[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. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. J Hand Surg Br. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 1976;58:106112. Bennet Fracture. 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%). Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligament Injuries 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. You've successfully added to your alerts. Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Complications Following Distal Radius Fractures - Mike Reinold 1995;23:222226. Complications after surgery were rare. government site. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 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.. PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Patient Demographics of Thumb RCL and UCL Injuries. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. doi: 10.1097/JSA.0000000000000322. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Please enable it to take advantage of the complete set of features! Dr. Holt will talk to you about when it is safe to return to work. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction Complications after surgical treatment of UCL injury are rare. Figure 46-2 Approach to the ulnar collateral ligament. If the latter was executed only partially, a score of 1 was assigned. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Please try after some time. Surgical management of chronic, 42. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. This article provides a review of . 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). RESULTS The mean follow-up time was 22.2 months (range 6-54 months). This leads to what is know as a positive ulnar variance. 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. 1994;25:2123. Throwing status reported in 4 studies. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 8600 Rockville Pike Exercises: Gradually progress to competitive throwing and sports . A score of 0 was assigned if the item was either omitted or not performed. Methods: Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 25. Abrahamsson SO, Sollerman C, Lundborg G, et al.. 1989;71:383387. Categorical variable data were reported as frequency with percentages. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Quantitative outcome of surgical repair. 1992;8:713732. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Complications after this procedure may include nerve or blood vessel damage. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. There were 200 acute injuries and 93 chronic injuries. 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 [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. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Unauthorized use of these marks is strictly prohibited. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 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. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 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. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. 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. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. PLoS Med. 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. Tension wire fixation of avulsion fractures in the hand. Arthrosc Sports Med Rehabil. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . For more information, please refer to our Privacy Policy. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. National Library of Medicine Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). 14 It is important to diagnose complete tears early because . 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. Infection is a rare complication of hand surgery. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Bookshelf Before J Hand Surg Am. *Glickel grading scale. Thumb sidedness reported in 3 studies (51 thumbs). 1962;124:396411. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . 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. Am J Sports Med. J Bone Joint Surg Am. Thirty-two thumbs were treated nonoperatively and 261 operatively. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 20. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Meta-analysis of the pooled data was completed. Chir Main. Your message has been successfully sent to your colleague. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Am J Sports Med. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Rupture of the. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Benson LS, Bailie DS. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. [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. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Your thumb will be immobilized in a splint and should not be moved until follow up. Fusetti C, Papaloizos M, Meyer H, et al.. Ulnar collateral ligament repair surgery Archives | OrthoVirginia Please enable scripts and reload this page. J Hand Surg Am. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Am J Sports Med. 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. If the force is too strong, the ligaments can tear. Fourteen articles were included and analyzed (293 thumbs).
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