%PDF-1.3 Skier's thumb is an acute partial or complete rupture of the ulnar collateral ligament (UCL) of the thumb's metacarpophalangeal joint (MCPJ) due to a hyperabduction trauma of the thumb. The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol Phase I: Immediate Post-Op (Weeks 0-2) . ~Y$'h9N`haq8"% {s D)gZ2J =ky~ pP],DQgUh6*DM6`vlK ,R /"0q^p3S;LrV?-VS(6E?VAQJ@p EQQKiqLf[~vA]"`qW `!a`05I**ThsrAD8WH6SXb^h:R.?Q(oeR~R^N Thumb UCL Repair With InternalBrace Ligament Augmentation. <> aY_dM\\Kq[SZ 6| F8$b2d`FVw028WYMlS:/2]pI*uIR>75f/Vz&) q3R`?.Xn:$ hw7tJw?8yZ |%1_. Steven Shin, MD, treats elite athletes in his clinic, but you don't have to play for a professional team to benefit from his groundbreaking technique for treating thumb ulnar collateral ligament (UCL) injuries.. For injuries that need more than a cast, internal brace augmentation gives better and much faster results than conventional surgery, according to Shin, executive vice chair of Cedars . At 10 to 12 weeks, return to . sHSlC:">)n2oAGV?vtE6f?r83bSXk8[~@t(zQXA>)V|@)} 1&%_qU}VuA (nKS"(;VB| >`UVtXb#xEpF,Z%ZX["'XP Exercises: Continue all exercises listed above Elbow ROM in brace (-30 to 100) Initiate isometric elbow extension Initiate wrist isometrics TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Elbow Ulnar Collateral Ligament (UCL) Repair Rehabilitation Protocol Kelly Holtkamp, M.D. !-twF)rm16:M.J r]Sc]Oi~ endobj 148 0 obj <>stream y!my6gvF-~g,8\'N&p[t|x0 u0vNzSKjZ*C(hZ}szu9`3_?=/ endobj The length of each phase varies depending on each patient and depends on tissue healing and progression. The brace may be removed for showering and gentle active motion exercises directed by the therapist. As the internal brace technique continues to mature, its application has been gradually expanded to include repair of the anterior talofibular ligament and deltoid ligament in the ankle, anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and medial patellar ligaments in the knee, and ulnar collateral ligaments in . %PDF-1.6 % hV]OF+B^ Traditional custom-fitted thumb spica orthosis In a recent cadaver study by Gil et. REHABILITATION PROTOCOL: ULNAR COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION RADIAL COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION THUMB MP JOINT WITH INTERNAL BRACE A. J. Mencias, M.D. 1). Initiate Throwing: 14-16 weeks (3.22 Months for Comparison) Bullpens: 24 Weeks (5.52 Months) Live BPs: 30-33 Weeks . hb``d``jd```y Shoulder isometrics (no shoulder internal rotation) Biceps isometrics . 2 0 obj Hand and Wrist They also showed that internal brace repair performs similarly to the docking reconstruction technique . ULNAR COLLATERAL LIGAMENT OF THE ELBOW RECONSTRUCTION USING AUTOGENOUS GRAFT PROTOCOL 3 Progress shoulder isometrics to isotonics, emphasize rotator cuff strengthening (Avoid resisted external rotation until 6th week to minimize forces on repaired UCL) Week 6 Brace - hinged elbow brace set 0-130 degrees. al., a radial-based thumb MCP orthosis designed to leave the thumb IP and CMC joints free limited thumb abduction which reduced the strain on the thumb UCL when loads were applied. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Thumb UCL Repair and Reconstruction With Internal Brace Ligament Augmentation Repair Ulnar collateral ligament (UCL) tears of the thumb are common injuries. !V!B;nkGL#_cz5asG) 0<>;Qm4P]3@41oJ5i~o;sJvQv9f r4A-C -Z]>T]Fo 6=J). 8q`Au8UnN6LW6eS4zdH 7gJRco6aDA+)vg+|Pn.Tz8W>dt+O)1L 1 0 obj % &H+JIKv)ATPJ};CH (1) See image 2. It's pretty neat to see how it has taken on a whole world of uses, including in the knee and ankle. A UCL repair with internal brace is reserved for use in cases of partial or complete tears at the origin or insertion of the UCL with good ligament tissue and low-grade mid-substance partial UCL tears [10]. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 502 0 obj <> endobj 3 0 obj Thumb UCL Repair with InternalBrace Ligament Augmentation 17,933 views Sep 6, 2018 89 Dislike Share Save Arthrex 64.2K subscribers Show more Comments are turned off. stream Resource Type: Surgical Technique Animations. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Phase I - Maximum Protection: 0 to 7 Days: Immobilization in posterior splint at 60-90 of elbow flexion . No driving. A recently developed UCL repair procedure with an internal brace, utilizing collagen tape, is gaining popularity. The athletes that were treated with UCL repair and internal . 104 0 obj <>/Filter/FlateDecode/ID[<33B8DE36AB984B418169C7A4E24F203B><19F8EE0B324BFE44BA1CA95B759557F5>]/Index[79 50]/Info 78 0 R/Length 117/Prev 108309/Root 80 0 R/Size 129/Type/XRef/W[1 3 1]>>stream <> endobj OSMOAJ.MS.ID.000151. Restrictions: No heavy lifting greater than 0 lbs. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. With the UCL repair, the surgeon will repair your native ligament and re-attach it to it's respective insertion site. @` I8 In a reconstruction the old, damaged ligament is removed, new portal holes are drilled and (in an autograft situation) a tendon from somewhere else in your body (palmaris longus, hamstring, etc) is docked as the new UCL. Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. ]rav?4V&%n\(blvdf)TUL"Q+zaH$!EWq,0S4o~!dAf36J5/JqR^)jUx}2}`4vT.5l;c6gA>< MVSxwkHW *LLGrj iBy+9,[Ld~!VpQ[/zT-k.x #M'Ismi>uw a8G PeT{qo| R7RP2rAK(; 0 Citation: Kevin E Wilk, Christopher A A, Rebekah J A. Abstract and Figures Acute rupture of the ulnar collateral ligament (UCL) of the thumb - also known as 'skier's thumb' - is a common injury which may cause long-term complications if. stream stream The primary goal of this surgery is to enhance elbow joint stability while the ligament is healing and to allow earlier return to sport after UCL reconstruction. 4 0 obj endobj 3 0 obj PubMed PMID: 30862273. <> Dressing changed at 7-10 days after surgery Week 2 Orthop & Spo Med Op Acc J 3(1)- 2019. 110 0 obj <> endobj We describe the surgical technique of suture tape augmentation for thumb UCL repair. % 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . Epub 2019 Mar 12. h!DWl{$A4L61)H}hJftyrI%kSQLc]5sbGP U_8v}9|(O(( qsMfGiICYL|*'VL+b% Late effect of dislocation (nonspecific) (905.6) Repair lateral collateral ligament, elbow, with local tissue (24343) Repair lateral collateral ligament, elbow, with tendon graft, including graft harvest (24344) Repair medial collateral ligament, elbow, with local tissue (24345) Repair medial collateral . stream !bq\n#z0y/16C0DLP"2wn|e&35`MX2 @@^ !+~(l)2B3% !!PsEUr,!NAqYkT0(*${YNB_sYGDa|)jN!vE ` Gc^N.&/v;5$*'BDh8P}!k!2YK-|)T\{|eF_xXC'o]8 yLt)n x[[o~70/5+/@`dk4],`hHp}9C9\YBKP.e?}|S-~K3KbEpSXy~ldpL"$.XHf>_~}d?Te5Zs$Rpdt Ulnar Collateral. % %PDF-1.7 Non-weight bearing to operative extremity. Brace Week 1: posterior split at 90 degrees elbow flexion Week 2: 25-100 degrees Week 3: 15-115 degrees Interventions Soft tissue mobilization, retrograde massage for swelling Elbow PROM (as tolerated) Ice and compression Exercises Wrist AROM (all directions) immediately post-op Gripper Opposition thumb to pinky 213 Figure 1: The UCL repair with the internal brace inserted within the ligament. x[k_!l&.]>d!EMeK-y2+^]=2>P?tq:LzN=VA5X\SWZiu*zzmjN5Ru= QRN>`:N}x^_o?y,A\C/WiNQu)Ftz#CBk_QoTk-)WUT^\QBOSRM]8zb'ai+Zd|oc5&hYGkC(KURumUHkf]*A+KU"1OZ&AUh )M4p0m|iMLku=uJ hbbd```b``3@$S=d`6;dq7.`.df`\0LE-`6H rlg4okAdaHMH SYMPTOMS: The thumb may be swollen, bruised and painful. ["BIA+ryv_cNaICaNJ!E.|dXTp3g@9< HTxS To date, no literat. %%EOF ,.l(\r @48 dJ^ %$HU 44HK[Y.D;2d8A1 d9\Imog|G|L8p,b}- BT"/q[[%p4)dl0( TOO#]x~0zKGeyk7-Zb!Z]#_@As r1'B04Lq0tS>Yf0lUQ0z.?9M7eCe[4^orMi|yF`8j_z\p=-g:I}^\RVDw*w Diagnosis relies upon thumb MCP radial-ulnar stress exam and MRI studies. 1 0 obj Finger and hand range of motion: maintain AROM and PROM 79 0 obj <> endobj Duration: 01:52. Phone: 574.247.9441 Fax: 574.247.9442 www.sbortho.com REHABILITATION PROTOCOL: THUMB UCL/RCL REPAIR SAM FULLER, M.D. Ligament / Volar Plate CPT Codes. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. . /&E-{BpR`buqyxw{y1E2vzy!`reY,$OcvCnbv_]pyu_//~0]8~t2Vj-/U <> 4 0 obj endobj Right after the surgery, the elbow is secured in a brace at a 60- to 90-degree angle. %PDF-1.5 Thumb Collateral Ligament Injuries, most commonly ulnar collateral (UCL), are athletic injuries that lead to a decrease in effective thumb pinch and grasp. %PDF-1.7 Read court documents, court records online and search Trellis.law comprehensive legal database for any state court documents. &AaBCZKqi =ip;!%RqhH%1[6[8]fwFxw l4)W%5 3BRKpw.4/Y. 4 0 obj 1 i^D=)ngloqvb_3.&3e/.[A GF;'YDL65_lZ4l$!`,yv I(=wY */xZFXDI6%t0^&2L7@~DSN1& Brotzman, S. & Novotny, S. (2018). 533 0 obj <>/Filter/FlateDecode/ID[<6B9C59BBC5B61A4384B9FC807F8AE13A><1E4DC5E074430D4EA5AA205F41080698>]/Index[502 56]/Info 501 0 R/Length 138/Prev 267459/Root 503 0 R/Size 558/Type/XRef/W[1 3 1]>>stream Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. H00:GCp#r x Revision Date: 10/29/2021. &Dam[L1-J" iiBUq[{0R 3xVoEouUja,Jd> k '! %PDF-1.6 % the thumb. Educate the patient on anti edema management. When the tear results in pain and instability, surgical repair offers a predictably successful outcome. ?3U,a_~`XRUWcQT2r?B73pgry.v3}w/2\Fz?6-SHK PXUU9:!$\@j)b;}r% /5 V5uz @ TY}]7KX75F1"3#TZLY|A/+{gc_?olhfGmHwiiB%"=CH$ai-`75 gdkZ_ endstream endobj startxref 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . See Tua at the University of Alabama, for examaple. Walters BL, Cain EL, Emblom BA, Frantz JT, Dugas JR.
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