complications after ucl repair of thumb

Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. Bean CH, Tencer AF, Trumble TE. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. Mean subject age was 33.9 years. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Bailie DS, Benson LS, Marymont JV. Arnold DM, Cooney WP, Wood MB. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. 1994;23:797804. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. A score of 0 was assigned if the item was either omitted or not performed. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. A systematic review of ulnar collateral ligament reconstruction techniques. [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 mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 1976;58:106112. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Bookshelf 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Orthop Clin North Am. and transmitted securely. At this stage, patients should be advised to wear your splint part-time. 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). 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. Muscles. Proximal interphalangeal joint injuries of the hand. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Ulnar collateral ligament injuries of the thumb: a comprehensive review. 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. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 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 PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Please confirm that you would like to log out of Medscape. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). I was able to work while wearing the splint. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Sakellarides HT, DeWeese JW. In these cases, a new graft may be used to perform a second reconstruction. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 1992;8:713732. 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. J Hand Surg Am. [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 splint for protection or at night until twelve weeks after the operation. 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. Non-Fusion. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Mechanism of injury to the RCL of the MCP joint of the thumb is force . #Injury location reported only in 3 studies. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. 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. Click the topic below to receive emails when new articles are available. Causes. Moher D, Liberati A, Tetzlaff J, et al.. Federal government websites often end in .gov or .mil. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Am J Sports Med. This leads to what is know as a positive ulnar variance. Complications after this procedure may include nerve or blood vessel damage. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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 . 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. Mean subject age was 33.9 years. The injury happens when you fall . Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. What Happens If We Sit for More Than 8 Hours Per Day? 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. government site. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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. Epub 2019 Mar 21. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. The mean patient age was 37.8 years (14.0-78.1). No study directly compared the different types of graft for UCL reconstruction. Epub 2014 Oct 22. 8600 Rockville Pike The site is secure. Arthritis Rheum. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". 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. Complications after surgical treatment of UCL injury are rare. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. The https:// ensures that you are connecting to the Please use this form to submit your questions or comments on how to make this article more useful to clinicians. sharing sensitive information, make sure youre on a federal MeSH important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. 26. Catalano LW III, Cardon L, Patenaude N, et al.. Surgical techniques and a review of 70 patients. The limitations of this systematic review are reliant on the studies analyzed. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Complications after surgery were rare. 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%). The effect of thumb metacarpophalangeal. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Study design: Evaluation and management of elbow injuries in the adolescent overhead athlete. 35. 1995;23:222226. *Glickel grading scale. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Kozin SH, Bishop AT. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. 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). The diagnosis is best established clinically, though MRI is the imaging modality of choice. [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. 2021 Apr 15;3(2):e527-e533. Orthopedics. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. Complications after surgical treatment of UCL injury are rare. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. Part I of this two-part article focuses on common tendon and . Data sources: Clipboard, Search History, and several other advanced features are temporarily unavailable. 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.. Disclaimer. three muscles provide deforming forces at the base of the thumb.

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