complications after ucl repair of thumb

Stretching or even a rupture of the graft is also possible. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 1994;25:2123. Hand Clin. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. SYMPTOMS: The thumb may be swollen, bruised and painful. Results: Early and late postoperative complications were recorded. They may even tear completely. 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. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. An official website of the United States government. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. abduction-adduction motion. Early diagnosis and treatment. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 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. 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. Epub 2013 Nov 12. Purpose. Kaplan EB. and twist using your thumb. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. The limitations of this systematic review are reliant on the studies analyzed. There were no cases of intraoperative ulnar nerve injury reported. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. The https:// ensures that you are connecting to the Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). In these cases, a new graft may be used to perform a second reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Commonly Missed Orthopedic Problems | AAFP 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. RCL Reconstruction Thumb MPJ - The Hand Treatment Center Complications after surgical treatment of UCL injury are rare. [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. If the force is too strong, the ligaments can tear. A p-value of 0.05 was considered statistically significant. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. MCP (MetaCarpophalangeal) Collateral Ligament Sprain PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics Orthopedics. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 10. 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. This damage may lead to temporary or permanent numbness or weakness. Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) The authors report no funding or conflicts of interest. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. J Bone Joint Surg Am. eCollection 2021 Apr. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 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. Surgical management of chronic, 42. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Ulnar Collateral Ligament (UCL) Injuries of the Elbow The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. In some cases, certain risk factors make it more likely that a bone will fail to heal. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. The anti edema management will continue for several weeks. Epub 2014 Dec 30. 13. A score of 0 was assigned if the item was either omitted or not performed. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist Wolters Kluwer Health, Inc. and/or its subsidiaries. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. Thumb collateral ligament injuries. 17. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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.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.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Base of Thumb Fractures - Hand - Orthobullets Data range was reported as minimum to maximum absolute values. [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. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 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. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. Objectives: There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. 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. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. If you log out, you will be required to enter your username and password the next time you visit. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 18. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). the splint for protection or at night until twelve weeks after the operation. 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. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. MLB - Inside Mike Trout's thumb procedure, recovery process - ESPN.com This article provides a review of . 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. Please enter a Recipient Address and/or check the Send me a copy checkbox. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). Educate the patient on anti edema management. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. [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. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. There is currently no consensus on treatment of acute or chronic UCL injuries. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery FOIA Thumb Ulnar Collateral Ligament repair; A Step by Step Guide All techniques improved clinical outcomes, including pain, motion, strength, and stability. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. 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. PIP Joint Injuries of the Finger - Orthogate 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. The Orthopedic Journal of Sports Medicine. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). Louis DS, Huebner JJ Jr, Hankin FM. If the latter was executed only partially, a score of 1 was assigned. government site. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Quantitative outcome of surgical repair. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Complications after this procedure may include nerve or blood vessel damage. 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. [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. Complications you may experience after Hand Surgery - Rebecca Ayers Injury. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. J Hand Surg Glob Online. 1992;8:713732. A broken thumb can also cause numbness or tingling. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. For more information, please refer to our Privacy Policy. 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. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Meta-analysis of the pooled data was completed. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube 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. Federal government websites often end in .gov or .mil. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Arthritis Rheum. There are some cases where the fusion is not successful and you will still have pain in . Am J Sports Med. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape If the tear is diagnosed later a ligament reconstruction might be a better option. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Keyword Highlighting 23. 2013;23(4):247-254. PMC Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Am J Orthop (Belle Mead NJ). Nonunions - OrthoInfo - AAOS The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 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. The overall complication rate was 13.8% (11/80). 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. You are being redirected to Medscape Education. All but 2 were level IV evidence. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. 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. SAGE Open Med. You will receive email when new content is published. Part I: anatomy and diagnosis. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. 2003;8:8185. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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.15,39 It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.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. 1989;14:567573. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Eurasian J Med. Unable to load your collection due to an error, Unable to load your delegates due to an error. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. The range of motion of the MP joint of the thumb following operative repair of the. PMC POST-OPERATIVE WEEKS 22-24. unstable when the thumb is used. eCollection 2021. 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 Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Accessibility A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. You may search for similar articles that contain these same keywords or you may There is currently no consensus on treatment of acute or chronic UCL injuries. 1996;25:474477. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 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. 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). Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. If it is appropriate, then surgical consent probably happened before the surgery. 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. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) A secondary purpose was to compare graft choice and surgical technique for reconstruction. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed Would you like email updates of new search results? Sports Med Arthrosc Rev. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 1989;71:383387. 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*.