complications after ucl repair of thumb

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. Jackson M, McQueen MM. 45. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Bennet Fracture. [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. Part II: treatment and complications. 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. 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). J Hand Surg Glob Online. 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. The https:// ensures that you are connecting to the MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 23. Upper extremity injuries in snow skiers. [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. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. If the latter was executed only partially, a score of 1 was assigned. Only prospective studies can determine this injury course. sharing sensitive information, make sure youre on a federal eCollection 2021 Mar. Moher D, Liberati A, Tetzlaff J, et al.. Orthop Clin North Am. 2018;6(4):1-7. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Thus, the true natural history is yet unknown. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 31. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 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%). ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Mean study follow-up was 42.8 months. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 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. Bailie DS, Benson LS, Marymont JV. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. 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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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 . Gamekeeper's thumb. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 10. This site needs JavaScript to work properly. 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. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 8600 Rockville Pike 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 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. Arnold DM, Cooney WP, Wood MB. 2009;34:304308. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Your surgeon will discuss these options with you. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Some error has occurred while processing your request. If it is appropriate, then surgical consent probably happened before the surgery. In these cases, a new graft may be used to perform a second reconstruction. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Background: All but 2 were level IV evidence. The limitations of this systematic review are reliant on the studies analyzed. Instability of the metacarpophalangeal joint of the thumb. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. J Hand Surg Am. At this stage, patients should be advised to wear your splint part-time. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 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. Bookshelf A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Stretching or even a rupture of the graft is also possible. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 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. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Am J Sports Med. The injury involves the ulnar collateral ligament (UCL) of the thumb. 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. official website and that any information you provide is encrypted 2009;6:e1000097. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). This ligament prevents the thumb from pointing too far away from the hand. 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. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 24. Purpose: J Hand Surg Br. government site. Thus, the true natural history is yet unknown. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. Study design: Proximal interphalangeal joint injuries of the hand. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Sakellarides HT, DeWeese JW. 32. Descriptive statistics were calculated. 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. 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 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. No study reported the outcomes of nonoperative management of chronic UCL injury. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. MeSH Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Data is temporarily unavailable. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Acta Chir Scand. Your thumb will be immobilized in a splint and should not be moved until follow up. Gamekeepers thumb: a prospective study of functional bracing. abduction-adduction motion. SYMPTOMS: The thumb may be swollen, bruised and painful. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 1,5,9,10 In acute cases of complete tears involving high-level . Early and late postoperative complications were recorded. Eventually this abnormal movement will wear out the joint and it will become arthritic. 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. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. 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 anti edema management will continue for several weeks. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Complications after surgical treatment of UCL injury are rare. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. A broken thumb can also cause numbness or tingling. Dr. Holt will talk to you about when it is safe to return to work. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. unstable when the thumb is used. Bookshelf Careers. Clin Orthop Relat Res. Possible complications include: - Complications after surgery were rare. Kozin SH, Bishop AT. Mean subject age was 33.9 years. J Hand Surg Am. Your surgeon is the person best able to help you avoid any serious recovery problems. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Fourteen articles were included and analyzed (293 thumbs). Arthritis Rheum. Exercises: Gradually progress to competitive throwing and sports . Thumb sidedness reported in 3 studies (51 thumbs). All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. PLoS Med. Rupture of the. 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. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. An official website of the United States government. 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. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. 2013Lippincott Williams & Wilkins. sharing sensitive information, make sure youre on a federal The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. 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%). Epub 2014 Oct 22. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. J Bone Joint Surg Am. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Unilateral injuries: 291 and bilateral injury: 1. J Bone Joint Surg Am. **Stener lesion status reported in 6 studies (145 thumbs). Early diagnosis and treatment. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Accessibility The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. and transmitted securely. The .gov means its official. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. If the force is too strong, the ligaments can tear. [38] Chuter et al[40] contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. Injuries to the PIP joint remain swollen for long periods of time. 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. Unauthorized use of these marks is strictly prohibited. Both repair and reconstruction (autograft and allograft) techniques were inclusive. National Library of Medicine The authors report no funding or conflicts of interest. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. 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. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 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. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. 2005;24:217221. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Keyword Highlighting 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. [15,39] It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament. 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. The site is secure. If you log out, you will be required to enter your username and password the next time you visit. Results: Main results: J Bone Joint Surg Am. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Wolters Kluwer Health 2000;16:345357. 1976;58:106112. Orthop J Sports Med. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. You will receive email when new content is published. Epub 2021 Sep 7. Smith RJ. Causes. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 16. Bostock S, Morris MA. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion.

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