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. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. At this stage, patients should be advised to wear your splint part-time. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. eCollection 2021 Mar. 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 . Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Possible complications include: - Fourteen articles were included and analyzed (293 thumbs). Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Thus, the true natural history is yet unknown. To date, no literat. When assessed, most patients returned to their preinjury employment. MCP collateral ligament sprain is most commonly an acute injury related to trauma. [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. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 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. Long-term results of ligament reconstruction. 1999;24:275282. If your bone is broken, a pin will be used to put it in place. Tension wire fixation of avulsion fractures in the hand. Federal government websites often end in .gov or .mil. The site is secure. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 3. The Orthopedic Journal of Sports Medicine. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. This leads to what is know as a positive ulnar variance. Bethesda, MD 20894, Web Policies 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. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). doi: 10.1097/JSA.0000000000000322. 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. Results: One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. No study directly compared nonoperative to operative treatment. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Thus, the true natural history is yet unknown. There were 200 acute injuries and 93 chronic injuries. Injury. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Systematic review and meta-analysis. He too had the internal brace augmentation. 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. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. 7. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 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). HHS Vulnerability Disclosure, Help Kuz JE, Husband JB, Tokar N, et al.. 1976;58:106112. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 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). Some error has occurred while processing your request. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Studies that duplicated patient populations from the same authors were excluded. MeSH It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Hand Clin. [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. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. three muscles provide deforming forces at the base of the thumb. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Sports Med Arthrosc Rev. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Bennet Fracture. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. You may be trying to access this site from a secured browser on the server. Am J Sports Med. What are the symptoms of GameKeeper's Thumb? Complications after this procedure may include nerve or blood vessel damage. 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. J Hand Surg Br. 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. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Complications after surgical treatment of UCL injury are rare. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 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. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 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. This article provides a review of . An official website of the United States government. 14. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . Stener B. Skeletal injuries associated with rupture of the. Conclusion: When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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. Continuous variable data were reported as mean SDs from the mean. You may search for similar articles that contain these same keywords or you may The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). History. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). NR, not reported. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Diagnosis of displaced, 43. This site needs JavaScript to work properly. 45. The LUCL is located on the lateral or outside part of the elbow. official website and that any information you provide is encrypted It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). Melone CP Jr, Beldner S, Basuk RS. Educate the patient on anti edema management. Complications after surgical treatment of UCL injury are rare. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. SYMPTOMS: The thumb may be swollen, bruised and painful. Please try again soon. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. For more information, please refer to our Privacy Policy.
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