There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. This leads to what is know as a positive ulnar variance. When assessed, most patients returned to their preinjury employment. This site needs JavaScript to work properly. Sakellarides HT, DeWeese JW. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. There were no cases of intraoperative ulnar nerve injury reported. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Bethesda, MD 20894, Web Policies Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. 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. 5. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Engelhardt JB, Christensen OM, Christiansen TG. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Abrahamsson SO, Sollerman C, Lundborg G, et al.. abduction-adduction motion. 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. Some error has occurred while processing your request. 1961;43-A:541546. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 1992;8:713732. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Both purely ligamentous and bony avulsion injuries were included. Various levels of pain, bruising, or edema may present at the site of damage. 6. Bethesda, MD 20894, Web Policies If the tear is diagnosed later a ligament reconstruction might be a better option. 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. 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. Early and late postoperative complications were recorded. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.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.31 The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . 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. Treatment of chronic injuries of the. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. The torn thumb ligament is repaired or reconstructed during surgery. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. 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). FOIA 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. This website also contains material copyrighted by 3rd parties. 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. A score of 2 was assigned if the item was completely and accurately performed and reported. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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%). 10. 1999;24:275282. official website and that any information you provide is encrypted 20. 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. Accessibility Unauthorized use of these marks is strictly prohibited. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Bean CH, Tencer AF, Trumble TE. 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. 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. 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. 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. 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. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. If it is appropriate, then surgical consent probably happened before the surgery. The mean time from reported injury date to surgery was 202.4 days (2-5969). Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Pichora DR, McMurtry RY, Bell MJ. The limitations of this systematic review are reliant on the studies analyzed. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 16. 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. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Please enable it to take advantage of the complete set of features! Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. Epub 2014 Dec 30. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Causes. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Nonoperative treatment often failed, necessitating surgery. You may search for similar articles that contain these same keywords or you may 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Melone CP Jr, Beldner S, Basuk RS. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. Fusetti C, Papaloizos M, Meyer H, et al.. 32. MCP collateral ligament sprain is most commonly an acute injury related to trauma. 1996;25:527530. The grip strength and the pinch strength were 94.3% and 92.27%,. 1995;23:222226. Meta-analysis of the pooled data was completed. 2022 Mar 1;30(1):e1-e8. Jupiter JB, Sheppard JE. J Bone Joint Surg Am. Categorical variable data were reported as frequency with percentages. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). and twist using your thumb. 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. 37. Acta Chir Scand. Am J Sports Med. No study directly compared the different types of graft for UCL reconstruction. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). 39. Ulnar collateral ligament injuries of the thumb: a comprehensive review. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. Metacarpophalangeal joint injuries of the thumb. 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. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. 2013;23(4):247-254. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 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. Benson LS, Bailie DS. J Hand Surg Am. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 8600 Rockville Pike [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. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 10. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 22. the thumb. Part I of this two-part article focuses on common tendon and . **Stener lesion status reported in 6 studies (145 thumbs). Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. 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. MCP fusion was performed . Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . 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). The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Patient Demographics of Thumb RCL and UCL Injuries. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. 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. 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Rupture and displacement of the. Mean subject age was 33.9 years. 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. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 1998;23:503506. Continue to stretch before and after throwing . This ligament prevents the thumb from pointing too far away from the hand. 35. 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. Surgical techniques and a review of 70 patients. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Bailie DS, Benson LS, Marymont JV. 12. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. 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. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 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. Only prospective studies can determine this injury course. They may even tear completely. 1,5,9,10 In acute cases of complete tears involving high-level . Am J Sports Med. You've successfully added to your alerts. 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. J Hand Surg Am. Rupture of the. A score of 2 was assigned if the item was completely and accurately performed and reported. The effect of thumb metacarpophalangeal. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. A systematic review of ulnar collateral ligament reconstruction techniques. 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). Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. If the latter was executed only partially, a score of 1 was assigned. A common complication following fracture of the distal radius is when the radius shortens. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. 3. 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. 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. 1987;214:113120. Disclaimer. 2009;6:e1000097. 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. 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. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. 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. 2005;24:217221. A p-value of 0.05 was considered statistically significant. 18. Arnold DM, Cooney WP, Wood MB. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Highlight selected keywords in the article text. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. There were 200 acute injuries and 93 chronic injuries. Conclusion: If any instability of the metacarpo-phalangeal joint is detected on the radial side of the joint with lateral stress and ulnar deviation than repair or reconstruction of the radial . 26. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Complications after surgical treatment of UCL injury are rare. Epub 2015 Sep 22. [31] The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. 2009;61:623632. No study reported the outcomes of nonoperative management of chronic UCL injury. flexion-extension motion. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The limitations of this systematic review are reliant on the studies analyzed. Would you like email updates of new search results? Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. 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%). Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. [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. These tears often occur as a result of a radially directed force on an extended thumb. Data is temporarily unavailable. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. 2018;6(4):1-7. Your thumb will be immobilized in a splint and should not be moved until follow up. Thus, the true natural history is yet unknown. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. J Hand Surg Br. Epub 2014 Oct 22. Unauthorized use of these marks is strictly prohibited. 19. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. Accessibility your express consent. The diagnosis is best established clinically, though MRI is the imaging modality of choice. 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 24. 2009;34:304308. Abstract. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. 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. The https:// ensures that you are connecting to the 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. At this stage, patients should be advised to wear your splint part-time. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Upper extremity injuries in snow skiers. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). and transmitted securely. 7. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Figure 46-2 Approach to the ulnar collateral ligament. These exercises may be directed by a physical or occupational therapist. eCollection 2021. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Chir Main. Epub 2021 Jan 18. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). Thirty-two thumbs were treated nonoperatively and 261 operatively. 1-8 Nevertheless, UCL injuries have also been described in javelin throwers, tennis players, arm wrestlers, collegiate wrestlers, and quarterbacks. Acute gamekeeper's thumb. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Non-Fusion. PMC 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). Continuous variable data were reported as mean SDs from the mean. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. There were 200 acute injuries and 93 chronic injuries. There is currently no consensus on treatment of acute or chronic UCL injuries. You may be trying to access this site from a secured browser on the server. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. J Hand Surg Am. Please confirm that you would like to log out of Medscape. SAGE Open Med. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Post-traumatic instability of the metacarpophalangeal joint of the thumb. the splint for protection or at night until twelve weeks after the operation. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Thumb from the common mechanism of falling on the thumb while holding a ski pole. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce.
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