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Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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 . Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. HHS Vulnerability Disclosure, Help Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Fourteen articles were included and analyzed (293 thumbs). You may be trying to access this site from a secured browser on the server. 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. The authors report no funding or conflicts of interest. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 2009;61:623632. All but 2 were level IV evidence. 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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. three muscles provide deforming forces at the base of the thumb. Jackson M, McQueen MM. 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. Epub 2021 Jan 18. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. National Library of Medicine Clipboard, Search History, and several other advanced features are temporarily unavailable. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. A secondary purpose was to compare graft choice and surgical technique for reconstruction. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. [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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Purpose. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Sakellarides HT, DeWeese JW. 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. SAGE Open Med. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Br. Louis DS, Huebner JJ Jr, Hankin FM. Epub 2014 Dec 30. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 1992;8:713732. 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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 36. Rupture and displacement of the. Hand Surg. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. If the latter was executed only partially, a score of 1 was assigned. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. A score of 0 was assigned if the item was either omitted or not performed. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 1996;25:527530. 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. There were 200 acute injuries and 93 chronic injuries. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. 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. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. 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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Disclaimer. Am J Sports Med. Keywords: eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Study design: Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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). The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 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. A p-value of 0.05 was considered statistically significant. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 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 Orthopedic Journal of Sports Medicine. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. [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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Please confirm that you would like to log out of Medscape. Am J Sports Med. 1989;71:383387. Your ligament may need to be reattached to the bone using a bone anchor. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Epub 2016 Jan 13. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint 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. Mean study follow-up was 42.8 months. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Thirty-two thumbs were treated nonoperatively and 261 operatively. Would you like email updates of new search results? 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. Bailie DS, Benson LS, Marymont JV. 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. unstable when the thumb is used. Injuries to the PIP joint remain swollen for long periods of time. eCollection 2022 May. A score of 2 was assigned if the item was completely and accurately performed and reported. Proximal interphalangeal joint injuries of the hand. MeSH Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The limitations of this systematic review are reliant on the studies analyzed. abduction-adduction motion. 14. For example, it can be removed when performing . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. modify the keyword list to augment your search. Keyword Highlighting 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Unable to load your collection due to an error, Unable to load your delegates due to an error. The .gov means its official. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 1994;25:2123. An official website of the United States government. Epub 2013 Nov 12. This website also contains material copyrighted by 3rd parties. 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. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. [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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Range of motion returns much sooner, too. 23. Your thumb will be immobilized in a splint and should not be moved until follow up. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 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. Arnold DM, Cooney WP, Wood MB. Data range was reported as minimum to maximum absolute values. 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. 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. Causes. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. The https:// ensures that you are connecting to the Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 2. Hand Clin. 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 . Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. 22. Only prospective studies can determine this injury course. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Am J Sports Med. Surgical management of chronic, 42. The LUCL is located on the lateral or outside part of the elbow. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Kaplan EB. Upper extremity injuries in snow skiers. 1987;214:113120. There were no cases of intraoperative ulnar nerve injury reported. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Fusetti C, Papaloizos M, Meyer H, et al.. An official website of the United States government. **Stener lesion status reported in 6 studies (145 thumbs). and twist using your thumb. Please enable scripts and reload this page. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Benson LS, Bailie DS. 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. Thumb from the common mechanism of falling on the thumb while holding a ski pole. The injury involves the ulnar collateral ligament (UCL) of the thumb. 2013Lippincott Williams & Wilkins. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 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. 7. If the force is too strong, the ligaments can tear. Moher D, Liberati A, Tetzlaff J, et al.. Part I: anatomy and diagnosis. Unilateral injuries: 291 and bilateral injury: 1. 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. This article provides a review of . Conclusions: Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). An anatomic basis for treatment. 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. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. To date, no literat. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Main results: 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. Stretching or even a rupture of the graft is also possible. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Thus, the true natural history is yet unknown. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. MCP collateral ligament sprain is most commonly an acute injury related to trauma. and transmitted securely. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 1996;25:474477. Epub 2019 Mar 21. Would you like email updates of new search results?