complications after ucl repair of thumb

Epub 2014 Dec 30. UCLR case series that contained complications data were included. [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. modify the keyword list to augment your search. 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. 8600 Rockville Pike 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. Thumb collateral ligament injuries. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 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. If the latter was executed only partially, a score of 1 was assigned. Only prospective studies can determine this injury course. 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. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 27. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. eCollection 2021 Mar. All but 2 were level IV evidence. 31. If the latter was executed only partially, a score of 1 was assigned. Bailie DS, Benson LS, Marymont JV. Ulnar Collateral Ligament Repair . 25. Search for Similar Articles [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 2009;34:304308. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 2. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Am J Sports Med. Part I: anatomy and diagnosis. 2018;6(4):1-7. Background: 5. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. This website also contains material copyrighted by 3rd parties. Range of motion returns much sooner, too. MeSH Am 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). There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. J Bone Joint Surg Am. 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. Jackson M, McQueen MM. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. The injury involves the ulnar collateral ligament (UCL) of the thumb. Ulnar Collateral Ligament Repair and Reconstruction When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Studies that duplicated patient populations from the same authors were excluded. Meta-analysis of the pooled data was completed. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 12. J Hand Surg Br. 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 . 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. If the tear is diagnosed later a ligament reconstruction might be a better option. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Fusetti C, Papaloizos M, Meyer H, et al.. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Moher D, Liberati A, Tetzlaff J, et al.. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Careers. Fourteen articles were included and analyzed (293 thumbs). 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. The LUCL is located on the lateral or outside part of the elbow. 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. 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. Arthritis Rheum. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. There were 200 acute injuries and 93 chronic injuries. For example, it can be removed when performing . 2022 Mar 1;30(1):e1-e8. *Glickel grading scale. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery Causes. Hand Surgery Recovery Time: Pain, Exercise & Complications This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". A score of 0 was assigned if the item was either omitted or not performed. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Muscles. 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. 23. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 1. 1989;14:567573. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. 13. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. *Glickel grading system. Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. You've successfully added to your alerts. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics I was able to work while wearing the splint. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 6. 1976;58:106112. Accessibility A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Hand Clin. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Clipboard, Search History, and several other advanced features are temporarily unavailable. unstable when the thumb is used. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. 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. Doi: 10.1177/2325967118769328. Commonly Missed Orthopedic Problems | AAFP PLoS Med. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . All but 2 were level IV evidence. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Upper extremity injuries in snow skiers. better/same/worse than preoperative status). 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. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 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. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Bean CH, Tencer AF, Trumble TE. There were 61 studies eliminated as secondary for being in a language other than English. Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. You may also begin strengthening exercises if needed. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Categorical variable data were reported as frequency with percentages. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Epub 2014 Oct 22. Part II: treatment and complications. Before Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Am J Orthop (Belle Mead NJ). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. A broken thumb can also cause numbness or tingling. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Nonoperative treatment often failed, necessitating surgery. PIP Joint Injuries of the Finger - Orthogate Figure 46-2 Approach to the ulnar collateral ligament. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Am J Sports Med. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Orthopedics. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 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). No study directly compared the different types of graft for UCL reconstruction. Disclaimer. Injuries to the PIP joint remain swollen for long periods of time. Disclaimer. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. official website and that any information you provide is encrypted Proximal interphalangeal joint injuries of the hand. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. MeSH Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). In general, be guided by symptoms and if an activity hurts, it is probably best avoided. All authors independently performed the search. 1,5,9,10 In acute cases of complete tears involving high-level . Please try after some time. 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]). MCP collateral ligament sprain is most commonly an acute injury related to trauma. 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). 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. J Hand Surg Am. 1996;25:527530. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 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%). 32. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 35. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 1995;23:222226. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Orthop Rev. It runs from the outer humerus, around the radial head and attaches to the ulna. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. At this stage, patients should be advised to wear your splint part-time. You will receive email when new content is published. Clin Orthop Relat Res. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery An anatomic basis for treatment. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Your surgeon will discuss these options with you. 37. Careers. Midterm clinical outcomes of collateral ligament repair of the thumb [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. 8. 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. Epub 2021 Jan 18. Ulnar Collateral Ligament (UCL) Injuries of the Elbow Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Early diagnosis and treatment. 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. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. 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*.

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