complications after ucl repair of thumb

The .gov means its official. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. 5. Acta Chir Scand. Results: These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. All rights reserved. Only prospective studies can determine this injury course. 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. #Injury location reported only in 3 studies. your express consent. 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. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. doi: 10.1097/JSA.0000000000000322. Meta-analysis of the pooled data was completed. 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. Instability of the metacarpophalangeal joint of the thumb. Continue to stretch before and after throwing . 12. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 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. [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. *Gender reported in 12 studies (218 subjects). Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 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. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Disclaimer. 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. 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. Epub 2015 Sep 22. Educate the patient on anti edema management. official website and that any information you provide is encrypted Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb 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. Surgical techniques and a review of 70 patients. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. and transmitted securely. 2003;8:8185. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Accessibility Epub 2016 Jan 13. 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. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. A score of 2 was assigned if the item was completely and accurately performed and reported. 1989;14:567573. J Bone Joint Surg Am. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Proximal interphalangeal joint injuries of the hand. Am J Orthop (Belle Mead NJ). Tension wire fixation of avulsion fractures in the hand. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 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 overall complication rate was 13.8% (11/80). [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. For example, it can be removed when performing . Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 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. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. The https:// ensures that you are connecting to the 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Melone CP Jr, Beldner S, Basuk RS. 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. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 2005;87:26322638. 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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 22. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 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. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 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. Diagnosis of displaced, 43. 1987;214:113120. Weakened grip or reduced thumb range of motion may occur. Careers. Louis DS, Huebner JJ Jr, Hankin FM. 16. 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 1999;24:7075. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 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%.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. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. There were 61 studies eliminated as secondary for being in a language other than English. If your bone is broken, a pin will be used to put it in place. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. Fusetti C, Papaloizos M, Meyer H, et al.. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 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. Downey DJ, Moneim MS, Omer GE Jr. 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. Eventually this abnormal movement will wear out the joint and it will become arthritic. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. [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. If the tear is diagnosed later a ligament reconstruction might be a better option. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Bostock S, Morris MA. Thus, the true natural history is yet unknown. Your surgeon will discuss these options with you. 21. 38. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Catalano LW III, Cardon L, Patenaude N, et al.. Would you like email updates of new search results? 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%). UCLR case series that contained complications data were included. Please confirm that you would like to log out of Medscape. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. HHS Vulnerability Disclosure, Help 10. You are being redirected to Medscape Education. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. sharing sensitive information, make sure youre on a federal Thirty-two thumbs were treated nonoperatively and 261 operatively. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Early and late postoperative complications were recorded. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. Methods: In these cases, a new graft may be used to perform a second reconstruction. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Unilateral injuries: 291 and bilateral injury: 1. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. In some cases, certain risk factors make it more likely that a bone will fail to heal. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Clinical Journal of Sport Medicine23(4):247-254, July 2013. 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. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. 35. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. abduction-adduction motion. 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. Abrahamsson SO, Sollerman C, Lundborg G, et al.. 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%). No study reported the outcomes of nonoperative management of chronic UCL injury. 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%). 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. Search performed on November 17, 2011. 17. Pichora DR, McMurtry RY, Bell MJ. Injury. 19. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Bailie DS, Benson LS, Marymont JV. Objectives: The site is secure. sharing sensitive information, make sure youre on a federal Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. J Bone Joint Surg Am. 32. 1989;17:751753. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). History. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). You will receive email when new content is published. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". If the tear is diagnosed early a repair will be possible. 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. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. The https:// ensures that you are connecting to the Kaplan EB. 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%). When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 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. 8600 Rockville Pike

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