complications after ucl repair of thumb

It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Before Would you like email updates of new search results? All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Smith RJ. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. UCLR case series that contained complications data were included. 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. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Sprained Thumb: Treatment, Symptoms & Recovery - Cleveland Clinic There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 1989;17:751753. eCollection 2021. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Methods: No study directly compared nonoperative to operative treatment. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.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.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. Kozin SH, Bishop AT. 22. 2005;24:217221. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Nonunions - OrthoInfo - AAOS Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Acta Chir Scand. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. PMC 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. 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%. Background: PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics abduction-adduction motion. 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. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. 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. 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. 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). 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 2009;6:e1000097. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). There were 200 acute injuries and 93 chronic injuries. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. The Effect of Ulnar Collateral Ligament Repair With Internal Brace The site is secure. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 1. 2018;6(4):1-7. If the latter was executed only partially, a score of 1 was assigned. [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. The .gov means its official. 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. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). 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%). 2022 Mar 1;30(1):e1-e8. Figure 46-2 Approach to the ulnar collateral ligament. This ligament prevents the thumb from pointing too far away from the hand. Van Dommelen BA, Zvirbulis RA. What are the symptoms of GameKeeper's Thumb? Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 16. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. PMC 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Ulnar collateral ligament injury of the thumb - Wikipedia Before 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. [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. Unilateral injuries: 291 and bilateral injury: 1. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Hand Injuries - Finger Tip Injuries, Jersey Finger, PIP Dislocations When applicable, these parameters were compared, integrated, summated, and statistically analyzed. official website and that any information you provide is encrypted Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Am J Sports Med. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Am J Sports Med. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Subject demographics are reported in Table 2. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Eventually this abnormal movement will wear out the joint and it will become arthritic. 1989;71:383387. 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. PLoS Med. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Thumb Collateral Ligament Injury - Hand - Orthobullets Conclusion: 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 You will receive email when new content is published. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Midterm clinical outcomes of collateral ligament repair of the thumb 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. MeSH Am J Orthop (Belle Mead NJ). 39. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. [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. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. PDF UCL/RCL Thumb MP Joint Repair Rehabilitation Protocol - Ortho Illinois Wong TC, Ip FK, Wu WC. Mean subject age was 33.9 years. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Engelhardt JB, Christensen OM, Christiansen TG. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). 34. 1962;124:396411. Epub 2021 Jan 18. 2003;8:8185. The range of motion of the MP joint of the thumb following operative repair of the. Clin Orthop Relat Res. 6. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. Disclaimer. Am J Sports Med. Ulnar Collateral Ligament Repair . Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Thumb sidedness reported in 3 studies (51 thumbs). Doi: 10.1177/2325967118769328. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Complications Following Distal Radius Fractures - Mike Reinold Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Clipboard, Search History, and several other advanced features are temporarily unavailable. Surgical Repair of Ulnar Collateral Ligament of Thumb - YouTube 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.. Injury. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. UCLR case series that contained complications data were included. Frykman G, Johansson O. Surgical repair of rupture of the, 46. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. You may search for similar articles that contain these same keywords or you may Quantitative outcome of surgical repair. Gamekeeper's thumb. PDF Rehabilitation Guidelines for Ulnar Collateral Ligament Reconstruction Complications you may experience after Hand Surgery - Rebecca Ayers What Happens If We Sit for More Than 8 Hours Per Day? The .gov means its official. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 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. Ulnar Collateral Ligament Injuries of the Thumb - Panther At this stage, patients should be advised to wear your splint part-time. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Complications after surgical treatment of UCL injury are rare. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. AAHS - Comparison of Complications after Thumb Metacarpophalangeal Surgical techniques and a review of 70 patients. This website also contains material copyrighted by 3rd parties. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Mechanism of injury to the RCL of the MCP joint of the thumb is force . [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. If the latter was executed only partially, a score of 1 was assigned. Highlight selected keywords in the article text. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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. The limitations of this systematic review are reliant on the studies analyzed. Eurasian J Med. J Bone Joint Surg Am. Thumb Ulnar Collateral Ligament Tear - Tran Plastic Surgery 1961;43-A:541546. MCP (MetaCarpophalangeal) Collateral Ligament Sprain 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. 1994;25:2123. Tension wire fixation of avulsion fractures in the hand. 33. 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. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 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. To date, no literat. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. Clipboard, Search History, and several other advanced features are temporarily unavailable. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. the splint for protection or at night until twelve weeks after the operation. to maintaining your privacy and will not share your personal information without Arthritis Rheum. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. 38. Kuz JE, Husband JB, Tokar N, et al.. Complications after surgery were rare. Bean CH, Tencer AF, Trumble TE. 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. 14 It is important to diagnose complete tears early because . Sixty nine (86.3%) patients had grade 3 tears. Bookshelf Possible complications include: - Catalano LW III, Cardon L, Patenaude N, et al.. Please enable scripts and reload this page. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 1995;23:222226. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Arthrosc Sports Med Rehabil. Symptoms are dependent on the cause and severity of injury to the UCL. Clin J Sport Med. For example, it can be removed when performing . Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. Complications after surgery were rare. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Complications after surgical treatment of UCL injury are rare. 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. Fusetti C, Papaloizos M, Meyer H, et al.. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). 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. Exercises: Gradually progress to competitive throwing and sports . Through a small incision along the side of the thumb joint, we will see where the ligament was torn. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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. Main results: 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 Your ligament may need to be reattached to the bone using a bone anchor. Disclaimer. Thumb Ulnar Collateral Ligament repair; A Step by Step Guide Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Treatment for thumb collateral ligament injury - KW orthopaedics Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. SYMPTOMS: The thumb may be swollen, bruised and painful. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Proximal interphalangeal joint injuries of the hand. All techniques improved clinical outcomes, including pain, motion, strength, and stability. Epub 2021 Sep 7. 1977;59:1421. An anatomic basis for treatment. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Your thumb will be immobilized in a splint and should not be moved until follow up. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. 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. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Search for Similar Articles Mean study follow-up was 42.8 months. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. This article provides a review of . government site. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 11. The Complications of CMC Thumb Surgery | Healthy Living Jupiter JB, Sheppard JE. 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. Chir Main. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Am. 2000;16:345357. 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis.