[16] Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. unstable when the thumb is used. the splint for protection or at night until twelve weeks after the operation. Categorical variable data were reported as frequency with percentages. 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*. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Riederer S, Nagy L, Buchler U. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). There were 200 acute injuries and 93 chronic injuries. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. If it is appropriate, then surgical consent probably happened before the surgery. J Hand Surg Am. 1994;23:797804. Exercises: Gradually progress to competitive throwing and sports . The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. A p-value of 0.05 was considered statistically significant. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. An anatomic basis for treatment. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Search performed on November 17, 2011. Fourteen articles were included and analyzed (293 thumbs). There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. Orthopedics. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 7. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. There were 61 studies eliminated as secondary for being in a language other than English. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. PMC RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. At this stage, patients should be advised to wear your splint part-time. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Before Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. Sports Health. 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. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. sharing sensitive information, make sure youre on a federal After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. A systematic review of ulnar collateral ligament reconstruction techniques. 1962;124:396411. government site. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Your message has been successfully sent to your colleague. Nonoperative treatment often failed, necessitating surgery. 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. Causes. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Kozin SH, Bishop AT. Clin Orthop Relat Res. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Mean subject age was 33.9 years. No study directly compared the different types of graft for UCL reconstruction. to maintaining your privacy and will not share your personal information without Accessibility Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Jackson M, McQueen MM. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. J Bone Joint Surg Am. 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. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. 25. Proximal interphalangeal joint injuries of the hand. 33. Treatment of chronic injuries of the. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Tension wire fixation of avulsion fractures in the hand. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. 1977;59:1421. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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 grip strength and the pinch strength were 94.3% and 92.27%,. This damage may lead to temporary or permanent numbness or weakness. Please enter a Recipient Address and/or check the Send me a copy checkbox. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. In these cases, a new graft may be used to perform a second reconstruction. Epub 2016 Jan 13. official website and that any information you provide is encrypted Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 45. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Gamekeeper's thumb. 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. #Injury location reported only in 3 studies. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. All rights reserved. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). [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.. Weakened grip or reduced thumb range of motion may occur. Nonoperative treatment often failed, necessitating surgery. 1961;43-A:541546. Moher D, Liberati A, Tetzlaff J, et al.. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. [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. MeSH If your bone is broken, a pin will be used to put it in place.