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. Nonoperative treatment often failed, necessitating surgery. This article provides a review of . Upper extremity injuries in snow skiers. The mean time from reported injury date to surgery was 202.4 days (2-5969). Careers. Accessibility No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 2013Lippincott Williams & Wilkins. 38. Thumb dominance reported in 8 studies (168 thumbs). 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . J Hand Surg Am. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Tension wire fixation of avulsion fractures in the hand. Riederer S, Nagy L, Buchler U. Sakellarides HT, DeWeese JW. It runs from the outer humerus, around the radial head and attaches to the ulna. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). Thumb sidedness reported in 3 studies (51 thumbs). 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. Doi: 10.1177/2325967118769328. 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. A p-value of 0.05 was considered statistically significant. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Wolters Kluwer Health, Inc. and/or its subsidiaries. 2013;23(4):247-254. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Quantitative outcome of surgical repair. **Stener lesion status reported in 6 studies (145 thumbs). All authors independently performed the search. 2022 Mar 1;30(1):e1-e8. All rights reserved. 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. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Meta-analysis of the pooled data was completed. 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. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. modify the keyword list to augment your search. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). sharing sensitive information, make sure youre on a federal Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 1999;24:275282. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Mean study follow-up was 42.8 months. MCP fusion was performed . The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Complications after surgery were rare. Jupiter JB, Sheppard JE. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Would you like email updates of new search results? The mean patient age was 37.8 years (14.0-78.1). MeSH This damage may lead to temporary or permanent numbness or weakness. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 1976;58:106112. Patient Demographics of Thumb RCL and UCL Injuries. The authors report no funding or conflicts of interest. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. 1995;23:222226. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Eventually this abnormal movement will wear out the joint and it will become arthritic. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 27. Evaluation and management of elbow injuries in the adolescent overhead athlete. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Weakened grip or reduced thumb range of motion may occur. may email you for journal alerts and information, but is committed
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Nonoperative treatment often failed, necessitating surgery. Bookshelf PMC Methods: Categorical variable data were reported as frequency with percentages. Symptoms are dependent on the cause and severity of injury to the UCL. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. J Bone Joint Surg Am. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Kozin SH, Bishop AT. Metacarpophalangeal joint injuries of the thumb. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Before Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. *Glickel grading scale. 7. There were 61 studies eliminated as secondary for being in a language other than English. [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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. J Hand Surg Am. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Frykman G, Johansson O. Surgical repair of rupture of the, 46. All but 2 were level IV evidence. National Library of Medicine Wong TC, Ip FK, Wu WC. 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. 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. 2018;6(4):1-7. History. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. [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 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. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. 14 It is important to diagnose complete tears early because . [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Purpose. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. HHS Vulnerability Disclosure, Help Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. There is currently no consensus on treatment of acute or chronic UCL injuries. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) A score of 2 was assigned if the item was completely and accurately performed and reported. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Please try after some time. 33. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Your ligament may need to be reattached to the bone using a bone anchor. Melone CP Jr, Beldner S, Basuk RS. 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. 1992;8:713732. Hand Surg. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Please try again soon. 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 . to maintaining your privacy and will not share your personal information without
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. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.