Acute gamekeeper's thumb. 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 . Bailie DS, Benson LS, Marymont JV. Your surgeon will discuss these options with you. 2005;24:217221. Kuz JE, Husband JB, Tokar N, et al.. Symptoms are dependent on the cause and severity of injury to the UCL. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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. Louis DS, Huebner JJ Jr, Hankin FM. Conflicts of interest The authors report no funding or conflicts of interest. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Click the topic below to receive emails when new articles are available. The .gov means its official. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 21. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 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. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. 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. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 1989;17:751753. 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.. [30] The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles. Bostock S, Morris MA. Early and late postoperative complications were recorded. Data sources: three muscles provide deforming forces at the base of the thumb. 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. Descriptive statistics were calculated. Mechanism of injury to the RCL of the MCP joint of the thumb is force . Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. 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. 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. 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. 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. 44. Purpose: *Glickel grading scale. Eurasian J Med. 2018;6(4):1-7. No study reported the outcomes of nonoperative management of chronic UCL injury. A p-value of 0.05 was considered statistically significant. J Bone Joint Surg Am. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Orthop Rev. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery 45. 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. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. The injury happens when you fall . Federal government websites often end in .gov or .mil. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Keyword Highlighting Please use this form to submit your questions or comments on how to make this article more useful to clinicians. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. Keywords: Accessibility Please try again soon. 31. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. 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. This article provides a review of . 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. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. 19. 1996;25:474477. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. 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. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. For example, it can be removed when performing . Background: [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. 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. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Bennet Fracture. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 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.
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