Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Dr. Holt will talk to you about when it is safe to return to work. Bostock S, Morris MA. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 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. 2022 Mar 1;30(1):e1-e8. 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%. Please confirm that you would like to log out of Medscape. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 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. Data sources: FOIA No study reported the outcomes of nonoperative management of chronic UCL injury. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 45. Epub 2014 Oct 22. 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. Rupture of the. Fourteen articles were included and analyzed (293 thumbs). The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 2018;6(4):1-7. 38. Quantitative outcome of surgical repair. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 36. 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. the splint for protection or at night until twelve weeks after the operation. The https:// ensures that you are connecting to the Conclusion: When untreated, this injury may lead to decreased pinch strength, pain, instability, and. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Before 2013;23(4):247-254. Orthop Rev. 2005;24:217221. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. This damage may lead to temporary or permanent numbness or weakness. Some error has occurred while processing your request. Figure 46-2 Approach to the ulnar collateral ligament. Hand Surg. The mean time from reported injury date to surgery was 202.4 days (2-5969). 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. official website and that any information you provide is encrypted TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Am J Sports Med. Unilateral injuries: 291 and bilateral injury: 1. Kaplan EB. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Clipboard, Search History, and several other advanced features are temporarily unavailable. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). A score of 0 was assigned if the item was either omitted or not performed. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Please try again soon. Keywords: 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. No study compared different graft types or fixation techniques. 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%). 18. 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). Federal government websites often end in .gov or .mil. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Please enable it to take advantage of the complete set of features! Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 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]). [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. Proximal interphalangeal joint injuries of the hand. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). 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. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. Am J Sports Med. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). sharing sensitive information, make sure youre on a federal better/same/worse than preoperative status). Conclusions: Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 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. 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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 1976;58:106112. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. MCP fusion was performed . Epub 2019 Mar 21. Systematic review and meta-analysis. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Benson LS, Bailie DS. If you log out, you will be required to enter your username and password the next time you visit. Sports Med Arthrosc Rev. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. POST-OPERATIVE WEEKS 22-24. 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. to maintaining your privacy and will not share your personal information without Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Wolters Kluwer Health 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. Engelhardt JB, Christensen OM, Christiansen TG. Mean study follow-up was 42.8 months. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Unable to load your collection due to an error, Unable to load your delegates due to an error. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Bean CH, Tencer AF, Trumble TE. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Epub 2016 Jan 13. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Am J Sports Med. The range of motion of the MP joint of the thumb following operative repair of the. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. 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. This website also contains material copyrighted by 3rd parties. 8. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. 5. Symptoms are dependent on the cause and severity of injury to the UCL. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Clipboard, Search History, and several other advanced features are temporarily unavailable. Thumb dominance reported in 8 studies (168 thumbs). If the latter was executed only partially, a score of 1 was assigned. 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). Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. He too had the internal brace augmentation. 1989;71:383387. 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 . The overall complication rate after primary thumb RCL and UCL repair was 13.8%. A broken thumb can also cause numbness or tingling. 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. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 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. The injury involves the ulnar collateral ligament (UCL) of the thumb. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. The Orthopedic Journal of Sports Medicine. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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. Data is temporarily unavailable. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 21. J Hand Surg Am. These exercises may be directed by a physical or occupational therapist. Studies that duplicated patient populations from the same authors were excluded. 2. 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