complications after ucl repair of thumb

Part II: treatment and complications. J Hand Surg Glob Online. 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. *Glickel grading scale. 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. 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%). 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. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 1961;43-A:541546. Evaluation and management of elbow injuries in the adolescent overhead athlete. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 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. [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. If the latter was executed only partially, a score of 1 was assigned. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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). 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. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). If it is appropriate, then surgical consent probably happened before the surgery. PMC All but 2 were level IV evidence. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. It runs from the outer humerus, around the radial head and attaches to the ulna. 37. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. 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. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Your ligament may need to be reattached to the bone using a bone anchor. A score of 0 was assigned if the item was either omitted or not performed. Would you like email updates of new search results? The LUCL is located on the lateral or outside part of the elbow. Muscles. You may also begin strengthening exercises if needed. Your surgeon is the person best able to help you avoid any serious recovery problems. You may search for similar articles that contain these same keywords or you may Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. sharing sensitive information, make sure youre on a federal No study directly compared the different types of graft for UCL reconstruction. 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.. 18. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. SYMPTOMS: The thumb may be swollen, bruised and painful. 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. POST-OPERATIVE WEEKS 22-24. 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. 20. All authors independently performed the search. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. This damage may lead to temporary or permanent numbness or weakness. 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. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 2013;23(4):247-254. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 1993;21:800804. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Bookshelf There are some cases where the fusion is not successful and you will still have pain in . Infection is a rare complication of hand surgery. The injury happens when you fall . A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. If the latter was executed only partially, a score of 1 was assigned. Eurasian J Med. 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%. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). An anatomic basis for treatment. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Both purely ligamentous and bony avulsion injuries were included. Patient Demographics of Thumb RCL and UCL Injuries. Diagnosis of displaced, 43. flexion-extension motion. Thumb from the common mechanism of falling on the thumb while holding a ski pole. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 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. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Before This website also contains material copyrighted by 3rd parties. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Downey DJ, Moneim MS, Omer GE Jr. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Kaplan EB. Click the topic below to receive emails when new articles are available. Hand Clin. Disclaimer. Complications after this procedure may include nerve or blood vessel damage. 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. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. eCollection 2021 Mar. 24. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 2005;87:26322638. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Range of motion returns much sooner, too. MeSH Bostock S, Morris MA. 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. I was able to work while wearing the splint. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Epub 2019 Mar 21. Exercises: Gradually progress to competitive throwing and sports . FOIA Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 2009;61:623632. Am J Sports Med. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Conflicts of interest The authors report no funding or conflicts of interest. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). The anti edema management will continue for several weeks. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. If the tear is diagnosed early a repair will be possible. J Bone Joint Surg Am. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 1989;71:383387. 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. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Complications after surgical treatment of UCL injury are rare. 13. For more information, please refer to our Privacy Policy. 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%). 10. The site is secure. Epub 2015 Sep 22. 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. Data range was reported as minimum to maximum absolute values. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.30 The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles.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. 33. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. A systematic review of ulnar collateral ligament reconstruction techniques. Your thumb will be immobilized in a splint and should not be moved until follow up. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. [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. 1992;8:713732. An official website of the United States government. Injury. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. 2021 Apr 15;3(2):e527-e533. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 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. 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%). Part I of this two-part article focuses on common tendon and . Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 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. Ulnar Collateral Ligament Repair . Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Smith RJ. The limitations of this systematic review are reliant on the studies analyzed. These tears often occur as a result of a radially directed force on an extended thumb. Am J Orthop (Belle Mead NJ). Fourteen articles were included and analyzed (293 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. All but 2 were level IV evidence. official website and that any information you provide is encrypted Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 23. Please try again soon. Clinical Journal of Sport Medicine23(4):247-254, July 2013. PMC Post-traumatic instability of the metacarpophalangeal joint of the thumb. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 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. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. This site needs JavaScript to work properly. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2009;34:304308. Would you like email updates of new search results? Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Epub 2013 Nov 12. MCP fusion was performed . 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. The site is secure. Surgical techniques and a review of 70 patients. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 35. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. HHS Vulnerability Disclosure, Help The limitations of this systematic review are reliant on the studies analyzed. Am J Sports Med. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Epub 2014 Oct 22. Acta Chir Scand. This site needs JavaScript to work properly. 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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Epub 2021 Jan 18. Benson LS, Bailie DS. Disclaimer. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 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. 2006;31:6875. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Fusetti C, Papaloizos M, Meyer H, et al.. Riederer S, Nagy L, Buchler U. Search performed on November 17, 2011. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 1962;124:396411. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Keywords: He too had the internal brace augmentation. Stener B. Skeletal injuries associated with rupture of the. Various levels of pain, bruising, or edema may present at the site of damage. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. [30] The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Please enable scripts and reload this page. Treatment of chronic injuries of the. The .gov means its official. Eventually this abnormal movement will wear out the joint and it will become arthritic. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. the splint for protection or at night until twelve weeks after the operation. 1999;24:7075. Complications after surgical treatment of UCL injury are rare. Am J Sports Med. Bailie DS, Benson LS, Marymont JV. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Arnold DM, Cooney WP, Wood MB. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Sports Med Arthrosc Rev. Stretching or even a rupture of the graft is also possible. National Library of Medicine Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. They may even tear completely. Continuous variable data were reported as mean SDs from the mean. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Please enable it to take advantage of the complete set of features! 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). [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. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. You've successfully added to your alerts. 34. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. 2003;8:8185. Data sources: J Bone Joint Surg Am. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1. 39. 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. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it .

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