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Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. National Library of Medicine 2009;61:623632. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 2005;87:26322638. your express consent. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 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. 2018;6(4):1-7. The injury happens when you fall . Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Epub 2015 Sep 22. 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. Would you like email updates of new search results? 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . Epub 2021 Sep 7. Eventually this abnormal movement will wear out the joint and it will become arthritic. Hand Clin. Nonoperative treatment often failed, necessitating surgery. 1. UCLR case series that contained complications data were included. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Am J Sports Med. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. [16] Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. Educate the patient on anti edema management. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. Disclaimer. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Arnold DM, Cooney WP, Wood MB. Study design: unstable when the thumb is used. 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). Studies that duplicated patient populations from the same authors were excluded. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. 39. Continue to stretch before and after throwing . J Bone Joint Surg Am. Careers. Federal government websites often end in .gov or .mil. 2014 Dec;33(6):384-9. doi: 10.1016/j.main.2014.10.003. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. Stretching or even a rupture of the graft is also possible. 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. 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. 4. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Thirty-two thumbs were treated nonoperatively and 261 operatively. eCollection 2021. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. *Gender reported in 12 studies (218 subjects). Before A blunt self-retainer is used to retract the musculature, and a small periosteal elevator can be used to clean any remaining muscle fibers from the UCL. 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. SAGE Open Med. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. 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. 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. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. 31. SYMPTOMS: The thumb may be swollen, bruised and painful. 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. Am J Orthop (Belle Mead NJ). Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 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. J Bone Joint Surg Am. Meta-analysis of the pooled data was completed. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. The https:// ensures that you are connecting to the 14 It is important to diagnose complete tears early because . Clipboard, Search History, and several other advanced features are temporarily unavailable. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). There are some cases where the fusion is not successful and you will still have pain in . Click the topic below to receive emails when new articles are available. Abstract. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. 8600 Rockville Pike Both purely ligamentous and bony avulsion injuries were included. Please confirm that you would like to log out of Medscape. Am J Sports Med. I was able to work while wearing the splint. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 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). History. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. A broken thumb can also cause numbness or tingling. HHS Vulnerability Disclosure, Help If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Jackson M, McQueen MM. Data is temporarily unavailable. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. eCollection 2021 Mar. 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. 36. PMC Clipboard, Search History, and several other advanced features are temporarily unavailable. 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). the splint for protection or at night until twelve weeks after the operation. In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Br. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. 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. Bethesda, MD 20894, Web Policies 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 . Bennet Fracture. 1995;23:222226. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Van Dommelen BA, Zvirbulis RA. 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. If the latter was executed only partially, a score of 1 was assigned. J Hand Surg Am. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 1994;23:797804. J Bone Joint Surg Am. Orthop J Sports Med. The injury involves the ulnar collateral ligament (UCL) of the thumb. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. 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. Stener B. Skeletal injuries associated with rupture of the. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. [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. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 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. Complications after surgery were rare. 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. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. HHS Vulnerability Disclosure, Help Sakellarides HT, DeWeese JW. For more information, please refer to our Privacy Policy. Metacarpophalangeal joint injuries of the thumb. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Thumb from the common mechanism of falling on the thumb while holding a ski pole. 6. 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. Epub 2016 Jan 13. All but 2 were level IV evidence. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. 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. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. The diagnosis is best established clinically, though MRI is the imaging modality of choice. MeSH This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. The effect of thumb metacarpophalangeal. Data range was reported as minimum to maximum absolute values. J Hand Surg Am. The site is secure. Orthop Clin North Am. Please enable it to take advantage of the complete set of features! A common complication following fracture of the distal radius is when the radius shortens. Sixty nine (86.3%) patients had grade 3 tears. Please try again soon. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%.16 Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. 8600 Rockville Pike 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. 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 repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Unauthorized use of these marks is strictly prohibited. Bookshelf [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. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Wolters Kluwer Health, Inc. and/or its subsidiaries. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. eCollection 2022 May. 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. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. official website and that any information you provide is encrypted 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. 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. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Thumb dominance reported in 8 studies (168 thumbs). 1962;124:396411. Complications after surgical treatment of UCL injury are rare. 13. There is currently no consensus on treatment of acute or chronic UCL injuries. 2014 Oct;42(10):2510-6. doi: 10.1177/0363546513509051. J Hand Surg Br. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Injury. Gamekeeper's thumb. Thus, the true natural history is yet unknown. 1976;58:106112. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Surgical management of chronic, 42. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Rupture of the. Your surgeon will discuss these options with you. Frykman G, Johansson O. Surgical repair of rupture of the, 46. Engelhardt JB, Christensen OM, Christiansen TG. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. When evaluating the relationship between ulnar and radial ligamentous injury and the presence or absence of complication, there was no significant difference, however trends were noted, X. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. 23. 24. Fourteen articles were included and analyzed (293 thumbs). Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Thumb sidedness reported in 3 studies (51 thumbs). Epub 2014 Oct 22. 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. You've successfully added to your alerts. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. 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. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 22. Rupture and displacement of the. The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). sharing sensitive information, make sure youre on a federal A score of 0 was assigned if the item was either omitted or not performed. Acute gamekeeper's thumb. All authors independently performed the search. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. 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 . Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. The Orthopedic Journal of Sports Medicine. **Stener lesion status reported in 6 studies (145 thumbs). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The site is secure. This ligament prevents the thumb from pointing too far away from the hand. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 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. Mean subject age was 33.9 years. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Am J Sports Med. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. When assessed, most patients returned to their preinjury employment. 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. Upper extremity injuries in snow skiers. There is currently no consensus on treatment of acute or chronic UCL injuries. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. 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%). 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. 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.. Abrahamsson SO, Sollerman C, Lundborg G, et al.. the thumb. Catalano LW III, Cardon L, Patenaude N, et al.. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Search performed on November 17, 2011. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. This site needs JavaScript to work properly. [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. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 2013;23(4):247-254. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Treatment of chronic injuries of the. Eurasian J Med. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. The anti edema management will continue for several weeks. This article provides a review of . An official website of the United States government. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. 10. Methods: Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Proximal interphalangeal joint injuries of the hand. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. These exercises may be directed by a physical or occupational therapist. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 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. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Your ligament may need to be reattached to the bone using a bone anchor. Results: A score of 2 was assigned if the item was completely and accurately performed and reported. The doctor won't know if the repair is . Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. government site. Main results: #Injury location reported only in 3 studies. 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.