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). Mean subject age was 33.9 years. 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%). It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Keywords: Please try again soon. 14 It is important to diagnose complete tears early because . 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. Metacarpophalangeal joint injuries of the thumb. 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. The anti edema management will continue for several weeks. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Diagnosis of displaced, 43. 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*. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Proximal interphalangeal joint injuries of the hand. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Possible complications include: - Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). [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. There is currently no consensus on treatment of acute or chronic UCL injuries. eCollection 2022 May. Studies that duplicated patient populations from the same authors were excluded. Symptoms are dependent on the cause and severity of injury to the UCL. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 1994;23:797804. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 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. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. [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. A broken thumb can also cause numbness or tingling. There were 61 studies eliminated as secondary for being in a language other than English. 31. 13. Purpose. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Complications after surgery were rare. Rupture and displacement of the. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Orthopedics. 2009;61:623632. This ligament prevents the thumb from pointing too far away from the hand. 2022 Mar 1;30(1):e1-e8. The mean patient age was 37.8 years (14.0-78.1). A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. PLoS Med. 19. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Please confirm that you would like to log out of Medscape. J Bone Joint Surg Am. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) 23. Bethesda, MD 20894, Web Policies The range of motion of the MP joint of the thumb following operative repair of the. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. The Orthopedic Journal of Sports Medicine. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. The LUCL is located on the lateral or outside part of the elbow. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. 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). may email you for journal alerts and information, but is committed The doctor won't know if the repair is . Disclaimer. No study directly compared the different types of graft for UCL reconstruction. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. unstable when the thumb is used. eCollection 2021 Mar. A score of 0 was assigned if the item was either omitted or not performed. Table 1. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. [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. 1998;23:503506. 1989;71:383387. MCP fusion was performed . This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. 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. Bean CH, Tencer AF, Trumble TE. Disclaimer. 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. Study design: No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 2013;23(4):247-254. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. The .gov means its official. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Please enable it to take advantage of the complete set of features! 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 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. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 2018;6(4):1-7. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. Am J Sports Med. What Happens If We Sit for More Than 8 Hours Per Day? Moher D, Liberati A, Tetzlaff J, et al.. Bethesda, MD 20894, Web Policies 20. [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. 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. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Bostock S, Morris MA. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 1999;24:7075. Epub 2014 Oct 22. PMC This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.".
complications after ucl repair of thumb
complications after ucl repair of thumb
