Reconstruction of the Thumb Metacarpophalangeal Ulnar Collateral Ligament With an Adductor Pollicis Slip: An Anatomic Evaluation

2021 ◽  
Author(s):  
Gregory J. Schmidt ◽  
Nicholas E. Crosby ◽  
Gregory A. Merrell
Keyword(s):  
Ulnar Collateral Ligament ◽  
Adductor Pollicis ◽  
Collateral Ligament

Dislocations of the Metacarpophalangeal Joint of the Thumb

1997 ◽  
Vol 22 (4) ◽  
pp. 499-504 ◽  
Author(s):  
M. PATEL ◽  
J. DAVÉ
Keyword(s):  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Adductor Pollicis ◽  
Flexor Pollicis Longus ◽  
Collateral Ligament ◽  
Abductor Pollicis Brevis ◽  
Extensor Pollicis Longus ◽  
Palmar Plate ◽  
Cadaver Studies

We report 13 cases of thumb metacarpophalangeal dislocations, ten dorsal and three palmar. Eleven had complex dislocations requiring open reductions. With dorsal dislocations the palmar plate, the tendon of flexor pollicis longus and the “thenar trap” (adductor pollicis, flexor pollicis brevis and abductor pollicis brevis) were the main impediments to reduction. The dorsal capsule, extensor expansion and extensor pollicis longus and brevis prevented reduction with the uncommon palmar dislocations. Cadaver studies showed that dorsal dislocations are hyperextension and pronation injuries and palmar dislocations are hyperflexion and supination injuries. The unique “handlebar grip” injury which can cause either dorsal or palmar dislocations is also discussed. The palmar plate is the single most important stabilizer of the metacarpophalangeal joint and it is impossible to sustain a dislocation without tearing it. It is most likely to get entrapped within the joint in dorsal dislocations. Ulnar collateral ligament tears are more common with palmar dislocations.

The ‘‘Two Fleck Sign’’ for an Occult Stener Lesion

2008 ◽  
Vol 33 (2) ◽  
pp. 208-211 ◽  
Author(s):  
SUNIL THIRKANNAD ◽  
THOMAS W. WOLFF
Keyword(s):  
Retrospective Review ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Adductor Pollicis ◽  
Collateral Ligament ◽  
Fracture Fragment ◽  
Adductor Pollicis Muscle ◽  
X Ray ◽  
Stener Lesion

We report a case of distal pull-off of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with two fracture fragments. The more obvious fracture fragment, seen on plain X-ray to be lying adjacent to the expected location of the attachment of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, was, in fact, unassociated with it and was part of the attachment of the adductor pollicis muscle. A second smaller fleck of bone which was attached to the displaced collateral ligament was only observed on plain X-ray on retrospective review. This second fleck of bone identified that this was a Stener lesion, requiring surgical reattachment of the ligament. Similar cases in the literature are reviewed and the use of MRI in detecting these lesions is discussed.

scholarly journals Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199005
Author(s):  
Jonathan S. Yu ◽  
James B. Carr ◽  
Jacob Thomas ◽  
Julianna Kostas ◽  
Zhaorui Wang ◽  
...  
Keyword(s):  
Social Media ◽  
Public Perception ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Social Media Analytics ◽  
Care Providers ◽  
Collateral Ligament ◽  
The Past ◽  
Positive Sentiment ◽  
Negative Sentiment

Background: Social media posts regarding ulnar collateral ligament (UCL) injuries and reconstruction surgeries have increased in recent years. Purpose: To analyze posts shared on Instagram and Twitter referencing UCL injuries and reconstruction surgeries to evaluate public perception and any trends in perception over the past 3 years. Study Design: Cross-sectional study. Methods: A search of a 3-year period (August 2016 and August 2019) of public Instagram and Twitter posts was performed. We searched for >22 hashtags and search terms, including #TommyJohn, #TommyJohnSurgery, and #tornUCL. A categorical classification system was used to assess the sentiment, media format, perspective, timing, accuracy, and general content of each post. Post popularity was measured by number of likes and comments. Results: A total of 3119 Instagram posts and 267 Twitter posts were included in the analysis. Of the 3119 Instagram posts analyzed, 34% were from patients, and 28% were from providers. Of the 267 Twitter posts analyzed, 42% were from patients, and 16% were from providers. Although the majority of social media posts were of a positive sentiment, over the past 3 years, there was a major surge in negative sentiment posts (97% increase) versus positive sentiment posts (9% increase). Patients were more likely to focus their posts on rehabilitation, return to play, and activities of daily living. Providers tended to focus their posts on education, rehabilitation, and injury prevention. Patient posts declined over the past 3 years (–28%), whereas provider posts increased substantially (110%). Of posts shared by health care providers, 4% of posts contained inaccurate or misleading information. Conclusion: The majority of patients who post about their UCL injury and reconstruction on social media have a positive sentiment when discussing their procedure. However, negative sentiment posts have increased significantly over the past 3 years. Patient content revolves around rehabilitation and return to play. Although patient posts have declined over the past 3 years, provider posts have increased substantially with an emphasis on education.

scholarly journals Effect of Ulnar Collateral Ligament Reconstruction on Pitch Accuracy, Velocity, and Movement in Major League Baseball Pitchers

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096853
Author(s):  
Braden McKnight ◽  
Nathanael D. Heckmann ◽  
Xiao T. Chen ◽  
Kevork Hindoyan ◽  
J. Ryan Hill ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Poor Performance ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Major League ◽  
The Mean ◽  
Performance Statistics

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers. Purpose/Hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A repeated-measures analysis of variance with a Tukey-Kramer post hoc test was used to determine statistically significant changes in performance over time. Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Results: We identified 56 pitchers with a total of 230,995 individual pitches for this study. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. The mean presurgery fastball pitch-to-target distance was 32.9 cm. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). The mean presurgery curveball movement of 34.49 cm vertically and 5.89 cm horizontally also did not change significantly ( P = .937 and .161, respectively). Conclusion: Fastball accuracy among MLB pitchers significantly decreased after UCL reconstruction for up to 3 years postoperatively. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers.

scholarly journals Adolescent Pitcher Fatigue: Ulnar Collateral Ligament Stress, Flexor-Pronator Mass Energy Depletion, and Correlation to Pitch Count

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Manuel Schubert ◽  
Tariq Awan ◽  
Aaron Sciascia ◽  
Emily Pacheco ◽  
Jennifer DeMink ◽  
...  
Keyword(s):  
Grip Strength ◽  
Muscle Glycogen ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Ulnar Collateral Ligament ◽  
Glycogen Storage ◽  
Collateral Ligament ◽  
Time Points ◽  
Subjective Fatigue ◽  
Forearm Flexor

Objectives: There has been a rise in elbow ulnar collateral ligament (UCL) injuries in youth pitchers over recent years. With forearm flexor-pronator mass fatigue, the dynamic stability provided could be diminished placing greater stress on the UCL. Pitch count limits have been instituted in an attempt to help curtail this rise in throwing injuries, especially in youth athletes. In order to provide more objective data regarding current pitch count limits for youth pitchers, the purpose of this pilot study was to evaluate for potential fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity, noninvasively characterizing changes in muscle glycogen storage within the forearm flexor-pronator mass, and evaluating changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing number of pitches thrown by 10-year-old pitchers up to their recommended 75 pitch count limit. Methods: After appropriate power analysis, male pitchers 10 years of age were recruited for the study (n=22). Pitchers threw a total of 75 pitches divided into sets of 25 pitches, with standardized periods of rest in between throws and sets to best simulate a game. Bilateral medial elbow laxity was measured by applying 10 decanewtons of valgus force with a standardized stress device and utilizing ultrasound imaging (Figures 1A-B) prior to pitching and after each pitching set. The change in medial ulnohumeral joint distance (Figure 1C) after stress was applied was calculated from baseline without stress. Relative changes in muscle glycogen storage, detected as changes in echogenicity, within the flexor carpi radialis (FCR) and the flexor digitorum superficialis (FDS)/flexor carpi ulnaris (FCU) muscles were measured non-invasively with ultrasound-based software (Figures 1D-E) and recorded as fuel percentile. Repeated measures analysis of variance and post-hoc testing were used to determine statistical significance (alpha=0.05). Results: There were no significant differences in medial elbow laxity between arms or time points. There was a trend for similar decline in FCR fuel percentile values between each arm, indicating relative decreases in glycogen storage bilaterally. However, only the throwing arm demonstrated a statistically significant decline in fuel percentile from baseline to after 75 pitches (p=0.05). There were no statistically significant differences across time points for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all time points compared to baseline (p≤0.03). Grip strength of the dominant arm after 75 pitches was significantly decreased compared to after 25 pitches (p=0.02). There were no statistically significant changes in other strength measurements, ROM, velocity, or accuracy between all time points. Conclusions: By the recommended 75 pitch count limit in 10-year-olds, subjective fatigue and a decrease in grip strength had occurred. Furthermore, relative glycogen storage of the flexor-pronator mass of the throwing arm decreased between pitching 50 to 75 pitches, but without an increase in medial elbow gapping. This study provides a foundation and raises questions for further objective testing of physiologic changes that occur throughout increasing pitching to better guide pitch count limits and ensure the safety of young athletes

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