Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. MeSH sharing sensitive information, make sure youre on a federal What are the symptoms of GameKeeper's Thumb? A p-value of 0.05 was considered statistically significant. 14. 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. 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. 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. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. The mean patient age was 37.8 years (14.0-78.1). [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Post-traumatic instability of the metacarpophalangeal joint of the thumb. You are being redirected to Medscape Education. [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. 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. Orthop Rev. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Long-term results of ligament reconstruction. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Eventually this abnormal movement will wear out the joint and it will become arthritic. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? J Hand Surg Br. 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. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. [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. 23. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Bailie DS, Benson LS, Marymont JV. Stener B. Skeletal injuries associated with rupture of the. 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. 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%). The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 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. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. to maintaining your privacy and will not share your personal information without Symptoms are dependent on the cause and severity of injury to the UCL. Nonoperative treatment often failed, necessitating surgery. Kozin SH, Bishop AT. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. The site is secure. 26. Infection is a rare complication of hand surgery. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. unstable when the thumb is used. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 11. Epub 2016 Jan 13. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. 25. Mean study follow-up was 42.8 months. 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. 1976;58:106112. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Mean subject age was 33.9 years. *Glickel grading scale. 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. Meta-analysis of the pooled data was completed. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. You may be trying to access this site from a secured browser on the server. Instability of the metacarpophalangeal joint of the thumb. 2018;6(4):1-7. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. An anatomic basis for treatment. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 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). UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. There is currently no consensus on treatment of acute or chronic UCL injuries. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Thumb from the common mechanism of falling on the thumb while holding a ski pole. All but 2 were level IV evidence. 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. Wolters Kluwer Health, Inc. and/or its subsidiaries. There were 200 acute injuries and 93 chronic injuries. 1999;24:275282. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. All authors independently performed the search. Epub 2019 Mar 21. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. Keyword Highlighting 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. If the tear is diagnosed early a repair will be possible. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. J Hand Surg Am. A common complication following fracture of the distal radius is when the radius shortens. Educate the patient on anti edema management. Table 1. Treatment of chronic injuries of the. Weakened grip or reduced thumb range of motion may occur. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Unauthorized use of these marks is strictly prohibited. 1999;24:7075. MCP fusion was performed . 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. A sprained thumb is a common injury among athletes. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. [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. The .gov means its official. Epub 2014 Oct 22. 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 **Stener lesion status reported in 6 studies (145 thumbs). No study reported the outcomes of nonoperative management of chronic UCL injury. 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. Surgical management of chronic, 42. [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]. 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%). 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. Complications after this procedure may include nerve or blood vessel damage. 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. 10. Am J Sports Med. better/same/worse than preoperative status). The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Both purely ligamentous and bony avulsion injuries were included. 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 . Purpose. and twist using your thumb. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . The injury involves the ulnar collateral ligament (UCL) of the thumb. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. You will receive email when new content is published. Would you like email updates of new search results? 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. If you log out, you will be required to enter your username and password the next time you visit. Bean CH, Tencer AF, Trumble TE. Careers. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. three muscles provide deforming forces at the base of the thumb. A systematic review of ulnar collateral ligament reconstruction techniques. HHS Vulnerability Disclosure, Help 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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. SAGE Open Med. Unable to load your collection due to an error, Unable to load your delegates due to an error. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Thus, the true natural history is yet unknown. 33. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. National Library of Medicine Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Methods: Only prospective studies can determine this injury course. Pichora DR, McMurtry RY, Bell MJ. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. Disclaimer. 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. Fusetti C, Papaloizos M, Meyer H, et al.. For example, it can be removed when performing . 4. No study directly compared the different types of graft for UCL reconstruction. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Gamekeepers thumb: a prospective study of functional bracing. After failure of nonoperative treatment, at anywhere from 6 months 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. Mitsionis GI, Varitimidis SE, Sotereanos GG. 45. 2009;34:304308. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. A broken thumb can also cause numbness or tingling. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Am J Sports Med. [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. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 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. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Only prospective studies can determine this injury course. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 5. Orthopedics. Meta-analysis of the pooled data was completed. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . You may search for similar articles that contain these same keywords or you may official website and that any information you provide is encrypted Thirty-two thumbs were treated nonoperatively and 261 operatively. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 21. Metacarpophalangeal joint injuries of the thumb. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. [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. Kaplan EB. Please try again soon. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). I was able to work while wearing the splint. 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. Acute gamekeeper's thumb. 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery.