complications after ucl repair of thumb complications after ucl repair of thumb

Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Unable to load your collection due to an error, Unable to load your delegates due to an error. 31. A score of 2 was assigned if the item was completely and accurately performed and reported. 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). Sports Med Arthrosc Rev. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Disclaimer. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Before 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. [31] The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. All rights reserved. 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. 38. Both purely ligamentous and bony avulsion injuries were included. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Complications after surgical treatment of UCL injury are rare. eCollection 2022 May. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Unable to load your collection due to an error, Unable to load your delegates due to an error. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. 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%). 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. Nonoperative treatment often failed, necessitating surgery. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Stretching or even a rupture of the graft is also possible. 2013;23(4):247-254. There is currently no consensus on treatment of acute or chronic UCL injuries. Meta-analysis of the pooled data was completed. 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. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 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. 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. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. If you log out, you will be required to enter your username and password the next time you visit. The anti edema management will continue for several weeks. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 16. 10. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. official website and that any information you provide is encrypted Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. Louis DS, Huebner JJ Jr, Hankin FM. Rupture and displacement of the. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. It runs from the outer humerus, around the radial head and attaches to the ulna. 1. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 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. [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. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). The injury involves the ulnar collateral ligament (UCL) of the thumb. Complications after this procedure may include nerve or blood vessel damage. [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. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Please enable it to take advantage of the complete set of features! 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. unstable when the thumb is used. 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. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Weakened grip or reduced thumb range of motion may occur. 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. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Thumb dominance reported in 8 studies (168 thumbs). 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. 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. [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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. J Bone Joint Surg Am. Mean subject age was 33.9 years. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 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. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. They may even tear completely. 2022 Mar 1;30(1):e1-e8. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). 1976;58:106112. sharing sensitive information, make sure youre on a federal Please enable it to take advantage of the complete set of features! Studies that duplicated patient populations from the same authors were excluded. Arthrosc Sports Med Rehabil. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. The https:// ensures that you are connecting to the J Hand Surg Br. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . For more information, please refer to our Privacy Policy. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. A sprained thumb is a common injury among athletes. Wong TC, Ip FK, Wu WC. Am J Orthop (Belle Mead NJ). Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. SAGE Open Med. The LUCL is located on the lateral or outside part of the elbow. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . If the force is too strong, the ligaments can tear. government site. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Results: 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. 24. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. You may search for similar articles that contain these same keywords or you may Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. 25. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. 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. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. 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. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. PLoS Med. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Subject demographics are reported in Table 2. Thirty-two thumbs were treated nonoperatively and 261 operatively. the thumb. the splint for protection or at night until twelve weeks after the operation. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Kaplan EB. 37. 39. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. Your thumb will be immobilized in a splint and should not be moved until follow up. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. 1989;14:567573. History. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Data is temporarily unavailable. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. 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. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 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. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. abduction-adduction motion. Fourteen articles were included and analyzed (293 thumbs). Only prospective studies can determine this injury course. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Epub 2015 Sep 22. Would you like email updates of new search results? Instability of the metacarpophalangeal joint of the thumb. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. 2. 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. 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.