complications after ucl repair of thumb

The grip strength and the pinch strength were 94.3% and 92.27%,. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Please confirm that you would like to log out of Medscape. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Clipboard, Search History, and several other advanced features are temporarily unavailable. The torn thumb ligament is repaired or reconstructed during surgery. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Ulnar Collateral Ligament Repair . Post-traumatic instability of the metacarpophalangeal joint of the thumb. No study reported the outcomes of nonoperative management of chronic UCL injury. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. 15. [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. 8. [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]. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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 . 2005;87:26322638. Kaplan EB. No study directly compared nonoperative to operative treatment. 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. Accessibility MeSH Orthop Rev. A sprained thumb is a common injury among athletes. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Bean CH, Tencer AF, Trumble TE. Clipboard, Search History, and several other advanced features are temporarily unavailable. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Continuous variable data were reported as mean SDs from the mean. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) J Hand Surg Am. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. [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. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 7. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. They may even tear completely. 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. 2009;61:623632. The https:// ensures that you are connecting to the Wolters Kluwer Health, Inc. and/or its subsidiaries. Injuries to the PIP joint remain swollen for long periods of time. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". FOIA Mean subject age was 33.9 years. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. *Glickel grading scale. 37. J Bone Joint Surg Am. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Fusetti C, Papaloizos M, Meyer H, et al.. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Your thumb will be immobilized in a splint and should not be moved until follow up. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Arthrosc Sports Med Rehabil. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Federal government websites often end in .gov or .mil. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Patient Demographics of Thumb RCL and UCL Injuries. 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. eCollection 2021. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Careers. 22. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. The overall complication rate was 13.8% (11/80). Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. This article provides a review of . This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Catalano LW III, Cardon L, Patenaude N, et al.. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. You may search for similar articles that contain these same keywords or you may three muscles provide deforming forces at the base of the thumb. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Weakened grip or reduced thumb range of motion may occur. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. There are some cases where the fusion is not successful and you will still have pain in . Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Injury. In these cases, a new graft may be used to perform a second reconstruction. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. 5. 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%. If the latter was executed only partially, a score of 1 was assigned. Systematic review and meta-analysis. What Happens If We Sit for More Than 8 Hours Per Day? There were 61 studies eliminated as secondary for being in a language other than English. 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 . 2018;6(4):1-7. Pain reduction was significantly improved in all subjects (P < 0.05). 1993;21:800804. A score of 2 was assigned if the item was completely and accurately performed and reported. Fourteen articles were included and analyzed (293 thumbs). Louis DS, Huebner JJ Jr, Hankin FM. 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. 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. 21. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. A p-value of 0.05 was considered statistically significant. The authors report no funding or conflicts of interest. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 32. Conclusion: Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 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. Gamekeeper's thumb. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. If the tear is diagnosed early a repair will be possible. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 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. Thus, the true natural history is yet unknown. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 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. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Bennet Fracture. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. All techniques improved clinical outcomes, including pain, motion, strength, and stability. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Complications after surgery were rare. abduction-adduction motion. Wolters Kluwer Health Rupture of the. Please try again soon. Complications after surgery were rare. Eurasian J Med. An official website of the United States government. There were 200 acute injuries and 93 chronic injuries. What are the symptoms of GameKeeper's Thumb? If the force is too strong, the ligaments can tear. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 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. Both purely ligamentous and bony avulsion injuries were included. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Kozin SH, Bishop AT. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. [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. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. Categorical variable data were reported as frequency with percentages. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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. Van Dommelen BA, Zvirbulis RA. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation 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%). Sports Health. 12. Abrahamsson SO, Sollerman C, Lundborg G, et al.. 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. sharing sensitive information, make sure youre on a federal Bookshelf Epub 2021 Jan 18. Both repair and reconstruction (autograft and allograft) techniques were inclusive. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. better/same/worse than preoperative status). It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. PMC Throwing status reported in 4 studies. A common complication following fracture of the distal radius is when the radius shortens. Pichora DR, McMurtry RY, Bell MJ. 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. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 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). In these patients, after failure of nonoperative treatment at anywhere from 1 month to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Please enter a Recipient Address and/or check the Send me a copy checkbox. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. The https:// ensures that you are connecting to the 31. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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. Please enable scripts and reload this page. Some error has occurred while processing your request. Highlight selected keywords in the article text. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Unauthorized use of these marks is strictly prohibited. There is currently no consensus on treatment of acute or chronic UCL injuries. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. J Bone Joint Surg Am. Stretching or even a rupture of the graft is also possible. eCollection 2021 Mar. government site. Sixty nine (86.3%) patients had grade 3 tears. Muscles. An official website of the United States government. Bostock S, Morris MA. 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. sharing sensitive information, make sure youre on a federal Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Moher D, Liberati A, Tetzlaff J, et al.. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. This website also contains material copyrighted by 3rd parties. Treatment of chronic injuries of the. 24. J Bone Joint Surg Am. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Sports Med Arthrosc Rev. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 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 rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 This site needs JavaScript to work properly. Studies that duplicated patient populations from the same authors were excluded. [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. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. 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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Wong TC, Ip FK, Wu WC. Clin Orthop Relat Res. Upper extremity injuries in snow skiers. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb.