Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 1995;18:11611165. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 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. Proximal interphalangeal joint injuries of the hand. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clipboard, Search History, and several other advanced features are temporarily unavailable. government site. Clin J Sport Med. What Happens If We Sit for More Than 8 Hours Per Day? In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . 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. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. In these cases, a new graft may be used to perform a second reconstruction. 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. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Categorical variable data were reported as frequency with percentages. to maintaining your privacy and will not share your personal information without Main results: Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 1993;21:800804. 44. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. A score of 0 was assigned if the item was either omitted or not performed. 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. Thumb sidedness reported in 3 studies (51 thumbs). Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. 5. 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. Orthop Clin North Am. 1994;25:2123. The grip strength and the pinch strength were 94.3% and 92.27%,. Diagnosis of displaced, 43. 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. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 2021 Apr 15;3(2):e527-e533. eCollection 2021 Apr. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. FOIA 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.. Studies that duplicated patient populations from the same authors were excluded. Your message has been successfully sent to your colleague. better/same/worse than preoperative status). Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). Quantitative outcome of surgical repair. Click the topic below to receive emails when new articles are available. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Gamekeeper's thumb. This damage may lead to temporary or permanent numbness or weakness. HHS Vulnerability Disclosure, Help 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 1989;14:567573. J Bone Joint Surg Am. This site needs JavaScript to work properly. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Epub 2016 Jan 13. Please try again soon. official website and that any information you provide is encrypted If the latter was executed only partially, a score of 1 was assigned. The doctor won't know if the repair is . Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Proximal interphalangeal joint injuries of the hand. Louis DS, Huebner JJ Jr, Hankin FM. 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. Arthritis Rheum. Am J Sports Med. 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. History. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. If you log out, you will be required to enter your username and password the next time you visit. Acute gamekeeper's thumb. 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. What are the symptoms of GameKeeper's Thumb? #Injury location reported only in 3 studies. For more information, please refer to our Privacy Policy. MeSH Data sources: Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 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. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 12. The anti edema management will continue for several weeks. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. National Library of Medicine If your bone is broken, a pin will be used to put it in place. Epub 2014 Oct 22. Thumb from the common mechanism of falling on the thumb while holding a ski pole. 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. Am J Sports Med. HHS Vulnerability Disclosure, Help Epub 2015 Sep 22. *Gender reported in 12 studies (218 subjects). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. the thumb. 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). 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Kuz JE, Husband JB, Tokar N, et al.. Injury. A score of 0 was assigned if the item was either omitted or not performed. 15. The limitations of this systematic review are reliant on the studies analyzed. 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. Accessibility It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Fourteen articles were included and analyzed (293 thumbs). Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. 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 . Jupiter JB, Sheppard JE. You may be trying to access this site from a secured browser on the server. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 1962;124:396411. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. 2006;31:6875. An anatomic basis for treatment. There is currently no consensus on treatment of acute or chronic UCL injuries. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 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. 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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. [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. 2. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. There were no cases of intraoperative ulnar nerve injury reported. These tears often occur as a result of a radially directed force on an extended thumb. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mean subject age was 33.9 years. The site is secure. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. and transmitted securely. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Throwing status reported in 4 studies. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. 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. 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. There were 61 studies eliminated as secondary for being in a language other than English. 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. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . The mean patient age was 37.8 years (14.0-78.1). This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Pichora DR, McMurtry RY, Bell MJ. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. A score of 2 was assigned if the item was completely and accurately performed and reported. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Accessibility Orthop Rev. 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.
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