Gamekeepers thumb: a prospective study of functional bracing. 2021 Apr 15;3(2):e527-e533. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. A secondary purpose was to compare graft choice and surgical technique for reconstruction. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 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. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . They may even tear completely. There are some cases where the fusion is not successful and you will still have pain in . This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . and transmitted securely. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. There were 200 acute injuries and 93 chronic injuries. [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. All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. 1994;23:797804. Midterm clinical outcomes of collateral ligament repair of the thumb However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Subject demographics are reported in Table 2. 35. SAGE Open Med. Nonoperative treatment often failed, necessitating surgery. 45. There is currently no consensus on treatment of acute or chronic UCL injuries. Meta-analysis of the pooled data was completed. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. Sports Health. 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. Catalano LW III, Cardon L, Patenaude N, et al.. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Kozin SH, Bishop AT. 1989;14:567573. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. 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 . Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Your surgeon is the person best able to help you avoid any serious recovery problems. You may search for similar articles that contain these same keywords or you may Nonoperative treatment often failed, necessitating surgery. 1999;24:275282. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 3. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 33. Injury. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. J Bone Joint Surg Am. 1998;23:503506. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The overall complication rate was 13.8% (11/80). It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Table 1. Am J Orthop (Belle Mead NJ). 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Surgical techniques and a review of 70 patients. 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. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb There were 61 studies eliminated as secondary for being in a language other than English. 24. Conflicts of interest The authors report no funding or conflicts of interest. Orthop J Sports Med. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Orthop Clin North Am. No study compared different graft types or fixation techniques. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . You are being redirected to Medscape Education. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Unilateral injuries: 291 and bilateral injury: 1. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 1996;25:474477. If the latter was executed only partially, a score of 1 was assigned. History. 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). Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). Search for Similar Articles 2. 13. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. AAHS - Comparison of Complications after Thumb Metacarpophalangeal Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. The diagnosis is best established clinically, though MRI is the imaging modality of choice. the splint for protection or at night until twelve weeks after the operation. 26. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Unauthorized use of these marks is strictly prohibited. Diagnosis of displaced, 43. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. If your bone is broken, a pin will be used to put it in place. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). The range of motion of the MP joint of the thumb following operative repair of the. 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. 14. Bookshelf For more information, please refer to our Privacy Policy. 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 sprained thumb is a common injury among athletes. This leads to what is know as a positive ulnar variance. Only prospective studies can determine this injury course. J Hand Surg Glob Online. All authors independently performed the search. 1999;24:7075. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. Post-traumatic instability of the metacarpophalangeal joint of the thumb. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. These tears often occur as a result of a radially directed force on an extended thumb. Kaplan EB. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. PMC 16. J Bone Joint Surg Am. There is currently no consensus on treatment of acute or chronic UCL injuries. The .gov means its official. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Patient Demographics of Thumb RCL and UCL Injuries. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 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*. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. Thumb from the common mechanism of falling on the thumb while holding a ski pole. A systematic review of ulnar collateral ligament reconstruction techniques. PIP Joint Injuries of the Finger - Orthogate 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. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent Bethesda, MD 20894, Web Policies three muscles provide deforming forces at the base of the thumb. Metacarpophalangeal joint injuries of the thumb. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute The authors report no funding or conflicts of interest. Commonly Missed Orthopedic Problems | AAFP Part II: treatment and complications. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Gamekeeper's thumb. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 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. [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. 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.