PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb UCL injuries: Defining risk and improving treatment - Mayo Clinic Mean study follow-up was 42.8 months. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 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. When assessed, most patients returned to their preinjury employment. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Meta-analysis of the pooled data was completed. Dr. Holt will talk to you about when it is safe to return to work. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Only prospective studies can determine this injury course. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Only prospective studies can determine this injury course. Thus, the true natural history is yet unknown. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . abduction-adduction motion. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic *Glickel grading scale. Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP 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. PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb the splint for protection or at night until twelve weeks after the operation. Accessibility 7. 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%). 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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). Doi: 10.1177/2325967118769328. Your ligament may need to be reattached to the bone using a bone anchor. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 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. J Hand Surg Glob Online. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. A sprained thumb is a common injury among athletes. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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. 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. [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. 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. 2009;6:e1000097. Athletes Can Return to Play in Half the Time with New Thumb Ligament 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. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Am J Sports Med. 1961;43-A:541546. National Library of Medicine This ligament prevents the thumb from pointing too far away from the hand. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. better/same/worse than preoperative status). Range of motion returns much sooner, too. 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. 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). Stener B. Skeletal injuries associated with rupture of the. 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%). You will receive email when new content is published. What are the symptoms of GameKeeper's Thumb? [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. official website and that any information you provide is encrypted Complications after surgery were rare. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Disclaimer. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Ulnar Collateral Ligament (UCL) Repair | SpringerLink In general, be guided by symptoms and if an activity hurts, it is probably best avoided. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. The grip strength and the pinch strength were 94.3% and 92.27%,. Bean CH, Tencer AF, Trumble TE. **Stener lesion status reported in 6 studies (145 thumbs). Ulnar Collateral Ligament Repair and Reconstruction A broken thumb can also cause numbness or tingling. Please enter a Recipient Address and/or check the Send me a copy checkbox. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. [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]. 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. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires.
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