complications after ucl repair of 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. 10. Most times, they won't know until they're in the surgery if the internal brace is appropriate. eCollection 2021 Apr. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used. Clipboard, Search History, and several other advanced features are temporarily unavailable. 26. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Wolters Kluwer Health It runs from the outer humerus, around the radial head and attaches to the ulna. Louis DS, Huebner JJ Jr, Hankin FM. Please enable scripts and reload this page. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 1992;8:713732. The Orthopedic Journal of Sports Medicine. 2009;34:304308. When assessed, most patients returned to their preinjury employment. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 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. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. The authors report no funding or conflicts of interest. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. 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. Mean study follow-up was 42.8 months. A score of 2 was assigned if the item was completely and accurately performed and reported. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. The anti edema management will continue for several weeks. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 1962;124:396411. All authors independently performed the search. A systematic review of ulnar collateral ligament reconstruction techniques. Some error has occurred while processing your request. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 1. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. These tears often occur as a result of a radially directed force on an extended thumb. 2021 Apr 15;3(2):e527-e533. Please try again soon. 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). 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. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Bostock S, Morris MA. 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). abduction-adduction motion. Causes. 39. Hand Clin. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Unilateral injuries: 291 and bilateral injury: 1. 3. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. The site is secure. 1994;25:2123. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 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. Part I of this two-part article focuses on common tendon and . Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 2006;31:6875. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 1961;43-A:541546. 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. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Unable to load your collection due to an error, Unable to load your delegates due to an error. and transmitted securely. Your ligament may need to be reattached to the bone using a bone anchor. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. PMC No study compared different graft types or fixation techniques. 1,5,9,10 In acute cases of complete tears involving high-level . Sports Med Arthrosc Rev. Only prospective studies can determine this injury course. 2009;6:e1000097. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Am J Sports Med. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Conflicts of interest The authors report no funding or conflicts of interest. 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). Please enable it to take advantage of the complete set of features! The injury happens when you fall . 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. J Hand Surg Am. Arthritis Rheum. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. J Hand Surg 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. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Wong TC, Ip FK, Wu WC. Data range was reported as minimum to maximum absolute values. Upper extremity injuries in snow skiers. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. HHS Vulnerability Disclosure, Help The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Mean subject age was 33.9 years. There is currently no consensus on treatment of acute or chronic UCL injuries. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Surgical management of chronic, 42. eCollection 2021. 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. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 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. MeSH J Bone Joint Surg Am. Eurasian J Med. SAGE Open Med. 21. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Am J Orthop (Belle Mead NJ). 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. 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). 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. MCP fusion was performed . A sprained thumb is a common injury among athletes. Am J Sports Med. Engelhardt JB, Christensen OM, Christiansen TG. PMC eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. [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. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 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%). J Hand Surg Am. Careers. 8. The mean time from reported injury date to surgery was 202.4 days (2-5969). Tension wire fixation of avulsion fractures in the hand. Jackson M, McQueen MM. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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. Symptoms are dependent on the cause and severity of injury to the UCL. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. PLoS Med. The site is secure. 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. Bennet Fracture. Meta-analysis of the pooled data was completed. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Before This site needs JavaScript to work properly. Bookshelf The range of motion of the MP joint of the thumb following operative repair of the. Clin Orthop Relat Res. *Gender reported in 12 studies (218 subjects). In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 1999;24:275282. Jupiter JB, Sheppard JE. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 12. and transmitted securely. Please try after some time. and twist using your thumb. 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. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Unauthorized use of these marks is strictly prohibited. There is currently no consensus on treatment of acute or chronic UCL injuries. sharing sensitive information, make sure youre on a federal Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Diagnosis of displaced, 43. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. official website and that any information you provide is encrypted 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 . 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*. Moher D, Liberati A, Tetzlaff J, et al.. 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%). Evaluation and management of elbow injuries in the adolescent overhead athlete. 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. Epub 2013 Nov 12. 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.. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. If the latter was executed only partially, a score of 1 was assigned. 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. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Infection is a rare complication of hand surgery. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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%.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. What Happens If We Sit for More Than 8 Hours Per Day? 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. 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. Continue to stretch before and after throwing . Complications after this procedure may include nerve or blood vessel damage. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.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.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.