Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Subject demographics are reported in Table 2. Search for Similar Articles The evidence regarding operative and nonoperative treatments of acute and chronic thumb UCL insufficiency is primarily limited to level IV retrospective case series and level V expert opinion. J Bone Joint Surg Am. J Hand Surg Am. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Kaplan EB. All rights reserved. Kuz JE, Husband JB, Tokar N, et al.. 2000;16:345357. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Clin Orthop Relat Res. 2006;31:6875. FOIA A p-value of 0.05 was considered statistically significant. Please enter a Recipient Address and/or check the Send me a copy checkbox. The authors report no funding or conflicts of interest. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. Your ligament may need to be reattached to the bone using a bone anchor. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Table 1. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. abduction-adduction motion. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Part I of this two-part article focuses on common tendon and . J Hand Surg Am. 2005;87:26322638. This website also contains material copyrighted by 3rd parties. eCollection 2021 Apr. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). 3. Some error has occurred while processing your request. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. It runs from the outer humerus, around the radial head and attaches to the ulna. 1989;71:383387. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Sixty nine (86.3%) patients had grade 3 tears. If the latter was executed only partially, a score of 1 was assigned. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation. 14. Treatment of chronic injuries of the. 2013Lippincott Williams & Wilkins. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Rupture of the. Rupture of the thumb ulnar collateral ligament (UCL) is a frequent injury of the hand, commonly caused by sports injuries and falls onto an outstretched hand.15 The mechanism of injury usually involves hyperabduction or hyperextension of the metacarpophalangeal (MP) joint of the thumb.6 Disruption of the UCL leads to decreased pinch strength, pain, instability, and ultimately osteoarthritis. Purpose. Wong TC, Ip FK, Wu WC. Inclusion criteria included English language studies after nonoperative or operative treatment of thumb UCL injuries with a minimum of 2 years mean follow-up. Differences in range of motion, pinch strength, biomechanical strength, or joint angulation have previously been investigated for various means of treatment of ulnar collateral ligament (UCL) tears. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. The site is secure. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 1995;23:222226. American Society of Anesthesiologist (ASA) status, Wound Class, UCL versus RCL repair, date of surgery), post-operative treatment (immobilization and rehab), complication type (prolonged stiffness/pain, instability, reoperation, salvage arthrodesis of the first MCP joint), complication treatment, and outcome of the complication (e.g. 2021 Apr 15;3(2):e527-e533. Background: Data range was reported as minimum to maximum absolute values. Disclaimer. Bethesda, MD 20894, Web Policies 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. 2020 Apr 28;14(1):25-30. doi: 10.1055/s-0040-1710154. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. to maintaining your privacy and will not share your personal information without Am J Sports Med. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. The .gov means its official. Wolters Kluwer Health, Inc. and/or its subsidiaries. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. [38] Chuter et al[40] contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. They may even tear completely. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. eCollection 2021. Study design: 25. MCP collateral ligament sprain is most commonly an acute injury related to trauma. Thumb sidedness reported in 3 studies (51 thumbs). and twist using your thumb. Clipboard, Search History, and several other advanced features are temporarily unavailable. Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Your surgeon is the person best able to help you avoid any serious recovery problems. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. Quantitative outcome of surgical repair. MeSH Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). Am J Sports Med. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. 1998;23:503506. Posner MA, Retaillaud JL. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Complications after surgery were rare. Arthritis Rheum. Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. PMC Mean study follow-up was 42.8 months. 2022 Mar 1;30(1):e1-e8. A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. The effect of thumb metacarpophalangeal. For all statistical analysis within all studies analyzed, P < 0.05 was deemed significant. 1999;24:7075. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. There is currently no consensus on treatment of acute or chronic UCL injuries. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Smith RJ. Thirty-two thumbs were treated nonoperatively and 261 operatively. I was able to work while wearing the splint. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Complications after surgery were rare. 1996;25:527530. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. This site needs JavaScript to work properly. 38. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Unable to load your collection due to an error, Unable to load your delegates due to an error. Benson LS, Bailie DS. Sollerman C, Abrahamsson SO, Lundborg G, et al.. Functional splinting versus plaster cast for ruptures of the, 41. No study directly compared the different types of graft for UCL reconstruction. Levels IIV evidence (according to the Oxford Centre for Evidence Based Medicine used by the American version of the Journal of Bone and Joint Surgery)14 were reviewed for inclusion in this review. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. Stener B. Skeletal injuries associated with rupture of the. The ulnar collateral ligament complex is located on the inside of the elbow (pinky or medial side). The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 39. 2009;6:e1000097. Please enable scripts and reload this page. Sakellarides HT, DeWeese JW. A score of 0 was assigned if the item was either omitted or not performed. Range of motion returns much sooner, too. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. Metacarpophalangeal joint instability was either not observed or mild (up to 9 degrees). A broken thumb can also cause numbness or tingling. Bean CH, Tencer AF, Trumble TE. Chir Main. An anatomic basis for treatment. The limitations of this systematic review are reliant on the studies analyzed. Evaluation and management of elbow injuries in the adolescent overhead athlete. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. official website and that any information you provide is encrypted 4. better/same/worse than preoperative status). An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . The injury happens when you fall . *Gender reported in 12 studies (218 subjects). Clin J Sport Med. Louis DS, Huebner JJ Jr, Hankin FM. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. 14 It is important to diagnose complete tears early because . Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Abrahamsson SO, Sollerman C, Lundborg G, et al.. If given within individual studies, the P values calculated by the authors of the individual studies were used and not retested because of a lack of subject-level data. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. Patient Demographics of Thumb RCL and UCL Injuries. Bookshelf These tears often occur as a result of a radially directed force on an extended thumb. Fourteen articles were included and analyzed (293 thumbs). PMC Careers. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Epub 2020 Jun 29. 2021 Mar 10;9(3):2325967121990052. doi: 10.1177/2325967121990052. The mean patient age was 37.8 years (14.0-78.1). Would you like email updates of new search results? The https:// ensures that you are connecting to the [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Abstract. Epub 2019 Mar 21. Conflicts of interest The authors report no funding or conflicts of interest. Both repair and reconstruction (autograft and allograft) techniques were inclusive. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". He too had the internal brace augmentation. If it is appropriate, then surgical consent probably happened before the surgery. No study reported the outcomes of nonoperative management of chronic UCL injury. Part II: treatment and complications. The grip strength and the pinch strength were 94.3% and 92.27%,. NR, not reported. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. [32] Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis. Ulnar collateral ligament injuries of the thumb: a comprehensive review. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Thumb collateral ligament injuries. Engelhardt JB, Christensen OM, Christiansen TG. [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. government site. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.32 The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.17,34 Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The mean time from reported injury date to surgery was 202.4 days (2-5969). 37. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. J Bone Joint Surg Am. 33. There were 200 acute injuries and 93 chronic injuries. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). [23,3638] Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. Only prospective studies can determine this injury course. 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 inadequately treated. Detection bias was present in the inconsistent use of an invalidated outcomes tool (Glickel grading system), visual measurement of range of motion, different tools for strength and stability measurement, and the subjective nature of reporting weakness and stability. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. 12. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Epub 2014 Oct 22. 34. 21. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. Doi: 10.1177/2325967118769328. UCLR case series that contained complications data were included. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size.41 Abrahamsson et al42 maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. **Stener lesion status reported in 6 studies (145 thumbs). Careers. The injury involves the ulnar collateral ligament (UCL) of the thumb. If the force is too strong, the ligaments can tear. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. sharing sensitive information, make sure youre on a federal Jupiter JB, Sheppard JE. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 2009;61:623632. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. Throwing status reported in 4 studies. Trends in Patient, Physician, and Public Perception of Ulnar Collateral Ligament Reconstruction Using Social Media Analytics. Fusetti C, Papaloizos M, Meyer H, et al.. Data sources: RESULTS The mean follow-up time was 22.2 months (range 6-54 months). A secondary purpose was to compare graft choice and surgical technique for reconstruction. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Epub 2021 Sep 7. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. Stretching or even a rupture of the graft is also possible. Nonoperative treatment often failed, necessitating surgery. Return-to-Play Outcomes in Professional Baseball Players After Medial Ulnar Collateral Ligament Injuries: Comparison of Operative Versus Nonoperative Treatment Based on Magnetic Resonance Imaging Findings. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. Baar H, Baar B, Kaplan T, Erol B, Tetik C. Chir Main. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Complications after surgical treatment of UCL injury are rare. The range of motion of the MP joint of the thumb following operative repair of the. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. flexion-extension motion. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. official website and that any information you provide is encrypted Fourteen articles were included and analyzed (293 thumbs). In sports or at work, injuries to the collateral ligament of the thumb's metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joints of the fingers are common [].The most common mechanism for a thumb ulnar collateral ligament (UCL) rupture is the forced abduction and hyperextension of the MCP joint of the thumb [2,3,4,5,6,7], which can occur when someone falls on the thumb . Continuous variable data were reported as mean SDs from the mean. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. This site needs JavaScript to work properly. Therefore, these patients were included in the surgical group for analysis, as they did have more than 2 years minimum clinical follow-up after surgical treatment. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. Dr. Holt will talk to you about when it is safe to return to work. 44. 1999;24:275282. Proximal interphalangeal joint injuries of the hand. the thumb. The Orthopedic Journal of Sports Medicine. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Disclaimer. No study compared different graft types or fixation techniques. Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 31. History. Systematic review and meta-analysis. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation.30 The stability of the MP joint derives from joint congruity, the true and accessory collateral ligaments, the volar plate, and the surrounding intrinsic muscles.31 The adductor pollicis supplies active support on the ulnar aspect, whereas the abductor pollicis brevis and flexor pollicis brevis provide dynamic stability on the radial border. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. [32], Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing[35] or via thumb spica casting or splinting. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. POST-OPERATIVE WEEKS 22-24. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. sharing sensitive information, make sure youre on a federal Wolters Kluwer Health 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. All authors independently performed the search. 1994;25:2123. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. The procedure involves a synthetic tape that is about a millimeter in width but exceedingly strong. Pichora DR, McMurtry RY, Bell MJ. 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers.