complications after ucl repair of thumb

A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. UCLR case series that contained complications data were included. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Complications after surgery were rare. If it is appropriate, then surgical consent probably happened before the surgery. It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). 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. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Long-term results of ligament reconstruction. Arthrosc Sports Med Rehabil. J Bone Joint Surg Am. MeSH There is currently no consensus on treatment of acute or chronic UCL injuries. 6. Benson LS, Bailie DS. 2009;6:e1000097. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. A sprained thumb is a common injury among athletes. He too had the internal brace augmentation. 31. All authors independently performed the search. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Both repair and reconstruction (autograft and allograft) techniques were inclusive. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. 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. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). 2009;34:304308. Methods: At this stage, patients should be advised to wear your splint part-time. Bethesda, MD 20894, Web Policies 1,5,9,10 In acute cases of complete tears involving high-level . 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. unstable when the thumb is used. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. 1962;124:396411. Educate the patient on anti edema management. Clin J Sport Med. Unilateral injuries: 291 and bilateral injury: 1. J Bone Joint Surg Am. All techniques improved clinical outcomes, including pain, motion, strength, and stability. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Orthop J Sports Med. 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. Early and late postoperative complications were recorded. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. 2013;23(4):247-254. Study design: 3. the thumb. 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. In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Accessibility 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. Conclusion: Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Epub 2016 Jan 13. Am J Sports Med. The mean time from reported injury date to surgery was 202.4 days (2-5969). 12. Ulnar Collateral Ligament Repair . 1961;43-A:541546. A p-value of 0.05 was considered statistically significant. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. For more information, please refer to our Privacy Policy. 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. 2021 Apr 15;3(2):e527-e533. 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. They may even tear completely. Wong TC, Ip FK, Wu WC. Am J Sports Med. 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. Quantitative outcome of surgical repair. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 1995;18:11611165. 35. A score of 0 was assigned if the item was either omitted or not performed. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Search for Similar Articles FOIA A score of 2 was assigned if the item was completely and accurately performed and reported. Please try again soon. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. 8. [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. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 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. Both purely ligamentous and bony avulsion injuries were included. Ulnar collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. 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%). Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.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.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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 26. 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 Purpose: Complications after surgical treatment of UCL injury are rare. The limitations of this systematic review are reliant on the studies analyzed. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. A broken thumb can also cause numbness or tingling. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. 22. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. J Hand Surg Am. 1992;8:713732. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. government site. Symptoms are dependent on the cause and severity of injury to the UCL. 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. Instability of the metacarpophalangeal joint of the thumb. Table 1. Keywords: 2022 Mar 1;30(1):e1-e8. 45. 23. 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. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Nonoperative treatment often failed, necessitating surgery. Ulnar collateral ligament injuries of the thumb: a comprehensive review. eCollection 2021 Apr. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Posner MA, Retaillaud JL. 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. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. *Gender reported in 12 studies (218 subjects). 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. 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*. There are some cases where the fusion is not successful and you will still have pain in . the splint for protection or at night until twelve weeks after the operation. doi: 10.1016/j.asmr.2020.12.004. 1998;23:503506. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Bostock S, Morris MA. NR, not reported. Eventually this abnormal movement will wear out the joint and it will become arthritic. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. *Glickel grading scale. Diagnosis of displaced, 43. J Bone Joint Surg Am. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. 1999;24:7075. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery There were no cases of intraoperative ulnar nerve injury reported. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Catalano LW III, Cardon L, Patenaude N, et al.. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. J Bone Joint Surg Am. 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. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. The grip strength and the pinch strength were 94.3% and 92.27%,. 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. 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. 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. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Metacarpophalangeal joint injuries of the thumb. Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Non-Fusion. sharing sensitive information, make sure youre on a federal 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. History. If the tear is diagnosed later a ligament reconstruction might be a better option. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Some error has occurred while processing your request. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Continue to stretch before and after throwing . Eurasian J Med. The https:// ensures that you are connecting to the Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Fourteen articles were included and analyzed (293 thumbs). modify the keyword list to augment your search. 2003;8:8185. 8600 Rockville Pike Bean CH, Tencer AF, Trumble TE. 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. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Epub 2019 Mar 21. You may search for similar articles that contain these same keywords or you may Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. The site is secure. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. to maintaining your privacy and will not share your personal information without 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. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. eCollection 2021. 2005;24:217221. Chir Main. 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. 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. 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%). Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. Frykman G, Johansson O. Surgical repair of rupture of the, 46. 2013Lippincott Williams & Wilkins. 24. The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. 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. Abstract. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Muscles. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. No study directly compared the different types of graft for UCL reconstruction. National Library of Medicine PMC 34. The https:// ensures that you are connecting to the POST-OPERATIVE WEEKS 22-24. Orthop Rev. 2000;16:345357. flexion-extension motion. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Surgical techniques and a review of 70 patients. Only prospective studies can determine this injury course. 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. Bailie DS, Benson LS, Marymont JV. Would you like email updates of new search results? 18. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Am J Sports Med. and transmitted securely. Accessibility 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. Mean study follow-up was 42.8 months. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Clinical Journal of Sport Medicine23(4):247-254, July 2013. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. This article provides a review of . HHS Vulnerability Disclosure, Help sharing sensitive information, make sure youre on a federal Categorical variable data were reported as frequency with percentages. 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%). Bookshelf This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 14 It is important to diagnose complete tears early because . Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Surgical management of chronic, 42. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 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 . eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. MeSH Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. An anatomic basis for treatment. It runs from the outer humerus, around the radial head and attaches to the ulna.