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Injury to the ulnar collateral ligament of the thumb is very common Ulnar collateral ligament thumb surgery can be disabling when missed or left untreated.

We present a review of literature and our preferred way of Carmen electra porn comics. Rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint MCPJ is a common hand injury that can lead to long-term problems if inadequately treated [ 3534 ].

Excessive valgus stress to the base of the thumb may result in disruption of the ulnar collateral ligament complex with or without an avulsion fracture of the base of the proximal phalanx. We present a review of current literature and our experience. The metacarpophalangeal MCP joint is a diarthrodial joint. The head of the first metacarpal can vary from dome-shaped to flattened, but the radial condyles of the proximal phalanx are always significantly more prominent on the volar side compared to the ulnar side [ 37 ].

The joint is mainly involved in flexion-extension but does also allow rotation, abduction, and adduction. The amount of varus or valgus laxity is also variable between normal thumbs and at the different positions of flexion of the same thumb. The static restraints of the MCP joint are the volar plate, the dorsal capsule, and the ulnar and radial collateral ligaments. The ulnar collateral ligament complex consists of a proper and an accessory ligament.

In flexion, the dorsal capsule and the proper collateral ligament are taut. The proper collateral ligament runs from the middle of the metacarpal head to the palmar aspect of the proximal phalanx.

The proper collateral ligament along with the dorsal capsule helps resist palmar Ulnar collateral ligament thumb surgery of the proximal phalanx in addition to resisting radially directed forces. In extension, the accessory collateral ligament and the palmar Ulnar collateral ligament thumb surgery are tight. The accessory collateral ligament lies palmar to the proper ligament and is in continuity with it and the volar plate [ 1626 ].

The role of the accessory collateral ligament in thumb stability has recently been proven [ 9 ]. The dynamic stabilizers include the thumb extrinsic muscles extensor pollicis longus, extensor pollicis brevis, and flexor pollicis longus and intrinsic muscles abductor pollicis brevis, flexor pollicis brevis, and adductor pollicis.

The adductor pollicis inserts into the extensor expansion through its aponeurosis, which normally lies superficial to the joint capsule and the ulnar collateral ligament. Disruption of the ulnar collateral ligament of the thumb MPJ was initially reported by Campbell in Campbell Ulnar collateral ligament thumb surgery laxity of the base of the thumb in Scottish gamekeepers as a result of chronic repetitive valgus strain [ 2 ].

Injury rates in skiers are as high as 2. Injuries to the thumb UCL also occur in rugby and other collision sports that involve twisting injuries to the thumb [ 34 ]. This injury has even been reported after a handshake [ 7 ]. When an acute excessive valgus stress is applied to the thumb Ulnar collateral ligament thumb surgery, three injuries can occur: rupture of the ulnar collateral ligament, avulsion fracture of the ulnar—volar base of the proximal phalanx displaced or not or both [ 10 ].

There is also a rare variation of this injury where the ulnar collateral ligament remains intact, and there is an avulsion fracture involving the volar plate [ 2529 ]. Stener lesions are missed despite the advances in imaging and the high suspicion of clinicians [ 1221 ]. Stener first described the interposition Ulnar collateral ligament thumb surgery the adductor aponeurosis and proximal retraction of the ruptured ulnar collateral ligament [ 35 ].

In a Stener lesion, the ulnar collateral ligament ruptures from the base of the proximal phalanx PP while the thumb is in valgus or abduction and retracts proximally and displaces superficial to the adductor pollicis that contracts to resist the load.

In this situation, healing is impossible Ulnar collateral ligament thumb surgery the torn proximal end and its footprint at the base of the PP due to the interposed adductor hood. The dorsal capsule may also be torn leading to subluxation of the MCP joint [ 434 ]. Unless there is underlying pathology as rheumatoid disease leading to degeneration of the UCL, trauma is required to rupture the UCL complex.

This is usually a forced valgus strain to the thumb MCP joint. Common mechanisms of injury include a fall while holding an object that is escaping—for example, a fall while skiing holding a ski pole, a hyperextension or abduction injury trying to catch a ball, or the thumb being caught into an artificial ski slope honeycomb matting.

The injury is followed by pain and swelling at the base of the thumb. Clinical examination may occasionally reveal a tender swelling at the ulnar side of the base of the thumb that represents the displaced Ulnar collateral ligament thumb surgery that is the Stener Ulnar collateral ligament thumb surgery. Abrahamsson in [ 1 ] recommended palpation of the displaced ulnar collateral ligament end as a means of differentiating Ulnar collateral ligament thumb surgery from undisplaced ligaments.

This sign was used to decide on conservative or surgical treatment—cast when the end of the ligament is not palpable, thus, nondisplaced; open repair when it is palpable and displaced. In the acute setting, there is pain on palpation, bruising, and swelling. The patient who presents late will have noticed weakness of grip and pinch as well as a sense of instability of the thumb. The injury is easily missed by inexperienced medical personnel.

Before testing for stability, it is important to obtain radiographs to exclude fractures of either the metacarpal or the proximal phalanx. If there is no associated fracture of the shaft, the thumb MCP joint stability is tested Fotos da shakira nua full flexion, a position where the proper ulnar collateral ligament is tight while stabilizing the thumb metacarpal proximal to the joint to stop rotation and radially angulating the thumb.

The same test is performed in extension, and when positive, it means the accessory ulnar collateral ligament is also torn [ 4293538 Ulnar collateral ligament thumb surgery Fig. An undisplaced avulsion fracture of the base of the proximal phalanx should not stop the examination since the injury force is always greater than the force applied on clinical examination; thus, it is very unlikely that displacement will occur [ 15 ].

Complete rupture of the ligament can coexist with an undisplaced fracture [ 101521 ]. Plain radiographs in both the AP and lateral plane are requested to exclude bone injury. Stress views with local anesthetic may help define the degree of instability Fig. Ultrasound has been Girls nude grocery shopping used in differentiating Stener lesions from simple avulsions of the ulnar collateral ligament [ 82228 ], Ulnar collateral ligament thumb surgery it may be misleading [ Ulnar collateral ligament thumb surgery ].

Magnetic resonance imaging MRI is more accurate Figs. Arthrography alone or with magnetic resonance has been advocated as method to diagnose Stener lesions [ 828 ]. The authors do not routinely use MRI but only when clinically in doubt. However, if the thumb is stable in extension while lax in flexion, one of the senior authors will attempt to treat the thumb with a 3-week course of cast immobilization. If the stability has not improved Ulnar collateral ligament thumb surgery this point, then surgical repair is sought.

Surgical treatment in the acute setting is favored since it has excellent results [ Ulnar collateral ligament thumb surgery ]. Great Ulnar collateral ligament thumb surgery must be taken to identify and protect the dorsal branches of the radial nerve that supply sensation to the ulnar aspect of the thumb Fig.

The proximal edge of the adductor aponeurosis is seen and, if a Stener lesion present Fig. The adductor aponeurosis must be incised longitudinally in a parallel fashion to the extensor pollicis longus. With retraction of the adductor aponeurosis, the dorsal capsule and the collateral ligaments are assessed. In a soft tissue ligament avulsion, a variety of techniques have been used for repair. A pull-out suture technique can be used Hoopz flavor of love nude a transosseous stainless steel wire or other nonabsorbable suture either tied over bone at the proximal phalanx or tied over a button on the radial side of the MCP joint [ 1534 ].

Mini anchors have successfully been used to secure the ligament in place without need for drilling two cortices or exposing suture material [ 17 ] Figs. The use of bone anchors is now the most common method of repair in modern practice [ 1217 ]. If both the proper and accessory ligaments are torn, they must both be repaired to ensure a good result. The proper ligament inserts at the palmar ulnar aspect of the base of the proximal phalanx and should Ulnar collateral ligament thumb surgery be secured in place anatomically.

Rarely, the palmar plate is reconstructed. However, if required, care should be taken not to over tighten this structure to avoid a fixed flexion contracture. The volar plate Ulnar collateral ligament thumb surgery difficult to approach form the ulnar midaxial incision.

The accessory ligament will be repaired to its insertion distal and palmar to the proper ligament. Finally the dorsal capsule is sutured, and the adductor aponeurosis repaired. Infrequently, the Sexy latina blow job is torn in its midsubstance Fig.

When there is a fracture of the base of the PP, this is usually avulsed from Ulnar collateral ligament thumb surgery ulnopalmar aspect. Smaller fragments can be excised, but larger ones should be reduced and fixed [ 615 ] with either a 1.

Tension band Ulnar collateral ligament thumb surgery has been successfully used for fixation of small fragments. However, it must be stressed that the location of the fragment in the ulnar volar corner of the base of the proximal phalanx often causes difficulty with screw placement due to the poor line of access.

Bone anchors are increasingly used for moderate-sized bony fragments either into the avulsion footprint or distal to the footprint and secure the fragment. With more extreme force, a dislocation of the joint may be combined with total rupture of the volar plate. The joint may not maintain stability when reduced and the ligaments repaired; in this case, a wire is used for temporary stabilization of the joint [ 34 ]. Chronic lesions are more difficult to treat, and in this section, we presume that no arthritis is present.

If a classic Stener lesion is found, it can be dissected off the adductor hood, the hood incised, and Indian mature hairy pussy ligament reattached with an anchor as in the acute setting.

This has been performed by one of Ulnar collateral ligament thumb surgery authors Ulnar collateral ligament thumb surgery three occasions with good long-term stability.

Often, the remnants of the ligament are degenerated. Repair has been tried [ 19 ] but usually is not possible. In this situation, the UCL is reconstructed using a tendon graft. The most common donor is the palmaris longus tendon followed by a strip of the flexor carpi radialis or ulnaris or the extensor pollicis brevis [ 1132 ].

The reconstruction can be performed in any bony tunnel configuration though it was shown that a triangular configuration with apex proximal Ulnar collateral ligament thumb surgery the thumb MCP joint with good results in maintaining the flexion or extension arc.

A neglected, undertreated, or missed injury of the ulnar collateral ligament of the thumb may lead to significant disability and chronic pain due to instability. Some authors suggest conservative treatment with cast or splint immobilization for complete undisplaced ruptures of the UCL as suggested by Abrahamsson regardless of the instability [ 112 ].

However, the outcome may not always be favorable; therefore, this approach is not largely accepted [ 1235 ]. Our Ulnar collateral ligament thumb surgery is that acute complete ruptures of the UCL with associated joint laxity should be repaired. Early mobilization after stable anatomical repair is associated with excellent return of movement and strength.

National Center for Biotechnology InformationU. Journal List Hand N Y v. Hand N Y. Published online Oct Chrysi Tsiouri1 Michael J.

Hayton1 and Mark Baratz 2. Michael J. Author information Article notes Copyright and License information Ulnar collateral ligament thumb surgery.


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