Before Am J Sports Med. Accessibility Injuries to the PIP joint remain swollen for long periods of time. If the tear is diagnosed later a ligament reconstruction might be a better option. 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). This website also contains material copyrighted by 3rd parties. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 20. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Orthopedics. 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 . The overall complication rate after primary thumb RCL and UCL repair was 13.8%. The https:// ensures that you are connecting to the Non-Fusion. J Hand Surg Am. Sports Med Arthrosc Rev. 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. Studies that duplicated patient populations from the same authors were excluded. the splint for protection or at night until twelve weeks after the operation. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Hand Clin. 36. Results: 2009;34:304308. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 44. Thus, the true natural history is yet unknown. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 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. Wolters Kluwer Health
Orthop Clin North Am. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 2000;16:345357. and transmitted securely. Would you like email updates of new search results? 2018;6(4):1-7. MCP collateral ligament sprain is most commonly an acute injury related to trauma. What are the symptoms of GameKeeper's Thumb? 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. 6. HHS Vulnerability Disclosure, Help After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. 21. The injury involves the ulnar collateral ligament (UCL) of the thumb. HHS Vulnerability Disclosure, Help Epub 2020 Jun 29. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Moher D, Liberati A, Tetzlaff J, et al.. Bookshelf Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 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. He too had the internal brace augmentation. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. You may search for similar articles that contain these same keywords or you may
2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Am J Orthop (Belle Mead NJ). The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. National Library of Medicine [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 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. There were 61 studies eliminated as secondary for being in a language other than English. A score of 0 was assigned if the item was either omitted or not performed. [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. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. MCP fusion was performed . flexion-extension motion. 2005;87:26322638. 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. There were 200 acute injuries and 93 chronic injuries. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 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. 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Only prospective studies can determine this injury course. 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. Categorical variable data were reported as frequency with percentages. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 1998;23:503506. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. *Glickel grading scale. These exercises may be directed by a physical or occupational therapist. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Subject demographics are reported in Table 2. If the force is too strong, the ligaments can tear. Nonoperative treatment often failed, necessitating surgery. Instability of the metacarpophalangeal joint of the thumb. Doi: 10.1177/2325967118769328. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Stretching or even a rupture of the graft is also possible. 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*. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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 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. The injury happens when you fall . 2006;31:6875. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. Eurasian J Med. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Clin J Sport Med. sharing sensitive information, make sure youre on a federal The authors report no funding or conflicts of interest. Educate the patient on anti edema management. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Your thumb will be immobilized in a splint and should not be moved until follow up. Highlight selected keywords in the article text. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away.
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