It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 16. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. 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. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Please try after some time. A systematic review of ulnar collateral ligament reconstruction techniques. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery PDF Ulnar Collateral Ligament (UCL) Injury and Surgical Repair to the Thumb [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Engelhardt JB, Christensen OM, Christiansen TG. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Conclusion: Ulnar Nerve Complications After Ulnar Collateral Ligament - PubMed J Hand Surg Am. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. J Hand Surg Br. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Nonunions - OrthoInfo - AAOS The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 12. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair Orthop Clin North Am. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". All but 2 were level IV evidence. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. There is currently no consensus on treatment of acute or chronic UCL injuries. Sakellarides HT, DeWeese JW. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. The overall complication rate was 13.8% (11/80). 8600 Rockville Pike 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. Thumb Ulnar Collateral Ligament repair; A Step by Step Guide 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 . The range of motion of the MP joint of the thumb following operative repair of the. Catalano LW III, Cardon L, Patenaude N, et al.. Subject demographics are reported in Table 2. Complications of Ulnar Collateral Ligament Repair | SpringerLink 1995;23:222226. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Please enable scripts and reload this page. Dr. Holt will talk to you about when it is safe to return to work. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 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. Disclaimer. Melone CP Jr, Beldner S, Basuk RS. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. *Glickel grading scale. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1989;17:751753. Am J Sports Med. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 1994;23:797804. 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. Hand Surg. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.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.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. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Thumb dominance reported in 8 studies (168 thumbs). 31. 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). Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. This site needs JavaScript to work properly. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Benson LS, Bailie DS. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. You are being redirected to Medscape Education. No study directly compared nonoperative to operative treatment. may email you for journal alerts and information, but is committed
Conclusions: Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 1992;8:713732. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 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. 7. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. This website also contains material copyrighted by 3rd parties. Federal government websites often end in .gov or .mil.