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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Bostock S, Morris MA. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. There were 200 acute injuries and 93 chronic injuries. Symptoms are dependent on the cause and severity of injury to the UCL. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Bean CH, Tencer AF, Trumble TE. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Eventually this abnormal movement will wear out the joint and it will become arthritic. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 37. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. UCLR case series that contained complications data were included. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 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 . UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. The mean time from reported injury date to surgery was 202.4 days (2-5969). Epub 2014 Dec 30. Only prospective studies can determine this injury course. Hand Surg. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 3. 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. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. What are the symptoms of GameKeeper's Thumb? Arthrosc Sports Med Rehabil. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Early diagnosis and treatment. MeSH 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 . Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 2005;87:26322638. Non-Fusion. Early and late postoperative complications were recorded. 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. J Bone Joint Surg Am. 24. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Clin Orthop Relat Res. 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. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 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. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. Unilateral injuries: 291 and bilateral injury: 1. POST-OPERATIVE WEEKS 22-24. J Hand Surg Br. 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%. A score of 0 was assigned if the item was either omitted or not performed. 11. 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. What Happens If We Sit for More Than 8 Hours Per Day? Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 35. Some error has occurred while processing your request. HHS Vulnerability Disclosure, Help A score of 0 was assigned if the item was either omitted or not performed. Unable to load your collection due to an error, Unable to load your delegates due to an error. Stretching or even a rupture of the graft is also possible. Categorical variable data were reported as frequency with percentages. Causes. 20. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Epub 2015 Sep 22. Table 1. I was able to work while wearing the splint. Upper extremity injuries in snow skiers. 21. *Glickel grading system. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. MCP collateral ligament sprain is most commonly an acute injury related to trauma. [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. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. 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.15,39 It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.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. 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 Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. 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. 2003;8:8185. 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. Epub 2014 Oct 22. 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*. official website and that any information you provide is encrypted Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. J Hand Surg Glob Online. 2009;34:304308. 1989;17:751753. three muscles provide deforming forces at the base of the thumb. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. In some cases, certain risk factors make it more likely that a bone will fail to heal. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 8600 Rockville Pike Objectives: 1994;23:797804. 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. Eurasian J Med. J Hand Surg Am. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 2009;6:e1000097. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. doi: 10.1097/JSA.0000000000000322. Accessibility J Hand Surg Br. 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. NR, not reported. 1. 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. Continuous variable data were reported as mean SDs from the mean. 2005;24:217221. Nonoperative treatment often failed, necessitating surgery. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 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). 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. The LUCL is located on the lateral or outside part of the elbow. Complications after surgical treatment of UCL injury are rare. Proximal interphalangeal joint injuries of the hand. your express consent. National Library of Medicine 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 . Van Dommelen BA, Zvirbulis RA. No study directly compared nonoperative to operative treatment. 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. 17. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Federal government websites often end in .gov or .mil. 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%). 2013;23(4):247-254. Am J Sports Med. Only prospective studies can determine this injury course. 2000;16:345357. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 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. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. The torn thumb ligament is repaired or reconstructed during surgery. Subject demographics are reported in Table 2. 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. Bethesda, MD 20894, Web Policies flexion-extension motion. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 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. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Please try after some time. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2006;31:6875. Both purely ligamentous and bony avulsion injuries were included. The https:// ensures that you are connecting to the Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Sakellarides HT, DeWeese JW. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. If the tear is diagnosed later a ligament reconstruction might be a better option. [15,39] It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.