complications after ucl repair of thumbthomas jefferson university hospital leadership

2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Early diagnosis and treatment. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 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. 1989;17:751753. Exercises: Gradually progress to competitive throwing and sports . 34. Federal government websites often end in .gov or .mil. 26. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 1977;59:1421. A common complication following fracture of the distal radius is when the radius shortens. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb Patient Demographics of Thumb RCL and UCL Injuries. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 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%). J Bone Joint Surg Am. 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. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1994;23:797804. Dr. Holt will talk to you about when it is safe to return to work. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. 16. three muscles provide deforming forces at the base of the thumb. In some cases, certain risk factors make it more likely that a bone will fail to heal. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. to maintaining your privacy and will not share your personal information without doi: 10.1097/JSA.0000000000000322. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. No study directly compared the different types of graft for UCL reconstruction. Please try after some time. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. There is currently no consensus on treatment of acute or chronic UCL injuries. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Clinical Journal of Sport Medicine23(4):247-254, July 2013. This site needs JavaScript to work properly. J Bone Joint Surg Am. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. The Orthopedic Journal of Sports Medicine. 1. Wong TC, Ip FK, Wu WC. Descriptive statistics were calculated. 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. 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%). Commonly Missed Orthopedic Problems | AAFP The doctor won't know if the repair is . Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. The site is secure. Am J Sports Med. When assessed, most patients returned to their preinjury employment. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . Thumb Sprain (Ulnar Collateral Ligament (UCL) Injury of Thumb) There were no cases of intraoperative ulnar nerve injury reported. Meta-analysis of the pooled data was completed. Please enter a Recipient Address and/or check the Send me a copy checkbox. J Bone Joint Surg Am. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. What are the symptoms of GameKeeper's Thumb? government site. This leads to what is know as a positive ulnar variance. PDF UVA HAND CENTER - THERAPY - University of Virginia School of Medicine Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . 2018;6(4):1-7. 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. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). Stener B. Skeletal injuries associated with rupture of the. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Orthop Rev. 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. and twist using your thumb. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. Educate the patient on anti edema management. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . The authors report no funding or conflicts of interest. National Library of Medicine A sprained thumb is a common injury among athletes. Epub 2014 Dec 30. Unauthorized use of these marks is strictly prohibited. These exercises may be directed by a physical or occupational therapist. Conclusions: Epub 2014 Oct 22. The injury involves the ulnar collateral ligament (UCL) of the thumb. This website also contains material copyrighted by 3rd parties. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 1996;25:527530. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic Subject demographics are reported in Table 2. A score of 0 was assigned if the item was either omitted or not performed. 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. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Continuous variable data were reported as mean SDs from the mean. Kaplan EB. Data is temporarily unavailable. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). 8600 Rockville Pike This site needs JavaScript to work properly. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 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). The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Ulnar collateral ligament injuries of the thumb: a comprehensive review. Skier's thumb - Physiopedia The range of motion of the MP joint of the thumb following operative repair of the. sharing sensitive information, make sure youre on a federal Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Am J Sports Med. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. The limitations of this systematic review are reliant on the studies analyzed. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Hand Surg. Please confirm that you would like to log out of Medscape. Thus, the true natural history is yet unknown. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair 1994;25:2123. There is currently no consensus on treatment of acute or chronic UCL injuries. Rupture of the. Please enable it to take advantage of the complete set of features! 32. 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. 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). 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 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. Accessibility Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. 35. J Hand Surg Am. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Complications after surgery were rare. Continue to stretch before and after throwing . 1989;14:567573. Results: 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. 1,5,9,10 In acute cases of complete tears involving high-level . For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Arthritis Rheum. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 33. Kuz JE, Husband JB, Tokar N, et al.. A score of 0 was assigned if the item was either omitted or not performed. Long-term results of ligament reconstruction. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. 31. Unilateral injuries: 291 and bilateral injury: 1. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. modify the keyword list to augment your search. [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. 37. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 2022 Mar 1;30(1):e1-e8. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complications Following Distal Radius Fractures - Mike Reinold 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. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist UCL Repair of the Thumb - MSA Hand Center Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. The anti edema management will continue for several weeks. FOIA Downey DJ, Moneim MS, Omer GE Jr. 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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. There were 200 acute injuries and 93 chronic injuries. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. An official website of the United States government. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction Catalano LW III, Cardon L, Patenaude N, et al.. Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 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 application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. MCP fusion was performed . Midterm clinical outcomes of collateral ligament repair of the thumb The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. The Complications of CMC Thumb Surgery | Healthy Living 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%. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Injuries to the PIP joint remain swollen for long periods of time. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). [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. UCLR case series that contained complications data were included. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. [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. What Happens If We Sit for More Than 8 Hours Per Day? HHS Vulnerability Disclosure, Help Part I: anatomy and diagnosis. Clin Orthop Relat Res. 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%). Am J Sports Med. Purpose: Engelhardt JB, Christensen OM, Christiansen TG. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Base of Thumb Fractures - Hand - Orthobullets Thumb from the common mechanism of falling on the thumb while holding a ski pole. Ulnar Collateral Ligament Injuries of the Thumb - Orthogate Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 2009;61:623632. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. There were 61 studies eliminated as secondary for being in a language other than English. Doi: 10.1177/2325967118769328. 8. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Frykman G, Johansson O. Surgical repair of rupture of the, 46. The https:// ensures that you are connecting to the Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up.

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