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. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. Click the topic below to receive emails when new articles are available. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Please enter a Recipient Address and/or check the Send me a copy checkbox. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Bookshelf 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. 10. Am J Sports Med. Muscles. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). They may even tear completely. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Objectives: 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). Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. This leads to what is know as a positive ulnar variance. When assessed, most patients returned to their preinjury employment. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). 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. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . The authors report no funding or conflicts of interest. 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. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Sixty nine (86.3%) patients had grade 3 tears. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. No study reported the outcomes of nonoperative management of chronic UCL injury. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 8. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. 4. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 35. This site needs JavaScript to work properly. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 2003;8:8185. 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. Exercises: Gradually progress to competitive throwing and sports . Proximal interphalangeal joint injuries of the hand. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. If it is appropriate, then surgical consent probably happened before the surgery. J Bone Joint Surg Am. If the tear is diagnosed early a repair will be possible. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Epub 2019 Mar 21. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. PLoS Med. 1999;24:275282. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? If you log out, you will be required to enter your username and password the next time you visit. Arnold DM, Cooney WP, Wood MB. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. J Hand Surg Am. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Orthop Clin North Am. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 2013;23(4):247-254. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 14. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Continue to stretch before and after throwing . 3. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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. No study compared different graft types or fixation techniques. to maintaining your privacy and will not share your personal information without If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Mitsionis GI, Varitimidis SE, Sotereanos GG. 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. flexion-extension motion. Your surgeon will discuss these options with you. Am J Sports Med. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. 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. Abstract. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. official website and that any information you provide is encrypted 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*. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Am J Sports Med. 1993;21:800804. Please try after some time. Dr. Holt will talk to you about when it is safe to return to work. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. If the latter was executed only partially, a score of 1 was assigned. J Hand Surg Br. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. 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. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 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. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Your ligament may need to be reattached to the bone using a bone anchor. your express consent. 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). Stener B. Skeletal injuries associated with rupture of the. government site. These tears often occur as a result of a radially directed force on an extended thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. 8600 Rockville Pike [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. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Quantitative outcome of surgical repair. Non-Fusion. 18. POST-OPERATIVE WEEKS 22-24. Disclaimer. Rupture and displacement of the. 2005;24:217221. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. MeSH 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. The LUCL is located on the lateral or outside part of the elbow. Search performed on November 17, 2011. [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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Bethesda, MD 20894, Web Policies Ulnar collateral ligament injuries of the thumb: a comprehensive review. 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. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. 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. Downey DJ, Moneim MS, Omer GE Jr. Educate the patient on anti edema management. sharing sensitive information, make sure youre on a federal Conflicts of interest The authors report no funding or conflicts of interest. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). All but 2 were level IV evidence. Data is temporarily unavailable. 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. Unauthorized use of these marks is strictly prohibited. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 1995;18:11611165. government site. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Epub 2016 Jan 13. Eventually this abnormal movement will wear out the joint and it will become arthritic. Data range was reported as minimum to maximum absolute values. Would you like email updates of new search results? Pain reduction was significantly improved in all subjects (P < 0.05). MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Please enable scripts and reload this page. 2000;16:345357. An official website of the United States government. 1992;8:713732. [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]. 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. *Glickel grading scale. Kozin SH, Bishop AT. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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). Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Metacarpophalangeal joint injuries of the thumb. 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. No study directly compared the different types of graft for UCL reconstruction. Bethesda, MD 20894, Web Policies 38. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 26. MCP fusion was performed . 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Gamekeeper's thumb. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 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. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 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. Kaplan EB. 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 . Benson LS, Bailie DS. Purpose: A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Acute gamekeeper's thumb. 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. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. PMC 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. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 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. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Systematic review and meta-analysis. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. There is currently no consensus on treatment of acute or chronic UCL injuries. 1977;59:1421. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. UCLR case series that contained complications data were included. 6. 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. 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. A score of 0 was assigned if the item was either omitted or not performed. In these cases, a new graft may be used to perform a second reconstruction. 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. J Hand Surg Glob Online. eCollection 2021 Mar. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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 .