Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Catalano LW III, Cardon L, Patenaude N, et al.. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. The mean patient age was 37.8 years (14.0-78.1). 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. Keyword Highlighting
Continue to stretch before and after throwing . Both purely ligamentous and bony avulsion injuries were included. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. When assessed, most patients returned to their preinjury employment. 19. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Wolters Kluwer Health
Downey DJ, Moneim MS, Omer GE Jr. J Bone Joint Surg Am. In these cases, a new graft may be used to perform a second reconstruction. Proximal interphalangeal joint injuries of the hand. Thus, the true natural history is yet unknown. You will receive email when new content is published. Data range was reported as minimum to maximum absolute values. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Kozin SH, Bishop AT. 16. Am J Orthop (Belle Mead NJ). Riederer S, Nagy L, Buchler U. [19] Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis. Clin J Sport Med. A common complication following fracture of the distal radius is when the radius shortens. sharing sensitive information, make sure youre on a federal Fourteen articles were included and analyzed (293 thumbs). The limitations of this systematic review are reliant on the studies analyzed. Thus, the true natural history is yet unknown. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. These exercises may be directed by a physical or occupational therapist. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). All techniques improved clinical outcomes, including pain, motion, strength, and stability. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. This ligament prevents the thumb from pointing too far away from the hand. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 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. You may be trying to access this site from a secured browser on the server. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 3. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Stener B. Skeletal injuries associated with rupture of the. 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%). Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. The LUCL is located on the lateral or outside part of the elbow. Hand Clin. Diagnosis of displaced, 43. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. For example, it can be removed when performing . Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 37. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Conclusions: Mitsionis GI, Varitimidis SE, Sotereanos GG. Am J Sports Med. This site needs JavaScript to work properly. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). 45. FOIA Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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%. Your thumb will be immobilized in a splint and should not be moved until follow up. 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). It runs from the outer humerus, around the radial head and attaches to the ulna. Upper extremity injuries in snow skiers. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. 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. What are the symptoms of GameKeeper's Thumb? No study directly compared nonoperative to operative treatment. 2005;87:26322638. Orthop Clin North Am. Mean subject age was 33.9 years. official website and that any information you provide is encrypted Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Accessibility Surgical techniques and a review of 70 patients. Jupiter JB, Sheppard JE. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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 are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. Am J Orthop (Belle Mead NJ). Epub 2016 Jan 13. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Conclusion: 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. 8600 Rockville Pike J Hand Surg Am. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. 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]). 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Accessibility Quantitative outcome of surgical repair. Mean study follow-up was 42.8 months. Conflicts of interest The authors report no funding or conflicts of interest. may email you for journal alerts and information, but is committed
2018;6(4):1-7. UCLR case series that contained complications data were included. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Before 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). The limitations of this systematic review are reliant on the studies analyzed. Tension wire fixation of avulsion fractures in the hand. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 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. 21. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. All but 2 were level IV evidence. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Orthop J Sports Med. Nonoperative treatment often failed, necessitating surgery. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 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%.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. 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. 1987;214:113120. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Epub 2021 Sep 7. eCollection 2022 May. sharing sensitive information, make sure youre on a federal Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Non-Fusion. If you log out, you will be required to enter your username and password the next time you visit. 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. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Bethesda, MD 20894, Web Policies Complications after surgery were rare. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2013;23(4):247-254. 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. 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. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 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. J Bone Joint Surg Am. Am J Sports Med. Kaplan EB. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Am J Sports Med. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. 38. HHS Vulnerability Disclosure, Help There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review.