complications after ucl repair of thumb

27. These exercises may be directed by a physical or occupational therapist. Thirty-two thumbs were treated nonoperatively and 261 operatively. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Quantitative outcome of surgical repair. PLoS Med. J Hand Surg Am. Kaplan EB. The anti edema management will continue for several weeks. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. J Bone Joint Surg Am. Study design: The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. J Hand Surg Am. Thumb dominance reported in 8 studies (168 thumbs). 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. 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. Federal government websites often end in .gov or .mil. What Happens If We Sit for More Than 8 Hours Per Day? MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 1. A common complication following fracture of the distal radius is when the radius shortens. Results: 34. 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. the thumb. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. PMC A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. The .gov means its official. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. If the force is too strong, the ligaments can tear. doi: 10.1097/JSA.0000000000000322. 8. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2018;6(4):1-7. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Please enable scripts and reload this page. 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. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 1995;23:222226. 31. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 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 limitations of this systematic review are reliant on the studies analyzed. 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. Epub 2014 Dec 30. Only prospective studies can determine this injury course. The https:// ensures that you are connecting to the 2009;61:623632. 8600 Rockville Pike 12. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Part I: anatomy and diagnosis. Your message has been successfully sent to your colleague. Hand Clin. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Unable to load your collection due to an error, Unable to load your delegates due to an error. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Part II: treatment and complications. 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. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Epub 2016 Jan 13. Proximal interphalangeal joint injuries of the hand. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Purpose. unstable when the thumb is used. There were 200 acute injuries and 93 chronic injuries. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 36. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Fusetti C, Papaloizos M, Meyer H, et al.. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Continuous variable data were reported as mean SDs from the mean. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Mean subject age was 33.9 years. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. Fourteen articles were included and analyzed (293 thumbs). A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. You may also begin strengthening exercises if needed. *Gender reported in 12 studies (218 subjects). 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Non-Fusion. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Symptoms are dependent on the cause and severity of injury to the UCL. Acute gamekeeper's thumb. No study reported the outcomes of nonoperative management of chronic UCL injury. and transmitted securely. If the latter was executed only partially, a score of 1 was assigned. MCP collateral ligament sprain is most commonly an acute injury related to trauma. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 1998;23:503506. MeSH Main results: The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Evaluation and management of elbow injuries in the adolescent overhead athlete. 1961;43-A:541546. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Acta Chir Scand. Careers. 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. 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. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. HHS Vulnerability Disclosure, Help National Library of Medicine The mean patient age was 37.8 years (14.0-78.1). A score of 0 was assigned if the item was either omitted or not performed. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Mean study follow-up was 42.8 months. Surgical techniques and a review of 70 patients. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Clinical Journal of Sport Medicine23(4):247-254, July 2013. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Stener B. Skeletal injuries associated with rupture of the. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Eurasian J Med. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. sharing sensitive information, make sure youre on a federal [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. 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. An official website of the United States government. No study compared different graft types or fixation techniques. You will receive email when new content is published. 15. Stretching or even a rupture of the graft is also possible. PMC Am J Sports Med. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Dr. Holt will talk to you about when it is safe to return to work. You've successfully added to your alerts. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. 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. 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. Wong TC, Ip FK, Wu WC. There were 200 acute injuries and 93 chronic injuries. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Sixty nine (86.3%) patients had grade 3 tears. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Both purely ligamentous and bony avulsion injuries were included. Am J Orthop (Belle Mead NJ). 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. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. government site. Thus, the true natural history is yet unknown. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. 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. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. FOIA Would you like email updates of new search results? I was able to work while wearing the splint. 2006;31:6875. [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. Pichora DR, McMurtry RY, Bell MJ. Methods: When assessed, most patients returned to their preinjury employment. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). 1992;8:713732. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 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. Your surgeon is the person best able to help you avoid any serious recovery problems. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Arthrosc Sports Med Rehabil. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Part I of this two-part article focuses on common tendon and . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Downey DJ, Moneim MS, Omer GE Jr. Conflicts of interest The authors report no funding or conflicts of interest. Van Dommelen BA, Zvirbulis RA. 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.. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. An anatomic basis for treatment. Throwing status reported in 4 studies. 2013Lippincott Williams & Wilkins. A sprained thumb is a common injury among athletes. **Stener lesion status reported in 6 studies (145 thumbs). If your bone is broken, a pin will be used to put it in place. [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. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 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%). 39. J Bone Joint Surg Am. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 25. 2022 Mar 1;30(1):e1-e8. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 1,5,9,10 In acute cases of complete tears involving high-level . the splint for protection or at night until twelve weeks after the operation. 33. Thirty-two thumbs were treated nonoperatively and 261 operatively. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Search performed on November 17, 2011. Jackson M, McQueen MM. Mean study follow-up was 42.8 months. Only prospective studies can determine this injury course. Highlight selected keywords in the article text. eCollection 2021. Nonoperative treatment often failed, necessitating surgery. The injury involves the ulnar collateral ligament (UCL) of the thumb. Injuries to the PIP joint remain swollen for long periods of time. Causes. Metacarpophalangeal joint injuries of the thumb. 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%). Complications after surgery were rare. 44. 8600 Rockville Pike 1989;71:383387. Upper extremity injuries in snow skiers. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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. Injury. This damage may lead to temporary or permanent numbness or weakness. Categorical variable data were reported as frequency with percentages. Keywords: National Library of Medicine Bethesda, MD 20894, Web Policies 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. Treatment of chronic injuries of the. sharing sensitive information, make sure youre on a federal 2005;87:26322638. J Hand Surg Glob Online. Am J Sports Med. may email you for journal alerts and information, but is committed The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). The limitations of this systematic review are reliant on the studies analyzed.