Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. J Hand Surg Am. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. 1989;17:751753. A broken thumb can also cause numbness or tingling. [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. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 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. better/same/worse than preoperative status). Throwing status reported in 4 studies. 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. What Happens If We Sit for More Than 8 Hours Per Day? sharing sensitive information, make sure youre on a federal Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. You may be trying to access this site from a secured browser on the server. 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%. Epub 2014 Oct 22. Sixty nine (86.3%) patients had grade 3 tears. 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. NR, not reported. There were no cases of intraoperative ulnar nerve injury reported. I was able to work while wearing the splint. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. 2000;16:345357. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Descriptive statistics were calculated. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. 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. Pain reduction was significantly improved in all subjects (P < 0.05). Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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. You are being redirected to Medscape Education. Am J Orthop (Belle Mead NJ). 27. J Hand Surg Am. Orthop Clin North Am. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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*. Acute gamekeeper's thumb. three muscles provide deforming forces at the base of the thumb. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. J Bone Joint Surg Am. 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. 11. Epub 2013 Nov 12. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. If the tear is diagnosed later a ligament reconstruction might be a better option. [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. All but 2 were level IV evidence. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 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. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. 14. Various levels of pain, bruising, or edema may present at the site of damage. government site. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. 1961;43-A:541546. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Early and late postoperative complications were recorded. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 8600 Rockville Pike Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. eCollection 2021 Apr. Methods: Please confirm that you would like to log out of Medscape. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 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. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 22. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Proximal interphalangeal joint injuries of the hand. Bennet Fracture. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Upper extremity injuries in snow skiers. Systematic review and meta-analysis. 13. 2. Pichora DR, McMurtry RY, Bell MJ. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Some error has occurred while processing your request. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. When assessed, most patients returned to their preinjury employment. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Background: The injury involves the ulnar collateral ligament (UCL) of the thumb. You may also begin strengthening exercises if needed. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Please enable it to take advantage of the complete set of features! No study compared different graft types or fixation techniques. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Please try after some time. sharing sensitive information, make sure youre on a federal Furthermore, it is interesting that our study quality results using the Quality Appraisal Tool were as low as they were (mean 54% with a range of 33%-79%). This site needs JavaScript to work properly. Disclaimer. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. National Library of Medicine may email you for journal alerts and information, but is committed 1994;23:797804. 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. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. The mean time from reported injury date to surgery was 202.4 days (2-5969). 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. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. [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]. Treatment of chronic injuries of the. Please enter a Recipient Address and/or check the Send me a copy checkbox. Eventually this abnormal movement will wear out the joint and it will become arthritic.