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. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Continue to stretch before and after throwing . Your message has been successfully sent to your colleague. Part I: anatomy and diagnosis. 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*. Exercises: Gradually progress to competitive throwing and sports . Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 1962;124:396411. Acute gamekeeper's thumb. I was able to work while wearing the splint. 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. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Smith RJ. There were no cases of intraoperative ulnar nerve injury reported. 1994;25:2123. doi: 10.1097/JSA.0000000000000322. A score of 0 was assigned if the item was either omitted or not performed. Clin Orthop Relat Res. There were 61 studies eliminated as secondary for being in a language other than English. 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. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. 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. 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 . The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. HHS Vulnerability Disclosure, Help Before Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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%). PMC Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. FOIA Injury. Kaplan EB. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Complications after this procedure may include nerve or blood vessel damage. 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. 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. Moher D, Liberati A, Tetzlaff J, et al.. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Please try after some time. Would you like email updates of new search results? Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. This website also contains material copyrighted by 3rd parties. 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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 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. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. the splint for protection or at night until twelve weeks after the operation. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 5. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Early diagnosis and treatment. 1,5,9,10 In acute cases of complete tears involving high-level . to maintaining your privacy and will not share your personal information without modify the keyword list to augment your search. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). J Hand Surg Am. History. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. 2. #Injury location reported only in 3 studies. Thumb sidedness reported in 3 studies (51 thumbs). Meta-analysis of the pooled data was completed. What Happens If We Sit for More Than 8 Hours Per Day? Before sharing sensitive information, make sure youre on a federal 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. NR, not reported. Would you like email updates of new search results? [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. There is currently no consensus on treatment of acute or chronic UCL injuries. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. J Hand Surg Glob Online. An anatomic basis for treatment. Meta-analysis of the pooled data was completed. 45. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Figure 46-2 Approach to the ulnar collateral ligament. 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 . This leads to what is know as a positive ulnar variance. 1989;14:567573. 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. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Early and late postoperative complications were recorded. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Bookshelf When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Unilateral injuries: 291 and bilateral injury: 1. 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. You are being redirected to Medscape Education. J Bone Joint Surg Am. A systematic review of ulnar collateral ligament reconstruction techniques. Federal government websites often end in .gov or .mil. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. [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. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 36. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Gamekeepers thumb: a prospective study of functional bracing. Am J Sports Med. Thirty-two thumbs were treated nonoperatively and 261 operatively. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. 1989;17:751753. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Only prospective studies can determine this injury course. Results: Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. the thumb. 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. Fusetti C, Papaloizos M, Meyer H, et al.. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Patient Demographics of Thumb RCL and UCL Injuries. [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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Bostock S, Morris MA. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Am J Sports Med. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Keywords: Am J Sports Med.