complications after ucl repair of thumb

This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Instability of the metacarpophalangeal joint of the thumb. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Because patients can start moving the thumb within days, it also mitigates some of the negative consequences of prolonged immobilization, such as stiffness and muscle atrophy. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Am. There is currently no consensus on treatment of acute or chronic UCL injuries. Thumb collateral ligament injuries. PMC [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. 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. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 1996;25:527530. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. All but 2 were level IV evidence. HHS Vulnerability Disclosure, Help UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Objectives: 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. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. The Orthopedic Journal of Sports Medicine. Your message has been successfully sent to your colleague. All rights reserved. 1962;124:396411. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Categorical variable data were reported as frequency with percentages. 12. [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]. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Unauthorized use of these marks is strictly prohibited. Federal government websites often end in .gov or .mil. Would you like email updates of new search results? If you log out, you will be required to enter your username and password the next time you visit. 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. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation 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. 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. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Am J Orthop (Belle Mead NJ). Commonly, the joint will be permanently enlarged due to the scarring of the healing process. POST-OPERATIVE WEEKS 22-24. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Please try again soon. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. 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 pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. The injury involves the ulnar collateral ligament (UCL) of the thumb. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Bailie DS, Benson LS, Marymont JV. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Sports Med Arthrosc Rev. Mean study follow-up was 42.8 months. 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. The grip strength and the pinch strength were 94.3% and 92.27%,. Early and late postoperative complications were recorded. 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. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Unilateral injuries: 291 and bilateral injury: 1. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Acta Chir Scand. Upper extremity injuries in snow skiers. Arthrosc Sports Med Rehabil. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Kaplan EB. No study reported the outcomes of nonoperative management of chronic UCL injury. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Benson LS, Bailie DS. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Clin J Sport Med. 1,5,9,10 In acute cases of complete tears involving high-level . 1993;21:800804. 19. A sprained thumb is a common injury among athletes. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Search for Similar Articles 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 sidedness reported in 3 studies (51 thumbs). The site is secure. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. FOIA Part I: anatomy and diagnosis. Keyword Highlighting Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. This site needs JavaScript to work properly. Complications after this procedure may include nerve or blood vessel damage. 1987;214:113120. the thumb. **Stener lesion status reported in 6 studies (145 thumbs). Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. These tears often occur as a result of a radially directed force on an extended thumb. Eventually this abnormal movement will wear out the joint and it will become arthritic. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Complications after surgery were rare. 33. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Muscles. Hand Surg. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 36. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. NR, not reported. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. In these cases, a new graft may be used to perform a second reconstruction. Van Dommelen BA, Zvirbulis RA. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 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. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. 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. 10. J Hand Surg Glob Online. 14. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Your thumb will be immobilized in a splint and should not be moved until follow up. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Early diagnosis and treatment. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. History. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Accessibility In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. National Library of Medicine After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. Eurasian J Med. Subject demographics are reported in Table 2. 2006;31:6875. Sports Health. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. Metacarpophalangeal joint injuries of the thumb. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 4. 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. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 1989;17:751753. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Surgical management of chronic, 42. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). [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. The .gov means its official. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.32 The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.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. Wolters Kluwer Health, Inc. and/or its subsidiaries. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. You may be trying to access this site from a secured browser on the server. These exercises may be directed by a physical or occupational therapist. Please try after some time. Quantitative outcome of surgical repair. UCLR case series that contained complications data were included. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. In some cases, certain risk factors make it more likely that a bone will fail to heal. Proximal interphalangeal joint injuries of the hand. Thus, the true natural history is yet unknown. 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 systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. MCP fusion was performed . 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There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. abduction-adduction motion. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. This article provides a review of . sharing sensitive information, make sure youre on a federal your express consent. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. If your bone is broken, a pin will be used to put it in place. Sixty nine (86.3%) patients had grade 3 tears. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Background: Pain reduction was significantly improved in all subjects (P < 0.05). 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. 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. The https:// ensures that you are connecting to the Figure 46-2 Approach to the ulnar collateral ligament. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. For example, it can be removed when performing . The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. FOIA Melone CP Jr, Beldner S, Basuk RS. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. Nonoperative treatment often failed, necessitating surgery. 2009;61:623632. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. government site. 24. 6. 2009;6:e1000097. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. The .gov means its official. 2. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. 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). A secondary purpose was to compare graft choice and surgical technique for reconstruction. Only prospective studies can determine this injury course. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 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%. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). The limitations of this systematic review are reliant on the studies analyzed. 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%.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. Part II: treatment and complications. 2005;87:26322638. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . 27. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. 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. Post-traumatic 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).

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complications after ucl repair of thumb

complications after ucl repair of thumb