complications after ucl repair of thumb
Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. National Library of Medicine Methods: If you log out, you will be required to enter your username and password the next time you visit. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 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. Arnold DM, Cooney WP, Wood MB. Riederer S, Nagy L, Buchler U. 10. Clin J Sport Med. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. Muscles. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Systematic review and meta-analysis. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Complications after surgical treatment of UCL injury are rare. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. MeSH 1989;71:383387. The overall complication rate was 13.8% (11/80). Please use this form to submit your questions or comments on how to make this article more useful to clinicians. If it is appropriate, then surgical consent probably happened before the surgery. Epub 2020 Jun 29. This leads to what is know as a positive ulnar variance. Wolters Kluwer Health 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. Acute gamekeeper's thumb. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Mean subject age was 33.9 years. Accessibility Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 14. He too had the internal brace augmentation. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 1987;214:113120. Clipboard, Search History, and several other advanced features are temporarily unavailable. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Jupiter JB, Sheppard JE. 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. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. eCollection 2021 Apr. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). eCollection 2022 May. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Thirty-two thumbs were treated nonoperatively and 261 operatively. Conclusion: 22. 27. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Hand Clin. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Louis DS, Huebner JJ Jr, Hankin FM. 2022 Mar 1;30(1):e1-e8. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 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. Before 23. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 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). and transmitted securely. 1995;18:11611165. Wolters Kluwer Health, Inc. and/or its subsidiaries. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 2021 Apr 15;3(2):e527-e533. 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. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 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. 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. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. If the tear is diagnosed early a repair will be possible. the splint for protection or at night until twelve weeks after the operation. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). In some cases, certain risk factors make it more likely that a bone will fail to heal. 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%). 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Please enter a Recipient Address and/or check the Send me a copy checkbox. Evaluation and management of elbow injuries in the adolescent overhead athlete. To date, no literat. 1995;23:222226. Am J Sports Med. 45. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Only prospective studies can determine this injury course. Dr. Holt will talk to you about when it is safe to return to work. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Complications after surgery were rare. J Hand Surg Am. 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. 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. Both repair and reconstruction (autograft and allograft) techniques were inclusive. SAGE Open Med. Pichora DR, McMurtry RY, Bell MJ. The range of motion of the MP joint of the thumb following operative repair of the. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Your message has been successfully sent to your colleague. 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%). Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. Orthop Clin North Am. 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 . 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. *Gender reported in 12 studies (218 subjects). Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Gamekeeper's thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 1999;24:7075. Abrahamsson SO, Sollerman C, Lundborg G, et al.. J Bone Joint Surg Am. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. When assessed, most patients returned to their preinjury employment. 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. 2003;8:8185. 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. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Unable to load your collection due to an error, Unable to load your delegates due to an error. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. Eventually this abnormal movement will wear out the joint and it will become arthritic. Only prospective studies can determine this injury course. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 3. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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 .