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Finger Metacarpophalangeal Joint Injuries in Athletes: Evaluation, Diagnosis, Treatment, and Return to Play. J Am Acad Orthop Surg 2023; 31:e177-e188. [PMID: 36757330 DOI: 10.5435/jaaos-d-21-01031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 11/27/2022] [Indexed: 02/10/2023] Open
Abstract
Metacarpophalangeal (MCP) joint injuries of the fingers are frequent among athletes and can markedly affect an athlete's ability to perform at a high level. Despite this, MCP finger injuries in athletes are not frequently discussed, particularly in comparison with MCP joint injuries of the thumb, and remain unrecognized and undertreated injuries in this cohort. Accurate diagnosis and treatment of these injuries begins with an understanding of all the potential diagnoses. The purpose of this study was to review the pertinent anatomy and differential diagnoses for MCP joint injuries in athletes, including the evaluation and management to allow for safe and early return to play.
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Mitchell TW, Mitchell SA, Wu C. Radial Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint. Curr Rev Musculoskelet Med 2022; 15:581-589. [PMID: 36303098 PMCID: PMC9789250 DOI: 10.1007/s12178-022-09805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Injuries to the radial collateral ligament (RCL) of the thumb are thought to be relatively uncommon, especially when compared to the ulnar collateral ligament. However, the radial collateral ligament is increasingly recognized as critical for the overall stability of the thumb metacarpophalangeal joint. This article sets out to provide a comprehensive review of RCL injuries of the thumb MCP joint, including epidemiology, biomechanics, diagnosis, and treatment. RECENT FINDINGS Although traditionally thought to respond well to conservative management, especially when compared to injuries to the ulnar collateral ligament, there is mounting evidence that chronic RCL injury leads to thumb metacarpophalangeal joint instability and can accelerate post-traumatic joint degeneration. Thus, much of the recent literature details surgical treatment options for radial collateral ligament injury, including repair and reconstruction. While incomplete tears of the thumb RCL respond well to immobilization, complete tears should generally be treated with operative management, either direct repair or anatomic reconstruction, depending on tissue quality. Even subacute and chronic injuries may be amenable to direct repair, with good to excellent outcomes, including in high-demand patient populations, such as professional athletes.
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Affiliation(s)
- Thomas W. Mitchell
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St Suite 10A, Houston, TX 77030 USA
| | - Scott A. Mitchell
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St Suite 10A, Houston, TX 77030 USA
| | - Chia Wu
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St Suite 10A, Houston, TX 77030 USA
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Scanaliato JP, Wells ME, Dunn JC, Garcia EJ. Overview of Sport-Specific Injuries. Sports Med Arthrosc Rev 2021; 29:185-190. [PMID: 34730116 DOI: 10.1097/jsa.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.
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Haug VFM, Diehm YF, Pfeiler P, Kotsougiani-Fischer D, Bickert B, Kneser U, Hirche C, Fischer S. Radial collateral ligament repair of the thumb: long-term outcomes and predictive factors of postoperative deficits. Arch Orthop Trauma Surg 2020; 140:1293-1299. [PMID: 32500203 DOI: 10.1007/s00402-020-03509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The thumb's radial collateral ligament (RCL) plays an important role in stabilizing the first metacarpophalangeal joint (MCP-1). RCL injuries are rare and treatment recommendations are inconsistent in the current literature. The aim of this study was to report on long-term outcomes following surgical repair of thumb RCL tear and to identify prognostic risk factors for treatment failure. METHODS Patients with RCL tear from 10/1998 to 10/2019 were included in the present retrospective single center cohort study. In follow-up visits, participants were assessed regarding pain, range of motion and strength as well as with disability of shoulder, arm and hands (DASH), and the Short-Form 36 (SF36) questionnaires. Finally, predictive factors of postoperative deficits were identified. RESULTS 43 patients fulfilled inclusion criteria. Median age was 43.5 years (range 18-80 years). The most frequent mechanism of injury was a fall or impact. Bony avulsions were identified in 46.5% (20/43). Time from injury to surgery was 12 days (0-276 days). One Stener-like lesion was observed intraoperatively among our patients. After surgical repair, the MCP-1 joint was stable in every patient. Mean time to follow-up was 5.3 years (1 month to 17 years). Persistency of pain in the MCP-1 joint was reported by 11 patients. Postoperative averaged score was 3.75 on DASH and 44.96 on SF36, respectively. The average grip and pinch strength was 32.7 kg and 8.37 kg, respectively. Predictive factors of postoperative deficits were delay of surgery of > 3 weeks (OR 10.72, p 0.017) and palmar subluxation prior to surgery (OR 8.86, p 0.019). CONCLUSION Long-term follow-up has proven that surgical repair of RCL enables the patient to regain adequate stability and strength of the MCP-1 joint and minimizes disability. Predictive risk factors of pain persistency after surgery are surgical delay and palmar subluxation of the MCP-1 joint.
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Affiliation(s)
- Valentin F M Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yannick F Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Pfeiler
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,Department of Plastic, Reconstructive and Aesthetic Surgery, ISAR Klinikum, Munich, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Berthold Bickert
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sebastian Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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