complications after ucl repair of thumb

Clin J Sport Med. If the latter was executed only partially, a score of 1 was assigned. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. *Glickel grading system. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Proximal interphalangeal joint injuries of the hand. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. These tears often occur as a result of a radially directed force on an extended thumb. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. 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. Kozin SH, Bishop AT. 8. 2018;6(4):1-7. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Fourteen articles were included and analyzed (293 thumbs). Am J Orthop (Belle Mead NJ). Bennet Fracture. 1. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. The authors report no funding or conflicts of interest. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. History. Benson LS, Bailie DS. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 31. HHS Vulnerability Disclosure, Help The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). may email you for journal alerts and information, but is committed Please try again soon. 2. 2006;31:6875. The limitations of this systematic review are reliant on the studies analyzed. Epub 2021 Sep 7. All but 2 were level IV evidence. Nonoperative treatment often failed, necessitating surgery. 5. [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. SAGE Open Med. 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. [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. Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 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%). Louis DS, Huebner JJ Jr, Hankin FM. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. 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. 1992;8:713732. Instability of the metacarpophalangeal joint of the thumb. POST-OPERATIVE WEEKS 22-24. A p-value of 0.05 was considered statistically significant. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. The .gov means its official. National Library of Medicine Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Continue to stretch before and after throwing . An official website of the United States government. The Orthopedic Journal of Sports Medicine. In these cases, a new graft may be used to perform a second reconstruction. 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. 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. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 2022 Jul;50(8):2324-2338. doi: 10.1177/03635465211023952. Treatment of chronic injuries of the. 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. Hand Surg. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. 6. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. There were no cases of intraoperative ulnar nerve injury reported. 1995;18:11611165. PMC Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. 35. 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. The mean time from reported injury date to surgery was 202.4 days (2-5969). Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Would you like email updates of new search results? The LUCL is located on the lateral or outside part of the elbow. Symptoms are dependent on the cause and severity of injury to the UCL. Methods: 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. Disclaimer. 4. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. 36. [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. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. 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. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 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. A common complication following fracture of the distal radius is when the radius shortens. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Complications after surgery were rare. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. 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. MeSH Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Wolters Kluwer Health J Bone Joint Surg Am. Van Dommelen BA, Zvirbulis RA. Am J Sports Med. 1987;214:113120. Both repair and reconstruction (autograft and allograft) techniques were inclusive. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Descriptive statistics were calculated. Ulnar Collateral Ligament Repair . Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Orthop Clin North Am. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Wong TC, Ip FK, Wu WC. The .gov means its official. Only prospective studies can determine this injury course. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. 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%. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. PMC 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. [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. All but 2 were level IV evidence. J Hand Surg Br. 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%). Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 16. Proximal interphalangeal joint injuries of the hand. Table 1. Pichora DR, McMurtry RY, Bell MJ. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Clipboard, Search History, and several other advanced features are temporarily unavailable. Stretching or even a rupture of the graft is also possible. 1995;23:222226. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Rupture and displacement of the. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Studies that duplicated patient populations from the same authors were excluded. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . You may also begin strengthening exercises if needed. 15. There were 61 studies eliminated as secondary for being in a language other than English. Catalano LW III, Cardon L, Patenaude N, et al.. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Moher D, Liberati A, Tetzlaff J, et al.. UCLR case series that contained complications data were included. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Upper extremity injuries in snow skiers. 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. Thumb sidedness reported in 3 studies (51 thumbs). The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Your message has been successfully sent to your colleague. 2003;8:8185. The site is secure. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). 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 Would you like email updates of new search results? Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 2013;23(4):247-254. 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. 1989;17:751753. This ligament prevents the thumb from pointing too far away from the hand. This site needs JavaScript to work properly. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. 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. Mean study follow-up was 42.8 months. 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. What are the symptoms of GameKeeper's Thumb? Careers. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. 1962;124:396411. Epub 2013 Nov 12. Disclaimer. Most times, they won't know until they're in the surgery if the internal brace is appropriate. 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%). Careers. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Please enable it to take advantage of the complete set of features! 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. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. [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. No study reported the outcomes of nonoperative management of chronic UCL injury. The overall complication rate was 13.8% (11/80). eCollection 2021 Mar. the splint for protection or at night until twelve weeks after the operation. Epub 2019 Mar 21. [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]. You will receive email when new content is published. There is currently no consensus on treatment of acute or chronic UCL injuries. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . Kaplan EB. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. FOIA 11. Part I: anatomy and diagnosis. Unauthorized use of these marks is strictly prohibited. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. Keywords: J Hand Surg Am. The https:// ensures that you are connecting to the 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. 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. Surgical techniques and a review of 70 patients. 39. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Most patients have minimal pain by 6 weeks after surgery, with nearly full thumb and hand motion by 3 months. 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. 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. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. official website and that any information you provide is encrypted This damage may lead to temporary or permanent numbness or weakness. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. The limitations of this systematic review are reliant on the studies analyzed. All authors independently performed the search. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Nonoperative treatment led to high patient satisfaction for acute thumb UCL injury in 2 studies.23,29 Thirty-two subjects were treated with thumb-spica immobilization (30 were proximal phalanx avulsion fractures). Ulnar collateral ligament injuries of the thumb: a comprehensive review. The mean patient age was 37.8 years (14.0-78.1). Engelhardt JB, Christensen OM, Christiansen TG. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. J Bone Joint Surg Am. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . Before If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. Early diagnosis and treatment. 34. 10. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. Management of thumb metacarpophalangeal ulnar collateral ligament injuries. 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. 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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . I was able to work while wearing the splint. J Bone Joint Surg Am. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. 12. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. J Hand Surg Glob Online. Federal government websites often end in .gov or .mil. Complications after surgery were rare. 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. 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. Thus, the true natural history is yet unknown. Acute gamekeeper's thumb. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. the thumb. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. Early and late postoperative complications were recorded. eCollection 2021. 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. Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. 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.. 1993;21:800804. The effect of thumb metacarpophalangeal. 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. 45. Sakellarides HT, DeWeese JW. 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. Commonly, the joint will be permanently enlarged due to the scarring of the healing process. Jupiter JB, Sheppard JE. Please enter a Recipient Address and/or check the Send me a copy checkbox. Frykman G, Johansson O. Surgical repair of rupture of the, 46. The grip strength and the pinch strength were 94.3% and 92.27%,. Posner MA, Retaillaud JL. 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. Infection is a rare complication of hand surgery. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Patient Demographics of Thumb RCL and UCL Injuries. Results: Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery doi: 10.1097/JSA.0000000000000322. For this elbow surgery, the internal brace is most appropriate for the athlete that has a UCL sprain that is not complex. Orthop J Sports Med. 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). flexion-extension motion. When untreated, this injury may lead to decreased pinch strength, pain, instability, and. Sports Med Arthrosc Rev. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . No study compared different graft types or fixation techniques. There is currently no consensus on treatment of acute or chronic UCL injuries. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. Click the topic below to receive emails when new articles are available. You've successfully added to your alerts. Purpose. 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. 24. 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. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. Mean study follow-up was 42.8 months. J Bone Joint Surg Am. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. Looney AM, Wang DX, Conroy CM, Israel JE, Bodendorfer BM, Fryar CM, Pianka MA, Fackler NP, Ciccotti MG, Chang ES. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. 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%). It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Long-term results of ligament reconstruction. Orthopedics. 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. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. 2013Lippincott Williams & Wilkins. The anti edema management will continue for several weeks. Main results: For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. Unable to load your collection due to an error, Unable to load your delegates due to an error.