Clin J Sport Med. Stener B. Skeletal injuries associated with rupture of the. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Epub 2014 Oct 22. 2005;87:26322638. If the tear is diagnosed early a repair will be possible. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Abrahamsson SO, Sollerman C, Lundborg G, et al.. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Disclaimer. Downey DJ, Moneim MS, Omer GE Jr. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Epub 2014 Dec 30. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Quantitative outcome of surgical repair. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. 10. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Arthrosc Sports Med Rehabil. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. 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. I was able to work while wearing the splint. 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. [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. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 1994;25:2123. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 3. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Treatment of chronic injuries of the. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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. Metacarpophalangeal joint injuries of the thumb. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Continue to stretch before and after throwing . Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. sharing sensitive information, make sure youre on a federal Part I: anatomy and diagnosis. In some cases, certain risk factors make it more likely that a bone will fail to heal. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Muscles. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. You may also begin strengthening exercises if needed. Kozin SH, Bishop AT. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. The grip strength and the pinch strength were 94.3% and 92.27%,. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Conclusions: 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. You may search for similar articles that contain these same keywords or you may There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Federal government websites often end in .gov or .mil. [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. Acute gamekeeper's thumb. [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. Only prospective studies can determine this injury course. NR, not reported. Doi: 10.1177/2325967118769328. 6. Sakellarides HT, DeWeese JW. 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. [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. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Am J Sports Med. 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. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. 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. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. There were no cases of intraoperative ulnar nerve injury reported. sharing sensitive information, make sure youre on a federal Am J Orthop (Belle Mead NJ). Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Purpose. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Surgical management of chronic, 42. If the latter was executed only partially, a score of 1 was assigned. 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). 1961;43-A:541546. Click the topic below to receive emails when new articles are available.

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