complications after ucl repair of thumb

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. Click the topic below to receive emails when new articles are available. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. For more information, please refer to our Privacy Policy. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Fourteen articles were included and analyzed (293 thumbs). Possible complications include: - Disclaimer. Careers. Both repair and reconstruction (autograft and allograft) techniques were inclusive. 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. 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. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Data is temporarily unavailable. A systematic review of ulnar collateral ligament reconstruction techniques. Accessibility The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. 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. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. A score of 0 was assigned if the item was either omitted or not performed. 45. 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. Non-Fusion. You may also begin strengthening exercises if needed. official website and that any information you provide is encrypted 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%). Only prospective studies can determine this injury course. Arnold DM, Cooney WP, Wood MB. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). A secondary purpose was to compare graft choice and surgical technique for reconstruction. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. Disclaimer. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Purpose: The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . Am J Sports Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 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. 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 . Tension wire fixation of avulsion fractures in the hand. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Bailie DS, Benson LS, Marymont JV. 1977;59:1421. [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. Pichora DR, McMurtry RY, Bell MJ. This website also contains material copyrighted by 3rd parties. NR, not reported. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. **Stener lesion status reported in 6 studies (145 thumbs). Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 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. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. For example, it can be removed when performing . 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. Epub 2019 Mar 21. 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%). Doi: 10.1177/2325967118769328. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Your surgeon will discuss these options with you. 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). The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. The grip strength and the pinch strength were 94.3% and 92.27%,. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. 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. 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. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Purpose. Table 1. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. eCollection 2021. 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. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Melone CP Jr, Beldner S, Basuk RS. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Downey DJ, Moneim MS, Omer GE Jr. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Clipboard, Search History, and several other advanced features are temporarily unavailable. Meta-analysis of the pooled data was completed. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Wolters Kluwer Health If it is appropriate, then surgical consent probably happened before the surgery. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. The limitations of this systematic review are reliant on the studies analyzed. Stretching or even a rupture of the graft is also possible. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. Data sources: 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Accessibility Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. eCollection 2021 Mar. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Am J Sports Med. If your bone is broken, a pin will be used to put it in place. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Abstract. 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. J Hand Surg Am. Federal government websites often end in .gov or .mil. Epub 2014 Oct 22. 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 . 37. 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. 2009;34:304308. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. In these patients, after failure of nonoperative treatment at anywhere from 1 month 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. Moher D, Liberati A, Tetzlaff J, et al.. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis.

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