and/or its subsidiaries. National Library of Medicine Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute 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. Possible complications include: - 11. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. This site needs JavaScript to work properly. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. FOIA Only prospective studies can determine this injury course. 38. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Pain reduction was significantly improved in all subjects (P < 0.05). [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. There is currently no consensus on treatment of acute or chronic UCL injuries. 31. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Orthop Rev. [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. Purpose: 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. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. [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]. This article provides a review of . 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . *Gender reported in 12 studies (218 subjects). Van Dommelen BA, Zvirbulis RA. 16. 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. The LUCL is located on the lateral or outside part of the elbow. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Orthop Clin North Am. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. #Injury location reported only in 3 studies. 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. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Fusetti C, Papaloizos M, Meyer H, et al.. 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. Metacarpophalangeal joint injuries of the thumb. 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. Non-Fusion. 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. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. If it is appropriate, then surgical consent probably happened before the surgery. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Thus, the true natural history is yet unknown. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. 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%). Bookshelf Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. No study compared different graft types or fixation techniques. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. POST-OPERATIVE WEEKS 22-24. 21. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.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.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. To date, no literat. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. A score of 0 was assigned if the item was either omitted or not performed. Please try again soon. Part I: anatomy and diagnosis. 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. 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. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 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. These exercises may be directed by a physical or occupational therapist. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. This damage may lead to temporary or permanent numbness or weakness. Upper extremity injuries in snow skiers. This site needs JavaScript to work properly. Proximal interphalangeal joint injuries of the hand. Please enable it to take advantage of the complete set of features! Bethesda, MD 20894, Web Policies Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Systematic review and meta-analysis. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 1,5,9,10 In acute cases of complete tears involving high-level . Figure 46-2 Approach to the ulnar collateral ligament. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Treatment of chronic injuries of the. NR, not reported. 39. Injuries to the PIP joint remain swollen for long periods of time. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. your express consent. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mean study follow-up was 42.8 months. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 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. Rupture and displacement of the. 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. If the latter was executed only partially, a score of 1 was assigned. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Clipboard, Search History, and several other advanced features are temporarily unavailable. The limitations of this systematic review are reliant on the studies analyzed. 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. Click the topic below to receive emails when new articles are available. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Your surgeon is the person best able to help you avoid any serious recovery problems. 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%). 1993;21:800804. Abstract Objectives: 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. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Sports Health. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Accessibility 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. 13. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 23. Results: Thus, the true natural history is yet unknown. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. 15. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Categorical variable data were reported as frequency with percentages. 2005;24:217221. I was able to work while wearing the splint. 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. 2021 Apr 15;3(2):e527-e533. 2003;8:8185. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Your ligament may need to be reattached to the bone using a bone anchor. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Objectives: 14. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Eventually this abnormal movement will wear out the joint and it will become arthritic. [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. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly.