1994;25:2123. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Both purely ligamentous and bony avulsion injuries were included. Am J Orthop (Belle Mead NJ). 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Complications after surgical treatment of UCL injury are rare. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. sharing sensitive information, make sure youre on a federal 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. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Accessibility official website and that any information you provide is encrypted Conclusion: Am J Sports Med. The doctor won't know if the repair is . 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). Mechanism of injury to the RCL of the MCP joint of the thumb is force . government site. 37. Epub 2019 Mar 21. **Stener lesion status reported in 6 studies (145 thumbs). All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. Disclaimer. Thumb collateral ligament injuries. Studies that duplicated patient populations from the same authors were excluded. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Categorical variable data were reported as frequency with percentages. 1999;24:275282. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. 19. 2013;23(4):247-254. Search performed on November 17, 2011. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Doi: 10.1177/2325967118769328. FOIA 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. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Bookshelf J Bone Joint Surg Am. Continuous variable data were reported as mean SDs from the mean. [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. Epub 2014 Dec 30. Objectives: 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 site needs JavaScript to work properly. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 1961;43-A:541546. History. 1989;71:383387. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Nonoperative treatment often failed, necessitating surgery. 25. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Careers. Accessibility This leads to what is know as a positive ulnar variance. 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. Non-Fusion. Before Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. There is currently no consensus on treatment of acute or chronic UCL injuries. An official website of the United States government. A systematic review of ulnar collateral ligament reconstruction techniques. The .gov means its official. No study directly compared nonoperative to operative treatment. Wolters Kluwer Health MCP fusion was performed . 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.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 31. Continue to stretch before and after throwing . When assessed, most patients returned to their preinjury employment. Am J Sports Med. What Happens If We Sit for More Than 8 Hours Per Day? Clinical Journal of Sport Medicine23(4):247-254, July 2013. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Unilateral injuries: 291 and bilateral injury: 1. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. The torn thumb ligament is repaired or reconstructed during surgery. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 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. Long-term results of ligament reconstruction. All but 2 were level IV evidence. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). #Injury location reported only in 3 studies. Pichora DR, McMurtry RY, Bell MJ. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. 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. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. 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.. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. The LUCL is located on the lateral or outside part of the elbow. Van Dommelen BA, Zvirbulis RA. If you log out, you will be required to enter your username and password the next time you visit. Epub 2013 Nov 12. Bookshelf You may search for similar articles that contain these same keywords or you may ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Part I of this two-part article focuses on common tendon and . UCLR case series that contained complications data were included. 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. Thirty-two thumbs were treated nonoperatively and 261 operatively. Wolters Kluwer Health, Inc. and/or its subsidiaries. Please enable it to take advantage of the complete set of features! 1987;214:113120. Muscles. Am J Sports Med. 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. A p-value of 0.05 was considered statistically significant. 44. Throwing status reported in 4 studies. To date, no literat. 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. J Hand Surg Am. [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. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. The site is secure. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex.
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