If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. Symptoms are dependent on the cause and severity of injury to the UCL. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Purpose. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 45. 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. Your surgeon will discuss these options with you. Catalano LW III, Cardon L, Patenaude N, et al.. Arnold DM, Cooney WP, Wood MB. Tension wire fixation of avulsion fractures in the hand. If the latter was executed only partially, a score of 1 was assigned. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. 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. Data is temporarily unavailable. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery and twist using your thumb. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Am J Sports Med. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 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. 1998;23:503506. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Ulnar collateral ligament injury of the thumb - Wikipedia Injuries to the PIP joint remain swollen for long periods of time. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Would you like email updates of new search results? Eurasian J Med. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 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. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. 21. The anti edema management will continue for several weeks. 2006;31:6875. Data sources: Complications If the UCL is ruptured there is a possibility that the distal end may become interposed by the adductor aponeurosis, which is referred to as a Stener lesion (Figure 5). This ligament prevents the thumb from pointing too far away from the hand. [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. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Range of motion returns much sooner, too. 16. PLoS Med. 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. 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. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. Background: The Complications of CMC Thumb Surgery | Healthy Living Disclaimer. Please confirm that you would like to log out of Medscape. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Am J Orthop (Belle Mead NJ). The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. 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. If the latter was executed only partially, a score of 1 was assigned. The limitations of this systematic review are reliant on the studies analyzed. Epub 2016 Jan 13. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Hand Clin. Bookshelf Orthopedics. 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. What Happens If We Sit for More Than 8 Hours Per Day? 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.. 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. J Hand Surg Am. Your message has been successfully sent to your colleague. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Acta Chir Scand. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb Gamekeeper's thumb. 33. Careers. [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. 14 It is important to diagnose complete tears early because . Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. You will receive email when new content is published. The mean patient age was 37.8 years (14.0-78.1). There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. A systematic review of ulnar collateral ligament reconstruction techniques. Throwing status reported in 4 studies. 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. 2009;34:304308. Base of Thumb Fractures - Hand - Orthobullets 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 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. Possible complications include: - Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. 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. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). eCollection 2022 May. The LUCL is located on the lateral or outside part of the elbow. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Accessibility Unauthorized use of these marks is strictly prohibited. Results: eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". Athletes Can Return to Play in Half the Time with New Thumb Ligament Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. The overall complication rate was 13.8% (11/80). 2005;24:217221. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA).