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No study reported the outcomes of nonoperative management of chronic UCL injury. Rupture and displacement of the. What are the symptoms of GameKeeper's Thumb? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Search for Similar Articles MeSH 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. Disclaimer. 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. I was able to work while wearing the splint. 20. Stretching or even a rupture of the graft is also possible. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 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. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Highlight selected keywords in the article text. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Arnold DM, Cooney WP, Wood MB. In these cases, a new graft may be used to perform a second reconstruction. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Epub 2019 Mar 21. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Keywords: Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 33. MCP collateral ligament sprain is most commonly an acute injury related to trauma. [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. Epub 2016 Jan 13. Gamekeeper's thumb. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. 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. 39. 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. 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*. 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%). 19. your express consent. 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. SYMPTOMS: The thumb may be swollen, bruised and painful. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Thumb collateral ligament injuries. UCLR case series that contained complications data were included. 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. Injuries to the PIP joint remain swollen for long periods of time. Federal government websites often end in .gov or .mil. 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 tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 45. Study design: 5. Mean study follow-up was 42.8 months. Part II: treatment and complications. 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. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Am J Sports Med. There were 200 acute injuries and 93 chronic injuries. If you log out, you will be required to enter your username and password the next time you visit. 14 It is important to diagnose complete tears early because . Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 2009;34:304308. Smith RJ. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Arthritis Rheum. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Descriptive statistics were calculated. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 12. 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. Mean study follow-up was 42.8 months. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. These tears often occur as a result of a radially directed force on an extended thumb. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Abstract. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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). Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Bookshelf 27. to maintaining your privacy and will not share your personal information without Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery If the force is too strong, the ligaments can tear. Continuous variable data were reported as mean SDs from the mean. Please enable it to take advantage of the complete set of features! 3. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 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). Your thumb will be immobilized in a splint and should not be moved until follow up. Melone CP Jr, Beldner S, Basuk RS. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Arthrosc Sports Med Rehabil. Epub 2020 Jun 29. 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. 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. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Bethesda, MD 20894, Web Policies The authors report no funding or conflicts of interest. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Am J Sports Med. J Hand Surg Am. 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. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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%). [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. Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. eCollection 2021 Apr. Would you like email updates of new search results? Thirty-two thumbs were treated nonoperatively and 261 operatively. Early and late postoperative complications were recorded. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. A score of 0 was assigned if the item was either omitted or not performed. 1989;71:383387. If your bone is broken, a pin will be used to put it in place. **Stener lesion status reported in 6 studies (145 thumbs). Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. If the tear is diagnosed early a repair will be possible. Mechanism of injury to the RCL of the MCP joint of the thumb is force . It runs from the outer humerus, around the radial head and attaches to the ulna. Nonoperative treatment often failed, necessitating surgery. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Upper extremity injuries in snow skiers. A broken thumb can also cause numbness or tingling. 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. 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. Range of motion returns much sooner, too. This leads to what is know as a positive ulnar variance. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 1961;43-A:541546. Main results: eCollection 2021 Mar. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Chir Main. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 8600 Rockville Pike Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Louis DS, Huebner JJ Jr, Hankin FM. The mean time from reported injury date to surgery was 202.4 days (2-5969). 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. Am J Sports Med. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. J Bone Joint Surg Am. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. 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. National Library of Medicine Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. You may search for similar articles that contain these same keywords or you may 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. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Hand Surg. 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. NR, not reported. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. J Hand Surg Am. Long-term results of ligament reconstruction. SAGE Open Med. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The torn thumb ligament is repaired or reconstructed during surgery. 1998;23:503506. Abrahamsson SO, Sollerman C, Lundborg G, et al.. For more information, please refer to our Privacy Policy. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Patient Demographics of Thumb RCL and UCL Injuries. PMC In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. UCLR case series that contained complications data were included. 1977;59:1421. No study directly compared the different types of graft for UCL reconstruction. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Engelhardt JB, Christensen OM, Christiansen TG. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. [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. 1995;18:11611165. 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. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. When assessed, most patients returned to their preinjury employment. Benson LS, Bailie DS. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. Infection is a rare complication of hand surgery. 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. modify the keyword list to augment your search. Surgical management of chronic, 42. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Your ligament may need to be reattached to the bone using a bone anchor. sharing sensitive information, make sure youre on a federal A score of 2 was assigned if the item was completely and accurately performed and reported. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Clipboard, Search History, and several other advanced features are temporarily unavailable. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication.