complications after ucl repair of thumb

Ulnar collateral ligament injuries of the thumb: a comprehensive review. Click the topic below to receive emails when new articles are available. Mitsionis GI, Varitimidis SE, Sotereanos GG. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Proximal interphalangeal joint injuries of the hand. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. the thumb. Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute Thirty-two thumbs were treated nonoperatively and 261 operatively. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 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. 18. If you log out, you will be required to enter your username and password the next time you visit. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Keywords: 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. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Weakened grip or reduced thumb range of motion may occur. The site is secure. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. 31. 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. Mean study follow-up was 42.8 months. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Gamekeeper's thumb. Wolters Kluwer Health, Inc. and/or its subsidiaries. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). The range of motion of the MP joint of the thumb following operative repair of the. 1989;17:751753. **Stener lesion status reported in 6 studies (145 thumbs). 19. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. 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%. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Am J Sports Med. Please try again soon. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Outcomes After Injury to the Thumb Ulnar Collateral Ligament Careers. Thumb Collateral Ligament Injury - Hand - Orthobullets 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. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. your express consent. 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. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Complications you may experience after Hand Surgery - Rebecca Ayers UCLR case series that contained complications data were included. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Descriptive statistics were calculated. 2. Please enter a Recipient Address and/or check the Send me a copy checkbox. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. [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. Infection is a rare complication of hand surgery. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). What Happens If We Sit for More Than 8 Hours Per Day? 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 UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). MCP fusion was performed . The https:// ensures that you are connecting to the Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Main results: Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. Van Dommelen BA, Zvirbulis RA. 6. Foveal Triangular Fibrocartilage Complex Tear Repair with Nonabsorbent No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 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. Exercises: Gradually progress to competitive throwing and sports . Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . *Glickel grading scale. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. 1995;18:11611165. Clin Orthop Relat Res. Epub 2015 Sep 22. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.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.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. to maintaining your privacy and will not share your personal information without Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. No study directly compared nonoperative to operative treatment. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. The Effect of Ulnar Collateral Ligament Repair With Internal Brace 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. Injury. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. PDF ULNAR COLLATERAL LIGAMENT REPAIR - Harry Belcher Only prospective studies can determine this injury course. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Before Hand Clin. Wolters Kluwer Health sharing sensitive information, make sure youre on a federal 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.. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. If the force is too strong, the ligaments can tear. Complications after surgical treatment of UCL injury are rare. Gamekeepers thumb: a prospective study of functional bracing. 16. Melone CP Jr, Beldner S, Basuk RS. Your message has been successfully sent to your colleague. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Epub 2020 Jun 29. 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. Rupture of the. There is currently no consensus on treatment of acute or chronic UCL injuries. If the latter was executed only partially, a score of 1 was assigned. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). J Bone Joint Surg Am. A broken thumb can also cause numbness or tingling. J Bone Joint Surg Am. Conclusion: 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. MCP (MetaCarpophalangeal) Collateral Ligament Sprain 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. 23. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb.

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