Continuous variable data were reported as mean SDs from the mean. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. No study directly compared nonoperative to operative treatment. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. There is currently no consensus on treatment of acute or chronic UCL injuries. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. Thirty-two thumbs were treated nonoperatively and 261 operatively. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Causes. 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.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.15 In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.15. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Sports Med Arthrosc Rev. Metacarpophalangeal joint injuries of the thumb. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. If the tear is diagnosed early a repair will be possible. The LUCL is located on the lateral or outside part of the elbow. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. 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. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. A score of 0 was assigned if the item was either omitted or not performed. 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. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. J Bone Joint Surg Am. NR, not reported. 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.. Your thumb will be immobilized in a splint and should not be moved until follow up. 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). Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Keywords: The torn thumb ligament is repaired or reconstructed during surgery. Proximal interphalangeal joint injuries of the hand. fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. MeSH 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. Complications after surgical treatment of UCL injury are rare. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. 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. 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. Only prospective studies can determine this injury course. The injury happens when you fall . Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. 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Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Orthopedics. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. UCLR case series that contained complications data were included. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 2009;34:304308. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Conflicts of interest The authors report no funding or conflicts of interest. Part II: treatment and complications. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 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. Part I of this two-part article focuses on common tendon and . 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.19 Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis.30,43,44 It has been well documented that direct suture techniques fail in chronic injuries.33,45 When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.46. No study directly compared the different types of graft for UCL reconstruction. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Wolters Kluwer Health
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. 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. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 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. 1999;24:7075. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. eCollection 2021 Apr. Early and late postoperative complications were recorded. You've successfully added to your alerts. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. Surgical management of chronic, 42. 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. Weakened grip or reduced thumb range of motion may occur. 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. There is currently no consensus on treatment of acute or chronic UCL injuries. Significantly better motion and strength and fewer complications were observed with suture anchors and early mobilization versus suture button and cast immobilization (P < 0.05).20 Only 3 patients in these 6 studies had residual laxity. 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. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Injury. Would you like email updates of new search results? government site. 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. may email you for journal alerts and information, but is committed
For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 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%). Epub 2014 Dec 30. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Am J Sports Med. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Federal government websites often end in .gov or .mil. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. 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. 45. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Meta-analysis of the pooled data was completed. 27. 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. 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. Am J Sports Med. Data sources: Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Acute gamekeeper's 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. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Thumb dominance reported in 8 studies (168 thumbs). Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. 2013;23(4):247-254. 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. I was able to work while wearing the splint. One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. 1961;43-A:541546. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. After failure of nonoperative treatment, at anywhere from 6 months 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. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. [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. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. 12. modify the keyword list to augment your search. Dr. Holt will talk to you about when it is safe to return to work. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. This ligament prevents the thumb from pointing too far away from the hand. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. 11. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. A common complication following fracture of the distal radius is when the radius shortens. Epub 2015 Sep 22. 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. This leads to what is know as a positive ulnar variance. 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. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. If it is appropriate, then surgical consent probably happened before the surgery. Orthop Clin North Am. J Hand Surg Am. 24. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. An official website of the United States government. 2009;6:e1000097. [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. official website and that any information you provide is encrypted Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1987;214:113120. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. There is currently no consensus on treatment of acute or chronic UCL injuries. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. 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. FOIA Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. This website also contains material copyrighted by 3rd parties. Careers. Please enable it to take advantage of the complete set of features! An official website of the United States government. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 38. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Am J Sports Med. 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. Careers. The anti edema management will continue for several weeks. Jupiter JB, Sheppard JE. J Hand Surg Am. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. Subject demographics are reported in Table 2. Study design: The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Downey DJ, Moneim MS, Omer GE Jr. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. 2022 Mar 1;30(1):e1-e8. What are the symptoms of GameKeeper's 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. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. Post-traumatic instability of the metacarpophalangeal joint of the thumb. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. Am J Orthop (Belle Mead NJ). Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. All but 2 were level IV evidence. 13. 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). Wong TC, Ip FK, Wu WC. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Stener B. Skeletal injuries associated with rupture of the. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Proximal interphalangeal joint injuries of the hand. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Clin J Sport Med. A systematic review of ulnar collateral ligament reconstruction techniques. The grip strength and the pinch strength were 94.3% and 92.27%,. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Arthritis Rheum. You will receive email when new content is published. Gamekeeper's thumb. Muscles. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Am J Sports Med. Van Dommelen BA, Zvirbulis RA. All rights reserved. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. An anatomic basis for treatment. 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 Complications after surgery were rare. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 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. Bethesda, MD 20894, Web Policies History. Long-term results of ligament reconstruction. Epub 2014 Oct 22. 10. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Your surgeon will discuss these options with you. No study compared different graft types or fixation techniques. Chir Main. Julie Balch Samora, MD, PhD*, Joshua D. Harris, MD, Michael J. Griesser, MD, Michael E. Ruff, MD* and Hisham M. Awan, MD* *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. doi: 10.1016/j.asmr.2020.12.004. 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. [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. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". [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. Am J Sports Med. Bethesda, MD 20894, Web Policies Frykman G, Johansson O. Surgical repair of rupture of the, 46. 32. 25. 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. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 2005;87:26322638. He too had the internal brace augmentation. If your bone is broken, a pin will be used to put it in place. 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. The Orthopedic Journal of Sports Medicine. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The mean patient age was 37.8 years (14.0-78.1). 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). Instability of the metacarpophalangeal joint of the thumb. If you log out, you will be required to enter your username and password the next time you visit. Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. 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%). However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury.
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