Surgical techniques and a review of 70 patients. 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 . Thumb collateral ligament injuries. Part II: treatment and complications. Nonunions - OrthoInfo - AAOS The injury involves the ulnar collateral ligament (UCL) of the thumb. Treatment for thumb collateral ligament injury - KW orthopaedics Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Clin J Sport Med. Your thumb will be immobilized in a splint and should not be moved until follow up. A p-value of 0.05 was considered statistically significant. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. 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. 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. 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 UCL is also known as the medial collateral ligament or "Tommy John Ligament". 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. Conflicts of interest The authors report no funding or conflicts of interest. 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. 2005;24:217221. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. You are being redirected to Medscape Education. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Federal government websites often end in .gov or .mil. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Wolters Kluwer Health Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment 15. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 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). In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Unable to load your collection due to an error, Unable to load your delegates due to an error. Clipboard, Search History, and several other advanced features are temporarily unavailable. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 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. UCL Repair of the Thumb - MSA Hand Center Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. It runs from the outer humerus, around the radial head and attaches to the ulna. 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. and transmitted securely. Most times, they won't know until they're in the surgery if the internal brace is appropriate. 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. eCollection 2021 Mar. At this stage, patients should be advised to wear your splint part-time. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Fourteen articles were included and analyzed (293 thumbs). Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. This ligament prevents the thumb from pointing too far away from the hand. MCP fusion was performed . Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 33. The Effect of Ulnar Collateral Ligament Repair With Internal Brace PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 17. 6. Downey DJ, Moneim MS, Omer GE Jr. 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%). Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Orthopedics. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Hand Injuries - Finger Tip Injuries, Jersey Finger, PIP Dislocations Mean subject age was 33.9 years. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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 Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Thus, the true natural history is yet unknown. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Complications after surgery were rare. 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. Bostock S, Morris MA. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 J Hand Surg Glob Online. PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Clin Orthop Relat Res. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. 5. Infection is a rare complication of hand surgery. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 25. 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. A sprained thumb is a common injury among athletes. Hand Surg. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Non-Fusion. Pichora DR, McMurtry RY, Bell MJ. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. PDF Pre/Post-Operative Information - Thumb UCL Repair/Reconstruction What It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. the thumb. UCLR case series that contained complications data were included. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Categorical variable data were reported as frequency with percentages. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. and transmitted securely. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Highlight selected keywords in the article text. Please enable scripts and reload this page. J Bone Joint Surg Am.