complications after ucl repair of thumb

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. Rupture and displacement of the. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Ulnar collateral ligament injuries of the thumb (gamekeeper or skier thumb) are more common than the radial side but both can cause significant disability. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. 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. 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. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. An official website of the United States government. *Gender reported in 12 studies (218 subjects). Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Only prospective studies can determine this injury course. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. 38. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. PMC Epub 2013 Nov 12. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Am J Sports Med. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. Infection is a rare complication of hand surgery. Unauthorized use of these marks is strictly prohibited. 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. 27. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Acute gamekeeper's thumb. Please enable scripts and reload this page. Upper extremity injuries in snow skiers. 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. 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. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. A score of 0 was assigned if the item was either omitted or not performed. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Bailie DS, Benson LS, Marymont JV. Catalano LW III, Cardon L, Patenaude N, et al.. 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. 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. Part II: treatment and complications. The authors report no funding or conflicts of interest. When assessed, most patients returned to their preinjury employment. 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 . All but 2 were level IV evidence. The grip strength and the pinch strength were 94.3% and 92.27%,. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Am J Sports Med. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. 1962;124:396411. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Part I of this two-part article focuses on common tendon and . 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). and twist using your 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. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. J Bone Joint Surg Am. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. [33] Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. In these patients, after failure of nonoperative treatment at anywhere from 1 month 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. Data range was reported as minimum to maximum absolute values. This ligament prevents the thumb from pointing too far away from the hand. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. [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. 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. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Studies that duplicated patient populations from the same authors were excluded. Your surgeon is the person best able to help you avoid any serious recovery problems. 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. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. 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. Click the topic below to receive emails when new articles are available. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. 1999;24:7075. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 22. A systematic review of ulnar collateral ligament reconstruction techniques. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Data is temporarily unavailable. 1994;25:2123. UCLR case series that contained complications data were included. 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. Mechanism of injury to the RCL of the MCP joint of the thumb is force . One study15 reported outcomes of 9 patients who had failed nonoperative treatment and underwent subsequent surgical repair. Conclusions: 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. If the latter was executed only partially, a score of 1 was assigned. These tears often occur as a result of a radially directed force on an extended thumb. Subject demographics are reported in Table 2. Keywords: 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. Thus, the true natural history is yet unknown. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 24. Although many injuries can be managed conservatively, some require more invasive interventions to prevent complications and loss of function. 1995;23:222226. Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. A broken thumb can also cause numbness or tingling. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. There is currently no consensus on treatment of acute or chronic UCL injuries. *Glickel grading scale. 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. Federal government websites often end in .gov or .mil. J Bone Joint Surg Am. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the 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. Orthop Clin North Am. Rupture of the. Bookshelf Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 1987;214:113120. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. An official website of the United States government. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Early and late postoperative complications were recorded. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). The torn thumb ligament is repaired or reconstructed during surgery. Complications after surgical treatment of UCL injury are rare. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . 4. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Bethesda, MD 20894, Web Policies Mean study follow-up was 42.8 months. To date, no literat. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Treatment of chronic injuries of the. 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. Stretching or even a rupture of the graft is also possible. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. 1,5,9,10 In acute cases of complete tears involving high-level . You will receive email when new content is published. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Intravenous regional anesthesia is commonly preferred for routine hand and wrist surgeries because it is well tolerated, safe, reliable, and has a rapid onset. 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 collateral ligament (UCL) injuries of the elbow are a common source of pain and disability in the overhead athlete and more particularly, baseball pitchers. J Bone Joint Surg Am. POST-OPERATIVE WEEKS 22-24. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Metacarpophalangeal joint injuries of the thumb. Some error has occurred while processing your request. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 6,15,19,20,24,29 First described by Frank Jobe in 1986, the procedure has undergone significant evolution . 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. Disclaimer. MeSH Eurasian J Med. The LUCL is located on the lateral or outside part of the elbow. Keyword Highlighting three muscles provide deforming forces at the base of the thumb. Purpose: When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 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 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. Table 1. Sports Health. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 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. Posner MA, Retaillaud JL. The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Am J Sports Med. Am J Sports Med. A score of 0 was assigned if the item was either omitted or not performed. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. 18. Sports Med Arthrosc Rev. The https:// ensures that you are connecting to the Methods: J Bone Joint Surg Am. 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. 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. eCollection 2021 Mar. [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. The site is secure. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. SAGE Open Med. Epub 2019 Mar 21. The anti edema management will continue for several weeks. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Results: 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. 33. Instability of the metacarpophalangeal joint of the thumb. Thumb dominance reported in 8 studies (168 thumbs). Fourteen articles were included and analyzed (293 thumbs). Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Wolters Kluwer Health 44. Complications after this procedure may include nerve or blood vessel damage. sharing sensitive information, make sure youre on a federal 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%). Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. An anatomic basis for treatment. The injury happens when you fall . 5. Am J Orthop (Belle Mead NJ). Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. 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. I was able to work while wearing the splint. 10. Your thumb will be immobilized in a splint and should not be moved until follow up. 2005;87:26322638. This website also contains material copyrighted by 3rd parties. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Kaplan EB. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery UCLR case series that contained complications data were included. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 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. 16. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. Surgical techniques and a review of 70 patients. 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. 8. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Bookshelf No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. 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%). Diagnosis of displaced, 43. 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). Would you like email updates of new search results? When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. These exercises may be directed by a physical or occupational therapist. 19. 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. 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. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. 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). Fusetti C, Papaloizos M, Meyer H, et al.. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Thirty-two thumbs were treated nonoperatively and 261 operatively. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 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. You've successfully added to your alerts. 39. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). 1989;17:751753. Various levels of pain, bruising, or edema may present at the site of damage. Both repair and reconstruction (autograft and allograft) techniques were inclusive. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. HHS Vulnerability Disclosure, Help After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. 1995;18:11611165. Fourteen articles were included and analyzed (293 thumbs). Please try after some time. 415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903 434-982-HAND (4263) Unable to load your collection due to an error, Unable to load your delegates due to an error. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Bostock S, Morris MA. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 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]). Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Symptoms are dependent on the cause and severity of injury to the UCL. NR, not reported.