Complications after this procedure may include nerve or blood vessel damage. Mean study follow-up was 42.8 months. MCP fusion was performed . Van Dommelen BA, Zvirbulis RA. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Your thumb will be immobilized in a splint and should not be moved until follow up. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 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 Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Pichora DR, McMurtry RY, Bell MJ. Thumb dominance reported in 8 studies (168 thumbs). Skier's thumb - Physiopedia Part I of this two-part article focuses on common tendon and . Am J Orthop (Belle Mead NJ). Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Kuz JE, Husband JB, Tokar N, et al.. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. *Glickel grading system. Mean study follow-up was 42.8 months. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Evaluation and management of elbow injuries in the adolescent overhead athlete. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Melone CP Jr, Beldner S, Basuk RS. An official website of the United States government. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 2018;6(4):1-7. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Ulnar Collateral Ligament Injuries of the Thumb - Panther Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Hand Clin. Thus, the true natural history is yet unknown. J Hand Surg Am. The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Meta-analysis of the pooled data was completed. 1989;14:567573. The Effect of Ulnar Collateral Ligament Repair With Internal Brace Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. Methods: Am J Sports Med. After failure of nonoperative treatment, at anywhere from 6 months 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. Orthop Clin North Am. HHS Vulnerability Disclosure, Help Your surgeon will discuss these options with you. SYMPTOMS: The thumb may be swollen, bruised and painful. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Treatment of chronic injuries of the. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. He too had the internal brace augmentation. Federal government websites often end in .gov or .mil. If the tear is diagnosed later a ligament reconstruction might be a better option. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Would you like email updates of new search results? Both repair and reconstruction (autograft and allograft) techniques were inclusive. Injury. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. A score of 0 was assigned if the item was either omitted or not performed. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. eCollection 2022 May. Am J Sports Med. If your bone is broken, a pin will be used to put it in place. 8. 23. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Epub 2019 Mar 21. 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. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Purpose: MCP collateral ligament sprain is most commonly an acute injury related to trauma. PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery Keywords: Causes. 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. Please try after some time. 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. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. 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. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) 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. The https:// ensures that you are connecting to the Sakellarides HT, DeWeese JW. 44. 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. UCL Repair of the Thumb - MSA Hand Center J Bone Joint Surg Am. NR, not reported. 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. Epub 2013 Nov 12. 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. 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%). It runs from the outer humerus, around the radial head and attaches to the ulna. [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. may email you for journal alerts and information, but is committed Data is temporarily unavailable. 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. 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. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.17,34 Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. The limitations of this systematic review are reliant on the studies analyzed. Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Please enable scripts and reload this page. Nonoperative treatment often failed, necessitating surgery. No study reported the outcomes of nonoperative management of chronic UCL injury. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 4. PIP Joint Injuries of the Finger - Orthogate [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. Early and late postoperative complications were recorded. When assessed, most patients returned to their preinjury employment. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Bethesda, MD 20894, Web Policies Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 37. Thumb Ulnar Collateral Ligament repair; A Step by Step Guide J Bone Joint Surg Am. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. 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. Ulnar Collateral Ligament Repair . Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. The authors report no funding or conflicts of interest. 24. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). If it is appropriate, then surgical consent probably happened before the surgery. 38. 32. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery 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. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Midterm clinical outcomes of collateral ligament repair of the thumb 16. UCL injuries: Defining risk and improving treatment - Mayo Clinic MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). 2005;87:26322638. Thumb collateral ligament injuries. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Thirty-two thumbs were treated nonoperatively and 261 operatively. the splint for protection or at night until twelve weeks after the operation. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Mean subject age was 33.9 years. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Both purely ligamentous and bony avulsion injuries were included. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape A common complication following fracture of the distal radius is when the radius shortens. 6. 33. No study directly compared nonoperative to operative treatment. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Gamekeepers thumb: a prospective study of functional bracing.