2009;61:623632. When assessed, most patients returned to their preinjury employment. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Surgical techniques and a review of 70 patients. 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%. 12. The https:// ensures that you are connecting to the 1977;59:1421. 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. 35. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 25. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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.. 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. 7. Complications after surgical treatment of UCL injury are rare. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. The limitations of this systematic review are reliant on the studies analyzed. Epub 2015 Sep 22. Treatment of chronic injuries of the. The range of motion of the MP joint of the thumb following operative repair of the. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Experience with and Recovery from Skier's Thumb (UCL Tear with Avulsion Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). PMC Data sources: government site. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. These exercises may be directed by a physical or occupational therapist. 1995;23:222226. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 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. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Fourteen articles were included and analyzed (293 thumbs). 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Only prospective studies can determine this injury course. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 1962;124:396411. 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. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. In these cases, a new graft may be used to perform a second reconstruction. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Descriptive statistics were calculated. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. flexion-extension motion. Gamekeepers thumb: a prospective study of functional bracing. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. PIP Joint Injuries of the Finger - Orthogate Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. NR, not reported. and twist using your thumb. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. 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. 1976;58:106112. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Epub 2021 Sep 7. This site needs JavaScript to work properly. FOIA The mean time from reported injury date to surgery was 202.4 days (2-5969). Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed your express consent. Thirty-two thumbs were treated nonoperatively and 261 operatively. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Sakellarides HT, DeWeese JW. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. Orthopedics. 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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. HHS Vulnerability Disclosure, Help Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. To date, no literat. Posner MA, Retaillaud JL. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Before 2021 Apr 15;3(2):e527-e533. Epub 2020 Jun 29. official website and that any information you provide is encrypted Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Quantitative outcome of surgical repair. Careers. Epub 2013 Nov 12. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic The doctor won't know if the repair is . All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Skier's thumb - aftercare: MedlinePlus Medical Encyclopedia Stretching or even a rupture of the graft is also possible. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Dr. Holt will talk to you about when it is safe to return to work. The injury involves the ulnar collateral ligament (UCL) of the thumb. If the latter was executed only partially, a score of 1 was assigned. J Bone Joint Surg Am. An official website of the United States government. All authors independently performed the search. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Thus, the true natural history is yet unknown. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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). Complications, failures, and reoperations are rare after surgical treatment of UCL injury. The mean patient age was 37.8 years (14.0-78.1). Eventually this abnormal movement will wear out the joint and it will become arthritic. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. Am J Sports Med. Systematic review and meta-analysis. Am J Sports Med. 2. PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 2000;16:345357. the splint for protection or at night until twelve weeks after the operation. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. You are being redirected to Medscape Education. All but 2 were level IV evidence. The injury happens when you fall . Epub 2019 Mar 21. 1989;17:751753. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Clipboard, Search History, and several other advanced features are temporarily unavailable. There is currently no consensus on treatment of acute or chronic UCL injuries. J Hand Surg Br. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. Keyword Highlighting
6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. A broken thumb can also cause numbness or tingling. Complications after this procedure may include nerve or blood vessel damage. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment.