Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. sharing sensitive information, make sure youre on a federal The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Subject demographics are reported in Table 2. 8600 Rockville Pike Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Non-Fusion. FOIA Bookshelf Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 4. [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. Fourteen articles were included and analyzed (293 thumbs). No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 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. Please try again soon. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 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. [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. Smith RJ. Wolters Kluwer Health, Inc. and/or its subsidiaries. Conflicts of interest The authors report no funding or conflicts of interest. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Hand Surg. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Wong TC, Ip FK, Wu WC. Muscles. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. 45. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Metacarpophalangeal joint injuries of the thumb. 2013Lippincott Williams & Wilkins. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Thumb dominance reported in 8 studies (168 thumbs). J Hand Surg Glob Online. 21. All rights reserved. Unilateral injuries: 291 and bilateral injury: 1. Early diagnosis and treatment. 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. The https:// ensures that you are connecting to the However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. 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. 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. In these cases, a new graft may be used to perform a second reconstruction. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 23. 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). 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. All authors independently performed the search. Melone CP Jr, Beldner S, Basuk RS. 37. Epub 2014 Oct 22. 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. 22. Results: What are the symptoms of GameKeeper's Thumb? Am J Sports Med. Ulnar Collateral Ligament Repair . 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. Chir Main. 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. Keywords: There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Moher D, Liberati A, Tetzlaff J, et al.. 1998;23:503506. The site is secure. Am J Sports Med. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Thus, the true natural history is yet unknown. The doctor won't know if the repair is . Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). government site. Am J Orthop (Belle Mead NJ). Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Objectives: Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 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. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. your express consent. 17. Arnold DM, Cooney WP, Wood MB. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Disclaimer. Sixty nine (86.3%) patients had grade 3 tears. The authors report no funding or conflicts of interest. *Glickel grading scale. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. No study reported the outcomes of nonoperative management of chronic UCL injury. Am J Sports Med. 2009;61:623632. Surgical management of chronic, 42. 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. Surgical techniques and a review of 70 patients. 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. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. You may also begin strengthening exercises if needed. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). It runs from the outer humerus, around the radial head and attaches to the ulna. 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. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. 31. These exercises may be directed by a physical or occupational therapist. 14 It is important to diagnose complete tears early because . 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. 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. Long-term results of ligament reconstruction. An official website of the United States government. Epub 2021 Jan 18. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 7. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Hand Clin. [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. 1962;124:396411. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 10. Only prospective studies can determine this injury course. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Treatment of chronic injuries of the. 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. All but 2 were level IV evidence. Bean CH, Tencer AF, Trumble TE. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Jupiter JB, Sheppard JE. 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. Study design: The range of motion of the MP joint of the thumb following operative repair of the. 6. Continuous variable data were reported as mean SDs from the mean. Continue to stretch before and after throwing . 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). Thirty-two thumbs were treated nonoperatively and 261 operatively. 2005;87:26322638. POST-OPERATIVE WEEKS 22-24. Background: PLoS Med. The .gov means its official. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. I was able to work while wearing the splint. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 32. Fourteen articles were included and analyzed (293 thumbs). Am J Sports Med. Quantitative outcome of surgical repair. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. The overall complication rate was 13.8% (11/80). If the tear is diagnosed early a repair will be possible. A score of 2 was assigned if the item was completely and accurately performed and reported. Louis DS, Huebner JJ Jr, Hankin FM. Would you like email updates of new search results? UCLR case series that contained complications data were included. Jackson M, McQueen MM. Educate the patient on anti edema management. Table 1. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. You are being redirected to Medscape Education. 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. Conclusion: Descriptive statistics were calculated. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 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). Furthermore, there was no donor site morbidity from autograft harvest sites across all 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. This ligament prevents the thumb from pointing too far away from the hand. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 1961;43-A:541546. Benson LS, Bailie DS. Unable to load your collection due to an error, Unable to load your delegates due to an error. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. After failure of nonoperative treatment, at anywhere from 6 months 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. Injury. 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 3. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Please enable scripts and reload this page. 13. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 2009;6:e1000097. Arthritis Rheum. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 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. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. The limitations of this systematic review are reliant on the studies analyzed. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 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. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. government site. The anti edema management will continue for several weeks. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. 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. Am J Sports Med. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Sports Health. There were 61 studies eliminated as secondary for being in a language other than English. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Epub 2016 Jan 13. 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. SAGE Open Med. Fusetti C, Papaloizos M, Meyer H, et al.. Epub 2015 Sep 22. Data sources: Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Methods: Meta-analysis of the pooled data was completed. Epub 2019 Mar 21. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Downey DJ, Moneim MS, Omer GE Jr. official website and that any information you provide is encrypted SYMPTOMS: The thumb may be swollen, bruised and painful. 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 . Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Van Dommelen BA, Zvirbulis RA. In some cases, certain risk factors make it more likely that a bone will fail to heal. Highlight selected keywords in the article text. 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. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Frykman G, Johansson O. Surgical repair of rupture of the, 46. If the tear is diagnosed later a ligament reconstruction might be a better option. When assessed, most patients returned to their preinjury employment. No study compared different graft types or fixation techniques. to maintaining your privacy and will not share your personal information without Orthop Rev. 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. 26. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). The effect of thumb metacarpophalangeal. The https:// ensures that you are connecting to the 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. three muscles provide deforming forces at the base of the thumb. Bailie DS, Benson LS, Marymont JV. Infection is a rare complication of hand surgery. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. J Hand Surg Am. 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. 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. 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. The .gov means its official. 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