Clinical Journal of Sport Medicine23(4):247-254, July 2013. government site. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The range of motion of the MP joint of the thumb following operative repair of the. Jackson M, McQueen MM. Thirty-two thumbs were treated nonoperatively and 261 operatively. *Glickel grading system. Thirty-two thumbs were treated nonoperatively and 261 operatively. Possible complications include: - Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. All but 2 were level IV evidence. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Muscles. Bookshelf 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%). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Please try after some time. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. 1989;71:383387. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Arthrosc Sports Med Rehabil. 7. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. If it is appropriate, then surgical consent probably happened before the surgery. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. UCLR case series that contained complications data were included. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. 1976;58:106112. 4. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. He too had the internal brace augmentation. A common complication following fracture of the distal radius is when the radius shortens. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. A secondary purpose was to compare graft choice and surgical technique for reconstruction. National Library of Medicine One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. abduction-adduction motion. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 1992;8:713732. and twist using your thumb. Mean subject age was 33.9 years. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. An anatomic basis for treatment. Hand Surg. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Clin Orthop Relat Res. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Data sources: Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Click the topic below to receive emails when new articles are available. Wolters Kluwer Health
Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 2022 Mar 1;30(1):e1-e8. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 2005;24:217221. Please enable it to take advantage of the complete set of features! Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 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. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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. 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. 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. Bean CH, Tencer AF, Trumble TE. Your surgeon is the person best able to help you avoid any serious recovery problems. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Complications after this procedure may include nerve or blood vessel damage. 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. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. 2003;8:8185. This website also contains material copyrighted by 3rd parties. 2009;6:e1000097. **Stener lesion status reported in 6 studies (145 thumbs). Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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%. The .gov means its official. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. HHS Vulnerability Disclosure, Help 1994;23:797804. The grip strength and the pinch strength were 94.3% and 92.27%,. Unauthorized use of these marks is strictly prohibited. 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. Please enable it to take advantage of the complete set of features! Meta-analysis of the pooled data was completed. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 1995;18:11611165. 26. Complications after surgical treatment of UCL injury are rare. Dr. Holt will talk to you about when it is safe to return to work. [38] Chuter et al[40] 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. 20. Meta-analysis of the pooled data was completed. For more information, please refer to our Privacy Policy. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Background: All but 2 were level IV evidence. In some cases, certain risk factors make it more likely that a bone will fail to heal. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. Orthop Clin North Am. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. To date, no literat. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Your ligament may need to be reattached to the bone using a bone anchor. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Sports Health. 2021 Apr 15;3(2):e527-e533. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Injury. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. 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. 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. The mean patient age was 37.8 years (14.0-78.1). 2005;87:26322638. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. 1994;25:2123. What are the symptoms of GameKeeper's Thumb? doi: 10.1016/j.asmr.2020.12.004. Bennet Fracture. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Please confirm that you would like to log out of Medscape. 22. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Ulnar Collateral Ligament Repair . gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Accessibility 1962;124:396411. Nonoperative treatment often failed, necessitating surgery. If the force is too strong, the ligaments can tear. I was able to work while wearing the splint. J Bone Joint Surg Am. 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. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 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. [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. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. the splint for protection or at night until twelve weeks after the operation. [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. eCollection 2021 Apr. Please enter a Recipient Address and/or check the Send me a copy checkbox. Categorical variable data were reported as frequency with percentages. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). If the tear is diagnosed early a repair will be possible. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 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. Throwing status reported in 4 studies. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. You've successfully added to your alerts. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Descriptive statistics were calculated. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. 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. Unauthorized use of these marks is strictly prohibited. Educate the patient on anti edema management. Melone CP Jr, Beldner S, Basuk RS. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 38. 1996;25:474477. Eventually this abnormal movement will wear out the joint and it will become arthritic. Sports Med Arthrosc Rev. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Mean study follow-up was 42.8 months. Sakellarides HT, DeWeese JW. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 2013;23(4):247-254. may email you for journal alerts and information, but is committed
Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Injuries to the PIP joint remain swollen for long periods of time. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. The https:// ensures that you are connecting to the J Hand Surg Glob Online. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups.
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