You may be trying to access this site from a secured browser on the server. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Proximal interphalangeal joint injuries of the hand. 1987;214:113120. The anti edema management will continue for several weeks. Exercises: Gradually progress to competitive throwing and sports . Please enter a Recipient Address and/or check the Send me a copy checkbox. There were 61 studies eliminated as secondary for being in a language other than English. Am J Orthop (Belle Mead NJ). Highlight selected keywords in the article text. 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 Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. 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. The overall complication rate was 13.8% (11/80). Various levels of pain, bruising, or edema may present at the site of damage. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. All rights reserved. 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. 14. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Orthop Rev. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Hand Clin. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 2018;6(4):1-7. Orthop Clin North Am. J Hand Surg Am. 1961;43-A:541546. Mean subject age was 33.9 years. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Throwing status reported in 4 studies. Early diagnosis and treatment. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. History. Am J Sports Med. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 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. A score of 0 was assigned if the item was either omitted or not performed. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. 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. Careers. 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. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Am J Sports Med. J Bone Joint Surg Am. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Please try again soon. SYMPTOMS: The thumb may be swollen, bruised and painful. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. 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. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. [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. If the latter was executed only partially, a score of 1 was assigned. Complications after surgery were rare. The site is secure. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Instability of the metacarpophalangeal joint of the thumb. 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. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. #Injury location reported only in 3 studies. 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. 1989;17:751753. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. abduction-adduction motion. Riederer S, Nagy L, Buchler U. [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. Ulnar collateral ligament injuries of the thumb: a comprehensive review. J Bone Joint Surg Am. The mean patient age was 37.8 years (14.0-78.1). The .gov means its official. Only prospective studies can determine this injury course. 2009;6:e1000097. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Thirty-two thumbs were treated nonoperatively and 261 operatively. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Please enable it to take advantage of the complete set of features! This site needs JavaScript to work properly. 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. Dr. Holt will talk to you about when it is safe to return to work. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Studies that duplicated patient populations from the same authors were excluded. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . official website and that any information you provide is encrypted 8600 Rockville Pike Click the topic below to receive emails when new articles are available. **Stener lesion status reported in 6 studies (145 thumbs). 26. 34. Epub 2016 Jan 13. To date, no literat. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 12. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Am J Sports Med. eCollection 2021 Mar. Stener B. Skeletal injuries associated with rupture of the. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. An official website of the United States government. Systematic review and meta-analysis. 23. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 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%). Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. The Orthopedic Journal of Sports Medicine. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 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).

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