To date, no literat. Bailie DS, Benson LS, Marymont JV. 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. Thumb from the common mechanism of falling on the thumb while holding a ski pole. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. eCollection 2021 Mar. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Injury. Purpose: Possible complications include: - I was able to work while wearing the splint. Part I of this two-part article focuses on common tendon and . PLoS Med. Bookshelf 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. The grip strength and the pinch strength were 94.3% and 92.27%,. Am J Sports Med. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The injury involves the ulnar collateral ligament (UCL) of the thumb. Conflicts of interest The authors report no funding or conflicts of interest. 8. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 2003;8:8185. Quantitative outcome of surgical repair. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Weakened grip or reduced thumb range of motion may occur. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Symptoms are dependent on the cause and severity of injury to the UCL. Smith RJ. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Metacarpophalangeal joint injuries of the thumb. A score of 0 was assigned if the item was either omitted or not performed. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Surgical management of chronic, 42. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . 11. 37. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Eventually this abnormal movement will wear out the joint and it will become arthritic. Mechanism of injury to the RCL of the MCP joint of the thumb is force . All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 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. Eurasian J Med. A score of 2 was assigned if the item was completely and accurately performed and reported. Gamekeeper's thumb. Clipboard, Search History, and several other advanced features are temporarily unavailable. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. [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. Kuz JE, Husband JB, Tokar N, et al.. government site. If you log out, you will be required to enter your username and password the next time you visit. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). The range of motion of the MP joint of the thumb following operative repair of the. [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. Kozin SH, Bishop AT. Thirty-two thumbs were treated nonoperatively and 261 operatively. Thumb dominance reported in 8 studies (168 thumbs). 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. Am J Sports Med. Complications after surgical treatment of UCL injury are rare. 17. 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]). Epub 2014 Dec 30. 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. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Orthop Clin North Am. 18. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Am J Sports Med. 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). 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. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 2000;16:345357. Figure 46-2 Approach to the ulnar collateral ligament. 8600 Rockville Pike The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Melone CP Jr, Beldner S, Basuk RS. Thirty-two thumbs were treated nonoperatively and 261 operatively. 25. The authors report no funding or conflicts of interest. Thus, the true natural history is yet unknown. The https:// ensures that you are connecting to the HHS Vulnerability Disclosure, Help There were 61 studies eliminated as secondary for being in a language other than English. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. [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. 26. 3. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Evaluation and management of elbow injuries in the adolescent overhead athlete. There were 200 acute injuries and 93 chronic injuries. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Throwing status reported in 4 studies. 12. No study directly compared nonoperative to operative treatment. You may also begin strengthening exercises if needed. 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 . 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%). Mean subject age was 33.9 years. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. 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. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Complications after this procedure may include nerve or blood vessel damage. 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. Would you like email updates of new search results? 2013;23(4):247-254.