Ulnar Collateral Ligament Repair

Chapter 20 Ulnar Collateral Ligament Repair

Coleen T. Gately, PT, DPT, MS

The ulnar collateral ligament (UCL) is the primary valgus stabilizer of the thumb metacarpophalangeal (MP) joint. The UCL is more frequently injured than the radial collateral ligament. A 10 to 1 ratio of injury is reported in the literature.

Historically, UCL laxity was observed in gamekeepers as a result of repetitive valgus stress placed on the thumb while pinning game between the thumb and index finger, and was subsequently referred to as “gamekeeper’s thumb.” Acute injury to the UCL results from a fall on an extended thumb forced into hyperabduction. This is a common skiing injury and is frequently referred to as “skier’s thumb.” The UCL can be ruptured or avulsed at the origin, with or without a bony fragment of the proximal phalanx. Symptoms following a UCL tear include pain, swelling, and instability of the MP during pinch activities. Many patients do not seek immediate medical attention. If left untreated, this injury can lead to long-term weakness, joint deformity (subluxation), and arthritis.

Surgical Overview

• UCL ruptures may be treated conservatively with immobilization splinting for 6 to 8 weeks in a hand-based thumb immobilization splint with the interphalangeal (IP) joint free. Surgical indications for a UCL injury include failure of conservative management, clinical joint instability, fracture or displacement, and a Stener lesion.

• A Stener lesion prevents the UCL from healing without surgery because of interposition of the adductor aponeurosis between the ligament’s torn edges.

• Several surgical techniques are used to repair a UCL tear.

1 They include a simple ligament repair and tendon reconstruction.

2 Suture anchors are used for the repair, and a Kirschner’s wire is used to stabilize larger avulsion fractures.

3 In certain cases, a temporary transarticular pin is used to control stress across the repair site.

4 The surgical technique is based on the extent of joint involvement and the time elapsed since injury. An acute injury is often treated with a simple repair, whereas a chronic injury may require a complex procedure.

Rehabilitation Overview

• The amount of surgical stability achieved will determine the rate of progression of therapeutic techniques in each phase of healing.

• Direct communication with the doctor is essential to determine the stability of the joint for appropriate therapeutic progression.

Postoperative Phase I: Protection (Weeks 0 to 4)

GOALS

• Correct protective immobilization

• Edema and pain control

• Full ROM of uninvolved joints

PRECAUTIONS

• No thumb MP motion

• Valgus forces

PIN AND WOUND CARE

• Pin care regimens vary: commonly, 50% peroxide and sterile water two times per day

• Standard wound care procedures followed for ORIF

Tags: Handbook of Postsurgical Rehabilitation Guidelines

Jun 22, 2016 | Posted by admin in PHYSICAL MEDICINE & REHABILITATION | Comments Off

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