complications after ucl repair of thumb

Educate the patient on anti edema management. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Meta-analysis of the pooled data was completed. J Bone Joint Surg Am. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. UCLR case series that contained complications data were included. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 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. I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. 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. Some error has occurred while processing your request. Keyword Highlighting Thumb collateral ligament injuries. 24. Nonoperative treatment often failed, necessitating surgery. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). A score of 0 was assigned if the item was either omitted or not performed. 2009;61:623632. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. A secondary purpose was to compare graft choice and surgical technique for reconstruction. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. J Hand Surg Br. Highlight selected keywords in the article text. 12. Accessibility Clinical Journal of Sport Medicine23(4):247-254, July 2013. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 1995;23:222226. Complications after surgical treatment of UCL injury are rare. 2006;31:6875. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Figure 46-2 Approach to the ulnar collateral ligament. 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. No study reported the outcomes of nonoperative management of chronic UCL injury. 8. If it is appropriate, then surgical consent probably happened before the surgery. 2013Lippincott Williams & Wilkins. Thumb sidedness reported in 3 studies (51 thumbs). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". The mean time from reported injury date to surgery was 202.4 days (2-5969). 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. Wolters Kluwer Health, Inc. and/or its subsidiaries. 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. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. doi: 10.1016/j.asmr.2020.12.004. 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. Riederer S, Nagy L, Buchler U. modify the keyword list to augment your search. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 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 surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. If your bone is broken, a pin will be used to put it in place. Mean study follow-up was 42.8 months. Federal government websites often end in .gov or .mil. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. *Glickel grading scale. Clin J Sport Med. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Wolters Kluwer Health 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. 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. Study design: Please enter a Recipient Address and/or check the Send me a copy checkbox. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. 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%). eCollection 2022 May. Symptoms are dependent on the cause and severity of injury to the UCL. Before Acute gamekeeper's thumb. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. and transmitted securely. 38. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Van Dommelen BA, Zvirbulis RA. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. 6. Melone CP Jr, Beldner S, Basuk RS. 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. An official website of the United States government. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Bostock S, Morris MA. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. All rights reserved. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 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. government site. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Subject demographics are reported in Table 2. PMC Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 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. The .gov means its official. There were 200 acute injuries and 93 chronic injuries. Your surgeon will discuss these options with you. 19. Arthrosc Sports Med Rehabil. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Am J Sports Med. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Epub 2021 Sep 7. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 10. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 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. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. 8600 Rockville Pike The authors report no funding or conflicts of interest. Upper extremity injuries in snow skiers. Search for Similar Articles 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 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. Instability of the metacarpophalangeal joint of the thumb. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. HHS Vulnerability Disclosure, Help 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. 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. 2009;34:304308. J Bone Joint Surg Am. 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. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. A score of 2 was assigned if the item was completely and accurately performed and reported. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. FOIA This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . [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. 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. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Weakened grip or reduced thumb range of motion may occur. The effect of thumb metacarpophalangeal. 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. 3. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). A broken thumb can also cause numbness or tingling. Complications after surgery were rare. Proximal interphalangeal joint injuries of the hand. Injuries to the PIP joint remain swollen for long periods of time. may email you for journal alerts and information, but is committed 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. Bean CH, Tencer AF, Trumble TE. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. 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. These exercises may be directed by a physical or occupational therapist. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 15. Hand Clin. Fusetti C, Papaloizos M, Meyer H, et al.. 1999;24:7075. 1989;14:567573. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 2. *Gender reported in 12 studies (218 subjects). Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. The site is secure. 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. UCLR case series that contained complications data were included. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Thirty-two thumbs were treated nonoperatively and 261 operatively. You will receive email when new content is published. 7. Search performed on November 17, 2011. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Eurasian J Med. Your surgeon is the person best able to help you avoid any serious recovery problems. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. This damage may lead to temporary or permanent numbness or weakness. 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. The injury involves the ulnar collateral ligament (UCL) of the thumb. The mean patient age was 37.8 years (14.0-78.1). Am J Sports Med. Gamekeeper's thumb. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. Careers.

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