Riederer S, Nagy L, Buchler U. It runs from the outer humerus, around the radial head and attaches to the ulna. 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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. 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. The site is secure. Clin Orthop Relat Res. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 1995;23:222226. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. [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]. 24. Causes. Hand Clin. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. 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. 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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Mechanism of injury to the RCL of the MCP joint of the thumb is force . 10. official website and that any information you provide is encrypted You may be trying to access this site from a secured browser on the server. Weakened grip or reduced thumb range of motion may occur. Rupture and displacement of the. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Exercises: Gradually progress to competitive throwing and sports . 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. Ulnar collateral ligament injuries of the thumb: a comprehensive review. You are being redirected to Medscape Education. Unauthorized use of these marks is strictly prohibited. J Hand Surg Am. The https:// ensures that you are connecting to the All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). [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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Complications after surgical treatment of UCL injury are rare. Descriptive statistics were calculated. Please confirm that you would like to log out of Medscape. MCP fusion was performed . Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. Patient Demographics of Thumb RCL and UCL Injuries. Moher D, Liberati A, Tetzlaff J, et al.. Am J Sports Med. At this stage, patients should be advised to wear your splint part-time. sharing sensitive information, make sure youre on a federal Eurasian J Med. eCollection 2022 May. Proximal interphalangeal joint injuries of the hand. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. The diagnosis is best established clinically, though MRI is the imaging modality of choice. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Bethesda, MD 20894, Web Policies Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Purpose: When assessed, most patients returned to their preinjury employment. Subject demographics are reported in Table 2. There were no cases of intraoperative ulnar nerve injury reported. Arnold DM, Cooney WP, Wood MB. Methods: Search performed on November 17, 2011. 3. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Benson LS, Bailie DS. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Complications after surgery were rare. J Bone Joint Surg Am. Thirty-two thumbs were treated nonoperatively and 261 operatively. Dr. Holt will talk to you about when it is safe to return to work. The grip strength and the pinch strength were 94.3% and 92.27%,. Complications after surgical treatment of UCL injury are rare. abduction-adduction motion. Arthritis Rheum. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. This site needs JavaScript to work properly. Systematic review and meta-analysis. 2009;34:304308. SYMPTOMS: The thumb may be swollen, bruised and painful. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. There were 200 acute injuries and 93 chronic injuries. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. There is currently no consensus on treatment of acute or chronic UCL injuries. Clipboard, Search History, and several other advanced features are temporarily unavailable. Both purely ligamentous and bony avulsion injuries were included. Hand Clin. 1989;14:567573. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Part II: treatment and complications. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. This website also contains material copyrighted by 3rd parties. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Downey DJ, Moneim MS, Omer GE Jr. There is currently no consensus on treatment of acute or chronic UCL injuries. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. PMC 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. three muscles provide deforming forces at the base of the thumb. 20. Careers. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Bennet Fracture. Some error has occurred while processing your request. 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.. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Bethesda, MD 20894, Web Policies 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. 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 . 2013Lippincott Williams & Wilkins. 1998;23:503506. POST-OPERATIVE WEEKS 22-24. *Glickel grading scale. Thus, the true natural history is yet unknown. Your ligament may need to be reattached to the bone using a bone anchor. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Ulnar Collateral Ligament Repair . 2009;6:e1000097. Figure 46-2 Approach to the ulnar collateral ligament. 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%. There are some cases where the fusion is not successful and you will still have pain in . Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 27. #Injury location reported only in 3 studies. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. You will receive email when new content is published. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Data is temporarily unavailable. A score of 2 was assigned if the item was completely and accurately performed and reported. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). This article provides a review of . RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Am J Sports Med. Orthopedics. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 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. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. All rights reserved. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Objectives: Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Would you like email updates of new search results? 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Before 1. *Glickel grading system. Epub 2020 Jun 29. The .gov means its official. If you log out, you will be required to enter your username and password the next time you visit. Sakellarides HT, DeWeese JW. 2005;24:217221. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 4. 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. The overall complication rate was 13.8% (11/80). 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 Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Kozin SH, Bishop AT. Thirty-two thumbs were treated nonoperatively and 261 operatively. Chir Main. Please enter a Recipient Address and/or check the Send me a copy checkbox. 17. Hand Surg. 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. 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%). Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Study design: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Click the topic below to receive emails when new articles are available. 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. 1989;17:751753. 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Epub 2013 Nov 12. 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. 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. 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. If the latter was executed only partially, a score of 1 was assigned. Bookshelf 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 . and twist using your thumb. 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. 1996;25:474477. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. No study directly compared the different types of graft for UCL reconstruction. 5. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 11. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. [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. [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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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.