complications after ucl repair of thumb

Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Mean subject age was 33.9 years. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Thus, the true natural history is yet unknown. Skier's thumb - Physiopedia There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. They may even tear completely. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. This website also contains material copyrighted by 3rd parties. Eventually this abnormal movement will wear out the joint and it will become arthritic. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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). Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. 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. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Hand Surgery Recovery Time: Pain, Exercise & Complications Data range was reported as minimum to maximum absolute values. 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. Descriptive statistics were calculated. This site needs JavaScript to work properly. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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 scripts and reload this page. Meta-analysis of the pooled data was completed. This ligament prevents the thumb from pointing too far away from the hand. Please enable it to take advantage of the complete set of features! Complications after surgical treatment of UCL injury are rare. Downey DJ, Moneim MS, Omer GE Jr. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. UCLR case series that contained complications data were included. 1999;24:7075. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 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. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Doi: 10.1177/2325967118769328. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 1992;8:713732. Unilateral injuries: 291 and bilateral injury: 1. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 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. Keyword Highlighting 1994;23:797804. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum. 1989;71:383387. modify the keyword list to augment your search. 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. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Gamekeeper's thumb. 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. Some error has occurred while processing your request. There is currently no consensus on treatment of acute or chronic UCL injuries. Diagnosis of displaced, 43. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). 45. Am J Sports Med. Metacarpophalangeal joint injuries of the thumb. J Bone Joint Surg Am. Thirty-two thumbs were treated nonoperatively and 261 operatively. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 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. *Glickel grading system. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 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. Rupture of the. Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries 23. Fourteen articles were included and analyzed (293 thumbs). [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. This damage may lead to temporary or permanent numbness or weakness. Nonsurgical Management of Ulnar Collateral Ligament Injuries Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 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. Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. 1995;18:11611165. Injuries to the PIP joint remain swollen for long periods of time. Van Dommelen BA, Zvirbulis RA. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Chir Main. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Catalano LW III, Cardon L, Patenaude N, et al.. Proximal interphalangeal joint injuries of the hand. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. A sprained thumb is a common injury among athletes. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Commonly Missed Orthopedic Problems | AAFP Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. The range of motion of the MP joint of the thumb following operative repair of the. Search performed on November 17, 2011. Epub 2015 Sep 22. AAHS - Comparison of Complications after Thumb Metacarpophalangeal The injury involves the ulnar collateral ligament (UCL) of the thumb. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Sports Med Arthrosc Rev. 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. J Bone Joint Surg Am. 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%). Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. If the latter was executed only partially, a score of 1 was assigned. If the force is too strong, the ligaments can tear. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 33. 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%). Moher D, Liberati A, Tetzlaff J, et al.. Conclusions: Continuous variable data were reported as mean SDs from the mean. 18. 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. Thus, the true natural history is yet unknown. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Ulnar collateral ligament injury of the thumb - Wikipedia Commonly, the joint will be permanently enlarged due to the scarring of the healing process. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Upper extremity injuries in snow skiers. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. UCL Repair of the Thumb - MSA Hand Center The doctor won't know if the repair is . Eurasian J Med. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). Midterm clinical outcomes of collateral ligament repair of the thumb Causes. 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. Objectives: 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. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. MCP fusion was performed . Kozin SH, Bishop AT. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. your express consent. A common complication following fracture of the distal radius is when the radius shortens. 5. 21. HHS Vulnerability Disclosure, Help MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 1. Complications of Ulnar Collateral Ligament Repair | SpringerLink Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 36. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 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. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Evaluation and management of elbow injuries in the adolescent overhead athlete. Ulnar Collateral Ligament (UCL) Repair | SpringerLink Highlight selected keywords in the article text. Anesthesia for Hand Surgery | The Hand & Wrist Center Epub 2014 Dec 30. There is currently no consensus on treatment of acute or chronic UCL injuries. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. There were 61 studies eliminated as secondary for being in a language other than English. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Conflicts of interest The authors report no funding or conflicts of interest. A score of 0 was assigned if the item was either omitted or not performed. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 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. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 1996;25:474477. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. 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).