Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Conclusion: Ulnar collateral ligament injuries of the thumb: a comprehensive review. Hand Surg. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Bethesda, MD 20894, Web Policies Only prospective studies can determine this injury course. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. [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]. 2000;16:345357. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 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. 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 . All rights reserved. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. 17. Clin J Sport Med. 18. J Bone Joint Surg Am. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 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. 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). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. The .gov means its official. Unauthorized use of these marks is strictly prohibited. Acute gamekeeper's thumb. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. What Happens If We Sit for More Than 8 Hours Per Day? All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). There is currently no consensus on treatment of acute or chronic UCL injuries. When assessed, most patients returned to their preinjury employment. This website also contains material copyrighted by 3rd parties. Studies that duplicated patient populations from the same authors were excluded. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics Purpose. Am J Sports Med. unstable when the thumb is used. Clipboard, Search History, and several other advanced features are temporarily unavailable. Fourteen articles were included and analyzed (293 thumbs). Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 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. Orthop Rev. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. eCollection 2021. 2022 Mar 1;30(1):e1-e8. MCP fusion was performed . Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. The limitations of this systematic review are reliant on the studies analyzed. 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. Thumb sidedness reported in 3 studies (51 thumbs). 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Fourteen articles were included and analyzed (293 thumbs). Thirty-two thumbs were treated nonoperatively and 261 operatively. Keywords: Gamekeepers thumb: a prospective study of functional bracing. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. J Bone Joint Surg Am. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Epub 2021 Sep 7. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%.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. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 1976;58:106112. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. may email you for journal alerts and information, but is committed In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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. 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. The mean time from reported injury date to surgery was 202.4 days (2-5969). 2013;23(4):247-254. Mitsionis GI, Varitimidis SE, Sotereanos GG. 5. 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. 44. Orthop Clin North Am. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. your express consent. Athletes Can Return to Play in Half the Time with New Thumb Ligament the thumb. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Your surgeon is the person best able to help you avoid any serious recovery problems. 25. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Continuous variable data were reported as mean SDs from the mean. Kozin SH, Bishop AT. A score of 2 was assigned if the item was completely and accurately performed and reported. 39. 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. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. There is currently no consensus on treatment of acute or chronic UCL injuries. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. official website and that any information you provide is encrypted After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Pain reduction was significantly improved in all subjects (P < 0.05). A score of 0 was assigned if the item was either omitted or not performed. 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. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Outcomes after injury to the thumb ulnar collateral ligament--a Before Instability of the metacarpophalangeal joint of the thumb. 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. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer.