Base of Thumb Fractures - Hand - Orthobullets UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. 1961;43-A:541546. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Sakellarides HT, DeWeese JW. At this stage, patients should be advised to wear your splint part-time. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Fusetti C, Papaloizos M, Meyer H, et al.. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. An anatomic basis for treatment. 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%). Am J Orthop (Belle Mead NJ). 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. The injury involves the ulnar collateral ligament (UCL) of the thumb. 4. 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. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 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. Gamekeeper's thumb. eCollection 2021 Apr. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Proximal interphalangeal joint injuries of the hand. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. HHS Vulnerability Disclosure, Help Treatment of chronic injuries of the. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Ulnar Collateral Ligament Injuries of the Thumb - Panther Studies that duplicated patient populations from the same authors were excluded. 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. A common complication following fracture of the distal radius is when the radius shortens. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The https:// ensures that you are connecting to the If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. #Injury location reported only in 3 studies. Your ligament may need to be reattached to the bone using a bone anchor. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Bone Joint Surg Am. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. 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. Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. No study compared different graft types or fixation techniques. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Stretching or even a rupture of the graft is also possible. Causes. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Would you like email updates of new search results? 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. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Surgical techniques and a review of 70 patients. *Glickel grading system. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. Keyword Highlighting Non-Fusion. 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. the thumb. Figure 46-2 Approach to the ulnar collateral ligament. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. UCL Repair of the Thumb - MSA Hand Center [38] Chuter et al[40] 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. Complications after surgery were rare. PMC 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). Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Your surgeon will discuss these options with you. Meta-analysis of the pooled data was completed. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Nonsurgical Management of Ulnar Collateral Ligament Injuries 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 36. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Kaplan EB. 2009;61:623632. 16. Eurasian J Med. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 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%). 37. 1999;24:7075. Thirty-two thumbs were treated nonoperatively and 261 operatively. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Range of motion returns much sooner, too. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. [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. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. An official website of the United States government. 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. Frykman G, Johansson O. Surgical repair of rupture of the, 46. doi: 10.1016/j.asmr.2020.12.004. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist doi: 10.1097/JSA.0000000000000322. Mean study follow-up was 42.8 months. Nonunions - OrthoInfo - AAOS 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. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 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 Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 5. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 12. This leads to what is know as a positive ulnar variance. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. UCL injuries: Defining risk and improving treatment - Mayo Clinic CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Thumb Collateral Ligament Injury - Hand - Orthobullets Epub 2014 Dec 30. There were 61 studies eliminated as secondary for being in a language other than English. 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). Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. 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. Part II: treatment and complications. A p-value of 0.05 was considered statistically significant. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. SYMPTOMS: The thumb may be swollen, bruised and painful. Please enable scripts and reload this page. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 10. 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. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Bean CH, Tencer AF, Trumble TE. Table 1. 1993;21:800804. Wolters Kluwer Health, Inc. and/or its subsidiaries. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. sharing sensitive information, make sure youre on a federal Smith RJ. government site. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Your surgeon is the person best able to help you avoid any serious recovery problems. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. The range of motion of the MP joint of the thumb following operative repair of the. POST-OPERATIVE WEEKS 22-24. 13. This site needs JavaScript to work properly. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. 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. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Disclaimer. Accessibility The site is secure. Both purely ligamentous and bony avulsion injuries were included. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 3. J Hand Surg Am. Thus, the true natural history is yet unknown. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 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. 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. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair The LUCL is located on the lateral or outside part of the elbow. UCLR case series that contained complications data were included. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 1,5,9,10 In acute cases of complete tears involving high-level . Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 20. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 33. Am J Sports Med. 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. Teatro Zinzanni Chicago Tickets, 217 Traffic Accident Today, Tom Webster Death, Articles C
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complications after ucl repair of thumb

complications after ucl repair of thumb

I had a UCL injury (incomplete, didn't require surgery) with a small avulsion fracture to my right thumb in 2015 at the age of 36. 8600 Rockville Pike Systematic review and meta-analysis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. He too had the internal brace augmentation. 1994;23:797804. Methods: Purpose. The mean time from reported injury date to surgery was 202.4 days (2-5969). Data is temporarily unavailable. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). 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. 22. Base of Thumb Fractures - Hand - Orthobullets UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. 1961;43-A:541546. Ulnar Collateral Ligament Injuries of the Thumb: Symptoms and Treatment Sakellarides HT, DeWeese JW. At this stage, patients should be advised to wear your splint part-time. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Fusetti C, Papaloizos M, Meyer H, et al.. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. An anatomic basis for treatment. 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%). Am J Orthop (Belle Mead NJ). 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. The injury involves the ulnar collateral ligament (UCL) of the thumb. 4. 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. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 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. Gamekeeper's thumb. eCollection 2021 Apr. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Proximal interphalangeal joint injuries of the hand. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. HHS Vulnerability Disclosure, Help Treatment of chronic injuries of the. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Ulnar Collateral Ligament Injuries of the Thumb - Panther Studies that duplicated patient populations from the same authors were excluded. 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. A common complication following fracture of the distal radius is when the radius shortens. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. The https:// ensures that you are connecting to the If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. #Injury location reported only in 3 studies. Your ligament may need to be reattached to the bone using a bone anchor. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Bone Joint Surg Am. Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. 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. Biomechanical Comparison of 3 Thumb Ulnar Collateral Ligament Repair Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. No study compared different graft types or fixation techniques. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Stretching or even a rupture of the graft is also possible. Causes. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Would you like email updates of new search results? 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. Injury to Ulnar Collateral Ligament of Thumb - Madan - 2014 Surgical techniques and a review of 70 patients. *Glickel grading system. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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. Keyword Highlighting Non-Fusion. 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. the thumb. Figure 46-2 Approach to the ulnar collateral ligament. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. UCL Repair of the Thumb - MSA Hand Center [38] Chuter et al[40] 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. Complications after surgery were rare. PMC 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). Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Your surgeon will discuss these options with you. Meta-analysis of the pooled data was completed. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Nonsurgical Management of Ulnar Collateral Ligament Injuries 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 36. Tommy John Surgery (Ulnar Collateral Ligament Reconstruction) Kaplan EB. 2009;61:623632. 16. Eurasian J Med. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. 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%). 37. 1999;24:7075. Thirty-two thumbs were treated nonoperatively and 261 operatively. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Range of motion returns much sooner, too. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. [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. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. An official website of the United States government. 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. Frykman G, Johansson O. Surgical repair of rupture of the, 46. doi: 10.1016/j.asmr.2020.12.004. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Gamekeepers Thumb: Symptoms, Surgery, & Treatment - Hand and Wrist doi: 10.1097/JSA.0000000000000322. Mean study follow-up was 42.8 months. Nonunions - OrthoInfo - AAOS 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. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 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 Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 5. Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if inadequately treated. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 12. This leads to what is know as a positive ulnar variance. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. UCL injuries: Defining risk and improving treatment - Mayo Clinic CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Thumb Collateral Ligament Injury - Hand - Orthobullets Epub 2014 Dec 30. There were 61 studies eliminated as secondary for being in a language other than English. 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). Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. 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. Part II: treatment and complications. A p-value of 0.05 was considered statistically significant. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. SYMPTOMS: The thumb may be swollen, bruised and painful. Please enable scripts and reload this page. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 10. 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. PDF Ulnar Collateral Ligament (UCL) Injury to the Thumb No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Bean CH, Tencer AF, Trumble TE. Table 1. 1993;21:800804. Wolters Kluwer Health, Inc. and/or its subsidiaries. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. sharing sensitive information, make sure youre on a federal Smith RJ. government site. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Your surgeon is the person best able to help you avoid any serious recovery problems. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. The range of motion of the MP joint of the thumb following operative repair of the. POST-OPERATIVE WEEKS 22-24. 13. This site needs JavaScript to work properly. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. 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. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Disclaimer. Accessibility The site is secure. Both purely ligamentous and bony avulsion injuries were included. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. 3. J Hand Surg Am. Thus, the true natural history is yet unknown. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. 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. 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. PDF After Your Surgery for Thumb Ulnar Collateral Ligament Repair The LUCL is located on the lateral or outside part of the elbow. UCLR case series that contained complications data were included. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. 1,5,9,10 In acute cases of complete tears involving high-level . Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 20. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 33. Am J Sports Med. 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.

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