Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. #Injury location reported only in 3 studies. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. 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. The range of motion of the MP joint of the thumb following operative repair of the. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 15. 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. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. 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. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Muscles. government site. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. 2006;31:6875. 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. Exercises: Gradually progress to competitive throwing and sports . 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 8. The torn thumb ligament is repaired or reconstructed during surgery. Meta-analysis of the pooled data was completed. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. This damage may lead to temporary or permanent numbness or weakness. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. The anti edema management will continue for several weeks. 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. 2022 Mar 1;30(1):e1-e8. 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. There were 200 acute injuries and 93 chronic injuries. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. A score of 2 was assigned if the item was completely and accurately performed and reported. Your thumb will be immobilized in a splint and should not be moved until follow up. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Nonoperative treatment often failed, necessitating surgery. Kaplan EB. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. It runs from the outer humerus, around the radial head and attaches to the ulna. Catalano LW III, Cardon L, Patenaude N, et al.. Clin Orthop Relat Res. 2009;34:304308. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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). If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Bostock S, Morris MA. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 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. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Careers. 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. 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. 27. An anatomic basis for treatment. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Purpose. better/same/worse than preoperative status). Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. The .gov means its official. 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. 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%). No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 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.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.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. Am J Sports Med. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Ulnar Collateral Ligament Repair . [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]. Jackson M, McQueen MM. 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%). 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. 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. Early diagnosis and treatment. 1976;58:106112. 2009;61:623632. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. The limitations of this systematic review are reliant on the studies analyzed. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Arthritis Rheum. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. J Bone Joint Surg Am. There is currently no consensus on treatment of acute or chronic UCL injuries. Moher D, Liberati A, Tetzlaff J, et al.. Fourteen articles were included and analyzed (293 thumbs). This ligament prevents the thumb from pointing too far away from the hand. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 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. Table 1. Acute gamekeeper's thumb. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Search for Similar Articles 1989;14:567573. The .gov means its official. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). 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). J Hand Surg Am. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 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 . No study reported the outcomes of nonoperative management of chronic UCL injury. [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. 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. **Stener lesion status reported in 6 studies (145 thumbs). Louis DS, Huebner JJ Jr, Hankin FM. Search performed on November 17, 2011. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Complications after this procedure may include nerve or blood vessel damage. Instability of the metacarpophalangeal joint of the thumb. The grip strength and the pinch strength were 94.3% and 92.27%,. Eurasian J Med. If the latter was executed only partially, a score of 1 was assigned. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Metacarpophalangeal joint injuries of the thumb. Epub 2019 Mar 21. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 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. 1987;214:113120. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Only prospective studies can determine this injury course. 2005;87:26322638. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Some error has occurred while processing your request. Meta-analysis of the pooled data was completed. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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%. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. and twist using your thumb. FOIA eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. [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. Surgical techniques and a review of 70 patients. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Am J Orthop (Belle Mead NJ). Posner MA, Retaillaud JL. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Please try after some time. Mean study follow-up was 42.8 months. HHS Vulnerability Disclosure, Help 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. Click the topic below to receive emails when new articles are available. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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. Study design: The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 1962;124:396411. 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. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. may email you for journal alerts and information, but is committed Injuries to the PIP joint remain swollen for long periods of time. Part I of this two-part article focuses on common tendon and . Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Complications after surgical treatment of UCL injury are rare. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Melone CP Jr, Beldner S, Basuk RS. Please try again soon. to maintaining your privacy and will not share your personal information without A score of 0 was assigned if the item was either omitted or not performed. 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. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. official website and that any information you provide is encrypted Abstract. Thus, the true natural history is yet unknown. Educate the patient on anti edema management. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant.
complications after ucl repair of thumb