complications after ucl repair of thumb

Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. J Hand Surg Br. You are being redirected to Medscape Education. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. 35. 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. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. An anatomic basis for treatment. Careers. Categorical variable data were reported as frequency with percentages. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Please try after some time. Surgical techniques and a review of 70 patients. 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. The mean time from reported injury date to surgery was 202.4 days (2-5969). 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. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Arnold DM, Cooney WP, Wood MB. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Wong TC, Ip FK, Wu WC. Epub 2016 Jan 13. Bostock S, Morris MA. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. There is currently no consensus on treatment of acute or chronic UCL injuries. Clipboard, Search History, and several other advanced features are temporarily unavailable. Evaluation and management of elbow injuries in the adolescent overhead athlete. Clin Orthop Relat Res. 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. 8600 Rockville Pike 12. Your ligament may need to be reattached to the bone using a bone anchor. You may be trying to access this site from a secured browser on the server. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. No study directly compared nonoperative to operative treatment. 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. 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 ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). 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. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Tension wire fixation of avulsion fractures in the hand. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Am J Sports Med. Hand Clin. 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. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Stretching or even a rupture of the graft is also possible. Epub 2014 Dec 30. 1993;21:800804. Epub 2013 Nov 12. Subject demographics are reported in Table 2. Descriptive statistics were calculated. Bethesda, MD 20894, Web Policies 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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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. 2005;87:26322638. Throwing status reported in 4 studies. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 2018;6(4):1-7. sharing sensitive information, make sure youre on a federal Post-traumatic instability of the metacarpophalangeal joint of the thumb. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. No study directly compared the different types of graft for UCL reconstruction. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Complications after surgery were rare. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Please enter a Recipient Address and/or check the Send me a copy checkbox. 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). Both repair and reconstruction (autograft and allograft) techniques were inclusive. There are some cases where the fusion is not successful and you will still have pain in . Careers. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 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. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 18. [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. These exercises may be directed by a physical or occupational therapist. Sakellarides HT, DeWeese JW. *Glickel grading system. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Clin J Sport Med. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Mean subject age was 33.9 years. 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. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Part II: treatment and complications. Table 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 7. Louis DS, Huebner JJ Jr, Hankin FM. Gamekeeper's thumb. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Acute gamekeeper's thumb. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Causes. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Data range was reported as minimum to maximum absolute values. Please confirm that you would like to log out of Medscape. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 33. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Highlight selected keywords in the article text. Am J Sports Med. J Bone Joint Surg Am. 1987;214:113120. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. All authors independently performed the search. Most times, they won't know until they're in the surgery if the internal brace is appropriate. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Study design: [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. J Hand Surg Am. official website and that any information you provide is encrypted Conclusions: In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Fourteen articles were included and analyzed (293 thumbs). 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Your surgeon is the person best able to help you avoid any serious recovery problems. PMC Injuries to the PIP joint remain swollen for long periods of time. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . This site needs JavaScript to work properly. 14 It is important to diagnose complete tears early because . Possible complications include: - PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. There is currently no consensus on treatment of acute or chronic UCL injuries. Accessibility Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. 1999;24:7075. Wolters Kluwer Health 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. 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. Van Dommelen BA, Zvirbulis RA. [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]. 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. 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. 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. No study reported the outcomes of nonoperative management of chronic UCL injury. Data sources: A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 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. Methods: 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. [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. doi: 10.1016/j.asmr.2020.12.004. Infection is a rare complication of hand surgery. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 1976;58:106112. sharing sensitive information, make sure youre on a federal Epub 2014 Oct 22. government site. Unilateral injuries: 291 and bilateral injury: 1. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Complications after surgery were rare. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. [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. Search for Similar Articles Hand Clin. 3. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Abstract. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction.

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