complications after ucl repair of thumb

Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Epub 2021 Jan 18. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Epub 2021 Sep 7. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Pain reduction was significantly improved in all subjects (P < 0.05). 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. Dr. Holt will talk to you about when it is safe to return to work. Unable to load your collection due to an error, Unable to load your delegates due to an error. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Chir Main. Studies that duplicated patient populations from the same authors were excluded. *Glickel grading scale. A broken thumb can also cause numbness or tingling. If the tear is diagnosed early a repair will be possible. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 6. 3. Early diagnosis and treatment. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. 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. 8600 Rockville Pike The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.17,34 Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. There is currently no consensus on treatment of acute or chronic UCL injuries. Am J Sports Med. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Metacarpophalangeal joint injuries of the thumb. Please enable it to take advantage of the complete set of features! Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Bostock S, Morris MA. Meta-analysis of the pooled data was completed. A systematic review of ulnar collateral ligament reconstruction techniques. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 15. To date, no literat. 1993;21:800804. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). Engelhardt JB, Christensen OM, Christiansen TG. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. You may be trying to access this site from a secured browser on the server. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. 22. Background: Moher D, Liberati A, Tetzlaff J, et al.. 27. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. I was able to work while wearing the splint. sharing sensitive information, make sure youre on a federal A score of 2 was assigned if the item was completely and accurately performed and reported. Both repair and reconstruction (autograft and allograft) techniques were inclusive. The LUCL is located on the lateral or outside part of the elbow. Various levels of pain, bruising, or edema may present at the site of damage. Wolters Kluwer Health Complications, failures, and reoperations are rare after surgical treatment of UCL injury. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Data sources: Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. doi: 10.1016/j.asmr.2020.12.004. 2000;16:345357. 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. At this stage, patients should be advised to wear your splint part-time. The .gov means its official. Wolters Kluwer Health, Inc. and/or its subsidiaries. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 20. Am J Orthop (Belle Mead NJ). Epub 2013 Nov 12. MCP fusion was performed . to maintaining your privacy and will not share your personal information without Exercises: Gradually progress to competitive throwing and sports . [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. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Hand Surg. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Orthop Rev. The overall complication rate was 13.8% (11/80). 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. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 1995;18:11611165. 34. 1999;24:275282. 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*. 11. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. This site needs JavaScript to work properly. The mean time from reported injury date to surgery was 202.4 days (2-5969). Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. 8. Fourteen articles were included and analyzed (293 thumbs). 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. 4. Results: fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Range of motion returns much sooner, too. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Please enable scripts and reload this page. Before This ligament prevents the thumb from pointing too far away from the hand. 39. 21. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Accessibility 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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. HHS Vulnerability Disclosure, Help Disclaimer. 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. 7. Continue to stretch before and after throwing . Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Posner MA, Retaillaud JL. Study design: Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. For more information, please refer to our Privacy Policy. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 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). Sixty nine (86.3%) patients had grade 3 tears. 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. 14 It is important to diagnose complete tears early because . [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. J Bone Joint Surg Am. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. [23,3638] Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Fourteen articles were included and analyzed (293 thumbs). three muscles provide deforming forces at the base of the thumb. Stretching or even a rupture of the graft is also possible. Gamekeeper's thumb. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 2. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2013Lippincott Williams & Wilkins. Unauthorized use of these marks is strictly prohibited. 1999;24:7075. There is currently no consensus on treatment of acute or chronic UCL injuries. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. When assessed, most patients returned to their preinjury employment. If you log out, you will be required to enter your username and password the next time you visit. Table 1. Purpose: Thirty-two thumbs were treated nonoperatively and 261 operatively. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Sports Med Arthrosc Rev. J Hand Surg Am. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. J Hand Surg Am. 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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 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 . 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). modify the keyword list to augment your search. Symptoms are dependent on the cause and severity of injury to the UCL. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 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. You may also begin strengthening exercises if needed. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery.

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