complications after ucl repair of thumb
Rupture and displacement of the. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Pain reduction was significantly improved in all subjects (P < 0.05). UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 34. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. If the tear is diagnosed early a repair will be possible. Sakellarides HT, DeWeese JW. Infection is a rare complication of hand surgery. 2005;24:217221. 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. Louis DS, Huebner JJ Jr, Hankin FM. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. 10. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Bostock S, Morris MA. 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. 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. The .gov means its official. 1999;24:275282. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 4. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Instability of the metacarpophalangeal joint of the thumb. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 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. 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. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. abduction-adduction motion. Early diagnosis and treatment. your express consent. Causes. Hand Clin. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. Abrahamsson SO, Sollerman C, Lundborg G, et al.. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 24. Ulnar Collateral Ligament Repair . The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Thirty-two thumbs were treated nonoperatively and 261 operatively. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Metacarpophalangeal joint injuries of the thumb. 23. 1. 26. The doctor won't know if the repair is . [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. Would you like email updates of new search results? After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Orthop Rev. 36. Van Dommelen BA, Zvirbulis RA. 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. Thus, the true natural history is yet unknown. There were 200 acute injuries and 93 chronic injuries. Only prospective studies can determine this injury course. Subject demographics are reported in Table 2. 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. 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. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Thumb dominance reported in 8 studies (168 thumbs). 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. official website and that any information you provide is encrypted Bethesda, MD 20894, Web Policies Table 1. The grip strength and the pinch strength were 94.3% and 92.27%,. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation Please try after some time. Throwing status reported in 4 studies. A sprained thumb is a common injury among athletes. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Epub 2014 Dec 30. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Kaplan EB. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. There were no cases of intraoperative ulnar nerve injury reported. Kuz JE, Husband JB, Tokar N, et al.. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Federal government websites often end in .gov or .mil. unstable when the thumb is used. 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. Clin J Sport Med. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. The mean patient age was 37.8 years (14.0-78.1). Your surgeon is the person best able to help you avoid any serious recovery problems. 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*. 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. Gamekeepers thumb: a prospective study of functional bracing. Mitsionis GI, Varitimidis SE, Sotereanos GG. 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. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. 1996;25:527530. Figure 46-2 Approach to the ulnar collateral ligament. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 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. Doi: 10.1177/2325967118769328. 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. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. HHS Vulnerability Disclosure, Help 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. Continuous variable data were reported as mean SDs from the mean. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . Before The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. [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. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Sports Med Arthrosc Rev. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Orthop Clin North Am. The authors report no funding or conflicts of interest. Unauthorized use of these marks is strictly prohibited. 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. 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. They may even tear completely. Mean subject age was 33.9 years. 19. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . He too had the internal brace augmentation. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. You will receive email when new content is published. 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. 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.