Upper extremity injuries in snow skiers. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 2005;24:217221. The Orthopedic Journal of Sports Medicine. Only prospective studies can determine this injury course. This site needs JavaScript to work properly. 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. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Am J Sports Med. There is currently no consensus on treatment of acute or chronic UCL injuries. Would you like email updates of new search results? 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. The limitations of this systematic review are reliant on the studies analyzed. Your thumb will be immobilized in a splint and should not be moved until follow up. There is currently no consensus on treatment of acute or chronic UCL injuries. 34. the thumb. Jackson M, McQueen MM. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Proximal interphalangeal joint injuries of the hand. 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. At this stage, patients should be advised to wear your splint part-time. Your message has been successfully sent to your colleague. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. J Bone Joint Surg Am. 8. 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. Objectives: Tension wire fixation of avulsion fractures in the hand. 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. 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. Dr. Holt will talk to you about when it is safe to return to work. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). I was able to work while wearing the splint. HHS Vulnerability Disclosure, Help Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Early and late postoperative complications were recorded. J Hand Surg Br. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. PLoS Med. Mechanism of injury to the RCL of the MCP joint of the thumb is force . There is currently no consensus on treatment of acute or chronic UCL injuries. 22. Mean subject age was 33.9 years. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. flexion-extension motion. 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. MeSH Arthritis Rheum. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 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. Highlight selected keywords in the article text. Surgical techniques and a review of 70 patients. [16] Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Please confirm that you would like to log out of Medscape. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 1,5,9,10 In acute cases of complete tears involving high-level . Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Sakellarides HT, DeWeese JW. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. The limitations of this systematic review are reliant on the studies analyzed. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 1989;71:383387. What Happens If We Sit for More Than 8 Hours Per Day? Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 2013;23(4):247-254. Am J Sports Med. Only prospective studies can determine this injury course. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. The authors report no funding or conflicts of interest. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Orthop J Sports Med. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 38. J Hand Surg Am. 2000;16:345357. An official website of the United States government. Doi: 10.1177/2325967118769328. 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. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. 2018;6(4):1-7. better/same/worse than preoperative status). **Stener lesion status reported in 6 studies (145 thumbs). 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. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 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*. 2009;6:e1000097. [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. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Orthop Clin North Am. [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. Infection is a rare complication of hand surgery. You've successfully added to your alerts. 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 Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. eCollection 2021. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. For example, it can be removed when performing . There is currently no consensus on treatment of acute or chronic UCL injuries. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Causes. Quantitative outcome of surgical repair. 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. doi: 10.1097/JSA.0000000000000322. A score of 2 was assigned if the item was completely and accurately performed and reported. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. You may also begin strengthening exercises if needed. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Studies that duplicated patient populations from the same authors were excluded. 2022 Mar 1;30(1):e1-e8. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 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.
California Deer Regulations, Articles C
California Deer Regulations, Articles C