2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 1976;58:106112. J Bone Joint Surg Am. 34. [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. Data sources: Early and late postoperative complications were recorded. 1999;24:7075. 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. If the force is too strong, the ligaments can tear. An anatomic basis for treatment. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Eventually this abnormal movement will wear out the joint and it will become arthritic. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. UCL injuries: Defining risk and improving treatment - Mayo Clinic 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. sharing sensitive information, make sure youre on a federal I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. If the tear is diagnosed early a repair will be possible. Proximal interphalangeal joint injuries of the hand. 2006;31:6875. In some cases, certain risk factors make it more likely that a bone will fail to heal. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Thirty-two thumbs were treated nonoperatively and 261 operatively. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Am J Orthop (Belle Mead NJ). What Happens If We Sit for More Than 8 Hours Per Day? 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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . No study reported the outcomes of nonoperative management of chronic UCL injury. Epub 2021 Sep 7. Thus, the true natural history is yet unknown. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube 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. 26. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Treatment for thumb collateral ligament injury - KW orthopaedics Mean study follow-up was 42.8 months. The anti edema management will continue for several weeks. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb the thumb. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. No study directly compared the different types of graft for UCL reconstruction. 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. government site. Am J Sports Med. Keywords: modify the keyword list to augment your search. This article provides a review of . PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Clin Orthop Relat Res. Benson LS, Bailie DS. 17. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Federal government websites often end in .gov or .mil. Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute 45. A broken thumb can also cause numbness or tingling. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Outcomes After Injury to the Thumb Ulnar Collateral Ligament No study compared different graft types or fixation techniques. The https:// ensures that you are connecting to the A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Ulnar Collateral Ligament Repair and Reconstruction The torn thumb ligament is repaired or reconstructed during surgery. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Studies that duplicated patient populations from the same authors were excluded. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. abduction-adduction motion. 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. J Hand Surg Am. 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. Am J Orthop (Belle Mead NJ). Dr. Holt will talk to you about when it is safe to return to work. eCollection 2022 May. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Engelhardt JB, Christensen OM, Christiansen TG. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. Smith RJ. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair 2013Lippincott Williams & Wilkins. Complications after surgery were rare. Federal government websites often end in .gov or .mil. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. Thumb Collateral Ligament Injury - Hand - Orthobullets There are some cases where the fusion is not successful and you will still have pain in . Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Gamekeepers thumb: a prospective study of functional bracing. 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. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 2022 Mar 1;30(1):e1-e8. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. 2005;87:26322638. AAHS - Comparison of Complications after Thumb Metacarpophalangeal Base of Thumb Fractures - Hand - Orthobullets MCP (MetaCarpophalangeal) Collateral Ligament Sprain Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed Catalano LW III, Cardon L, Patenaude N, et al.. Please enable it to take advantage of the complete set of features! Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Acute gamekeeper's thumb. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 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. Please try again soon. Pain reduction was significantly improved in all subjects (P < 0.05). MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com UCL Repair of the Thumb - MSA Hand Center Complications after this procedure may include nerve or blood vessel damage. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. unstable when the thumb is used. 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]). PIP Joint Injuries of the Finger - Orthogate J Hand Surg Am. UCL Surgery- Internal Brace Repair or Reconstruction - Lenny Macrina 1995;18:11611165. FOIA Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Hand Surgery Recovery Time: Pain, Exercise & Complications important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Descriptive statistics were calculated. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. MCP collateral ligament sprain is most commonly an acute injury related to trauma. UCLR case series that contained complications data were included. J Hand Surg Br. No study directly compared nonoperative to operative treatment. Methods: 2013;23(4):247-254. Fourteen articles were included and analyzed (293 thumbs). 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. 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. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. J Hand Surg Glob Online. Epub 2016 Jan 13. Injuries to the PIP joint remain swollen for long periods of time. Chir Main. Pichora DR, McMurtry RY, Bell MJ. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Your ligament may need to be reattached to the bone using a bone anchor. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Bostock S, Morris MA. 1987;214:113120. 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.
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