complications after ucl repair of thumb

You've successfully added to your alerts. Moher D, Liberati A, Tetzlaff J, et al.. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Studies that duplicated patient populations from the same authors were excluded. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 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. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Kozin SH, Bishop AT. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. J Bone Joint Surg Am. For more information, please refer to our Privacy Policy. Thumb from the common mechanism of falling on the thumb while holding a ski pole. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 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%). This site needs JavaScript to work properly. Complications after surgical treatment of UCL injury are rare. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Your message has been successfully sent to your colleague. Search for Similar Articles SYMPTOMS: The thumb may be swollen, bruised and painful. To date, no literat. Tension wire fixation of avulsion fractures in the hand. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Your ligament may need to be reattached to the bone using a bone anchor. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. Hand Clin. 2005;87:26322638. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 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. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. An official website of the United States government. Am J Sports Med. Proximal interphalangeal joint injuries of the hand. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. The site is secure. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 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. 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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Conclusions: J Bone Joint Surg Am. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . This damage may lead to temporary or permanent numbness or weakness. Fusetti C, Papaloizos M, Meyer H, et al.. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Meta-analysis of the pooled data was completed. Mean Quality Appraisal Tool score was 13.1 3.5 (range, 819), which correlated with a 54.6% 14.5% quality rating. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. [30] The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles. 1994;23:797804. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In some cases, certain risk factors make it more likely that a bone will fail to heal. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 21. 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. The https:// ensures that you are connecting to the 10. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 8. Thirty-two thumbs were treated nonoperatively and 261 operatively. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Study design: 16. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. 8600 Rockville Pike Symptoms are dependent on the cause and severity of injury to the UCL. This leads to what is know as a positive ulnar variance. 2005;24:217221. Sports Med Arthrosc Rev. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. The grip strength and the pinch strength were 94.3% and 92.27%,. unstable when the thumb is used. 12. The injury involves the ulnar collateral ligament (UCL) of the thumb. Accessibility 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. 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. [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 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. MeSH 5. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. 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. J Hand Surg Am. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Rupture of the. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 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. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. 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). 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. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Educate the patient on anti edema management. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Before official website and that any information you provide is encrypted No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. No study directly compared the different types of graft for UCL reconstruction. *Gender reported in 12 studies (218 subjects). This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Before 1996;25:527530. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Quantitative outcome of surgical repair. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Wong TC, Ip FK, Wu WC. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. 1. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 1999;24:7075. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. MCP fusion was performed . Abstract. POST-OPERATIVE WEEKS 22-24. J Hand Surg Glob Online.