4 0 obj reported 92% success some returning overhead athletes to the same a high level of competition is an average of 6.7 months with UCL repair and internal brace . 2 0 obj 502 0 obj <> endobj endobj Exercises: Continue all exercises listed above Elbow ROM in brace (-30 to 100) Initiate isometric elbow extension Initiate wrist isometrics UCL Repair with Internal Bracing versus UCL Reconstruction (Tommy John). <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> When the tear results in pain and instability, surgical repair offers a predictably successful outcome. y!my6gvF-~g,8\'N&p[t|x0 u0vNzSKjZ*C(hZ}szu9`3_?=/ Background: The purpose of this study is to describe our technique of thumb ulnar collateral ligament (UCL) repair with suture tape augmentation and to evaluate the short-term outcomes in our initial series of patients treated with this method of repair.Methods: Patients with minimum one-year follow up after isolated UCL repair with suture tape augmentation were contacted for clinical . endobj <> Rehabilitation Following UCL Repair with Internal Brace. Shoulder isometrics (no shoulder internal rotation) Biceps isometrics . V8FW <>/Metadata 558 0 R/ViewerPreferences 559 0 R>> You are still advised to avoid gripping, grasping and twisting with your thumb. m"cpQ|fP]3{&N5)M7!s( c A@%'I0*>% J$WNDoN`OM" ,aIENP57SNP zg FQVI@L+ F}t 8Bpt 3x` Q/}2cd}2"[& VL1zeGe:Jz). 2 WEEKS (1st Visit) Fit with custom hand based thumb spica splint (Please allow thumb IPJ motion) OT INSTRUCTIONS - Ok to work on wrist, CMP, IPJ motion, & scar massage 8g14IRxEm`YH#V b6 be1Gv=*K:.;>'!y^vf%lX")z^-vr3[\)U8RnOG8+5[Y#l'^aAWgI>i];%*8jpht4%< pKV[t/ 8]oQ5JF*+zWQ61Hu^DDJT.0H>? 4 0 obj 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. Phase I (weeks 0 to 3): Splint for one week, then transition to a hinged elbow brace with gentle motion from 30 to 110 progressing to 10 to 125 at week 3. Elsevier. <>/Metadata 83 0 R/ViewerPreferences 84 0 R>> Diagnosis s/p RIGHT/LEFT UCL Repair with Internal Brace Date of Surgery_____ Frequency: ____ times/week Duration: _____ Weeks Week 1: Elbow is immobilized in Hinged Elbow Brace at 75 degrees flexion (7 - 10 days), wrist free, in sling. UCL Repair; Young overhead athletes who sustain an injury to their medial ulnar collateral ligament (UCL) complex, isolated to the proximal or distal end of the ligament and without chronic attritional damage, may benefit from a repair rather than a reconstruction procedure.1 Reference 1. %PDF-1.6 % endobj There was gross instability of the ulnar collateral . The anti edema management will continue for several weeks. hb``g``Zs01G83023>"`*`+MKx.00e)zz oIB`F2Af*LoApKX@D l^" This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. <> ,.l(\r @48 dJ^ %$HU 44HK[Y.D;2d8A1 d9\Imog|G|L8p,b}- BT"/q[[%p4)dl0( TOO#]x~0zKGeyk7-Zb!Z]#_@As r1'B04Lq0tS>Yf0lUQ0z.?9M7eCe[4^orMi|yF`8j_z\p=-g:I}^\RVDw*w ["BIA+ryv_cNaICaNJ!E.|dXTp3g@9< HTxS %%EOF 110 0 obj <> endobj endstream endobj 111 0 obj <>/Metadata 5 0 R/Outlines 9 0 R/PageLayout/OneColumn/Pages 108 0 R/StructTreeRoot 16 0 R/Type/Catalog>> endobj 112 0 obj <>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 113 0 obj <>stream SYMPTOMS: The thumb may be swollen, bruised and painful. Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. A bP .a+ZY^tL3ab`y7*n&++c Thumb Ulnar Collateral Ligament Repair Post-Operative Protocol Days 0- until first Post-Op Apt. The newer repair procedure utilizes internalbrace, which comprises high-strength fibertape suture, to reenforce and protect the ligament while it is healing, and provide additional protection during throwing activities. Hand and Wrist endobj Brotzman, S. & Novotny, S. (2018). hYmO8+NR)nEr'@]fuv4RUB;OfP&,!z3$Q"9#*m cLC. `eDp4)J00"2N$b\3HZhSCR H00:GCp#r x The success of that surgery resulted in it being called the Tommy John procedure. x]kF_!BBf%I(BTb%]3NrqO%)(V}nu+;jvcyiwuY[_4*j{]e>gUQU~"_e? 6=J). Please fax initial evaluation and progress notes to 8153817498. !-twF)rm16:M.J r]Sc]Oi~ endobj A longitudinal incision was made over the thumb over the metacarpophalangeal (MP) joint, the skin flaps elevated, the extensor shroud released, tendon pulled back, the adductor attachment released and the ulnar collateral ligament identified. Jsx cx=[wOGvu UV]QEMtejL11eO2\5~B*q>vvcu9]dtUbqjNU{ Recently, Dugas et al. ]rav?4V&%n\(blvdf)TUL"Q+zaH$!EWq,0S4o~!dAf36J5/JqR^)jUx}2}`4vT.5l;c6gA>< MVSxwkHW *LLGrj iBy+9,[Ld~!VpQ[/zT-k.x #M'Ismi>uw a8G PeT{qo| R7RP2rAK(; 0 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. stream endstream endobj startxref Read court documents, court records online and search Trellis.law comprehensive legal database for any state court documents. << /Length 5 0 R /Filter /FlateDecode >> 213 Figure 1: The UCL repair with the internal brace inserted within the ligament. DOI: 10.32474/OSMOAJ.2019.03.000151. Thumb UCL Repair (Internal Brace) 0-2 weeks: The postoperative dressing is removed. During this time, active ROM is started as well as light isotonic . c5(Ly%CDer,ZbE+ImgILF cy9 Thumb UCL Repair With InternalBrace Ligament Augmentation What's New in Orthopedics 207K subscribers Subscribe 24 Save 3.8K views 1 year ago .more .more Notice Age-restricted video. endobj Clinical Orthopeadic Rehabilitation: A Team Approach E-Book, 4th Edition. r e c . The UCL provides up to 50% of the frontal plane stabilization of the Abbreviations UCL, ulnar collateral ligament; US, elbow against a valgus load.5 During the clinical evaluation, the ultrasound patient's elbow is placed under a valgus load with the elbow in vary- ing amounts of exion. Splint: A hand-based thumb spica splint with IP free (for thumb) or Safe Position Splint (for other digits) with medial or lateral stops on the opposite site of the repaired ligament is constructed to be worn between exercises and at night. !bq\n#z0y/16C0DLP"2wn|e&35`MX2 @@^ !+~(l)2B3% !!PsEUr,!NAqYkT0(*${YNB_sYGDa|)jN!vE ` Gc^N.&/v;5$*'BDh8P}!k!2YK-|)T\{|eF_xXC'o]8 yLt)n FWfvgYpmphZsrDo\!WG-W.4BAj]Z^4~v:34a'9cl'LlL/Ka:XsWpv>{|MGK>\#(hO 7-10 day post-op OT to fabricate a custom FA based thumb spica AROM of the wrist and IP of thumb 1 0 obj The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). 1 0 obj 6f*&aibfSwv{tNcj7Dcg_7ml0`afdMq{Ccbm*"CAp lI"5JK>nt=tuGi0E1O{c2{n BOIu}B)wQ78LyWe-|k#$B/y*jY8 t7X,RpATy+{,q(3#/Plb 'xA+^v(o[l!O U=2EE#/gtcXjQO17D[=tvq;2T(=X"#n:fZ=%S-` Educate the patient on anti edema management. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj h!DWl{$A4L61)H}hJftyrI%kSQLc]5sbGP U_8v}9|(O(( qsMfGiICYL|*'VL+b% x[[o:~xpPh.IvEMmi3C]lQ,z X3*{c{XKbMa;{;o>H&PIffS+e@.+>|7mw;L"cH"dMn8)Sy,2*npGWwE&k=|"tbE}%2*R0(jK(s#.$"X$VcY#>J>2pCMW[XHOq{ = wD0NC?IF5tV$ZtR& K"=,`y];]NxIo>r?R'n)locmMuf$[g6\1eu8^s=POm6|GHkOzDuDiIpqT+"'"%;ED/,H$g=Ie9fRH*/ 6Tc`;GJEwvQ*X}:LGKX`n)Bq)su9:qF~b. the thumb. These tears often occur as a result of a radially directed force on an extended thumb. The rehabilitation protocol after a Ulnar Collateral Ligament Repair with Internal Brace surgery typically involves several phases. 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. 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. A recently developed UCL repair procedure with an internal brace, utilizing collagen tape, is gaining popularity. K`d:V0!QGXCor&J;#Z?='lH3cy?_pOk0qWR_heBU] u)dh5Q :e16&\H11}8 1AE Qf>`?SLXSu {q?u,:g@l2;1FhCSTV9}WKH}[agS~?P3{47*c:lg3l#`vLx}{*_Q]}O)D5*wX[PB{A8k1GtM{@onC 0Ggtz=CiZM.sVLCbi`JC3T)q7]tZ4c^l&XkC~?G.9J7 ]sO0h5_K]@GB[q[Vg"$(MjTy Thumb UCL Repair- Conservative This protocol is intended to provide the clinician with a guideline for the postoperative rehabilitation course of a patient who has undergone thumb UCL reconstruction/repair. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endstream endobj 503 0 obj <. Its many uses has helped numerous athletes return back from their injuries quicker than ever. In a recent laboratory study conducted by the Arthrex Research Department using cadaver specimens, the thumb UCL with internal brace was four times stronger than the standard repair with suture alone. If <> endobj Brace: Elbow ROM 30-100 Cryotherapy: Continue ice to elbow joint and graft site . J Orthop Sports Phys Ther. Acute UCL tears: Thumb spica splint/cast for up to 4 weeks, interphalangeal joint free. xZS8~AO[H[ULj!W0"Esvo 0h2ULlYRZ?.-ax0Iz_]0lnY>__-\x2`\DL^dRrzIE:d2bdcz{Izw^,&={y@{w=:'=aa=T()VCA6kGQlS9?LX|^+#{zX/.zLNT^Z^jg]X6g8If55/_BYjWpE\,#w+"6A UCL REPAIR WITH INTERNAL BRACE . endstream endobj startxref x[[o~70/5+/@`dk4],`hHp}9C9\YBKP.e?}|S-~K3KbEpSXy~ldpL"$.XHf>_~}d?Te5Zs$Rpdt Restrictions: No heavy lifting greater than 0 lbs. 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. 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]. Thumb UCL Repair With InternalBrace Ligament Augmentation. stream Resource Type: Surgical Technique Animations. Duration: 01:52. We describe the surgical technique of suture tape augmentation for thumb UCL repair. Finger and hand range of motion: maintain AROM and PROM 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 . 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. Thumb Collateral Ligament Injuries, most commonly ulnar collateral (UCL), are athletic injuries that lead to a decrease in effective thumb pinch and grasp. With the UCL repair, the surgeon will repair your native ligament and re-attach it to it's respective insertion site. hb```) $- `>bPO,VLW0ba6d.fb>4mfBs2hef`t| Steven Shin, MD, treats elite athletes in his clinic, but you don't have to play for a professional team to benefit from his groundbreaking technique for treating thumb ulnar collateral ligament (UCL) injuries.. For injuries that need more than a cast, internal brace augmentation gives better and much faster results than conventional surgery, according to Shin, executive vice chair of Cedars . 60 0 obj <>/Filter/FlateDecode/ID[<0AF1E1B641B34B46855587C2A48FF27B><237A0C35EE1B4C46B05DEA8683FB9A51>]/Index[49 44]/Info 48 0 R/Length 76/Prev 328473/Root 50 0 R/Size 93/Type/XRef/W[1 3 1]>>stream %%EOF 14 Days Postoperative Do NOT remove the surgical bandage. your repair for 4 more weeks. 1 0 obj Skier's thumb is an acute partial or complete rupture of the ulnar collateral ligament (UCL) of the thumb's metacarpophalangeal joint (MCPJ) due to a hyperabduction trauma of the thumb. endobj Finger spring: Place a large rubber band around the outside of your thumb and fingers. The ulnar collateral ligament (UCL) does not play a large role in elbow stability for most activities of daily living, but it does undergo tremendous stresses with overhead throwing and is susceptible to injury in overhead athletes. % >W ` 8;d3^ The UCL is the main ligament, located on the inner aspect at the base of the thumb, which stabilizes the metacarpophalangeal (MCP) joint. 3 0 obj The internalbrace is the underpinning of the repair procedure. At 4 to 6 weeks, removable thumb spica splint, and protected range-of-motion exercises. Epub 2019 Mar 12. The rise of ulnar collateral ligament reconstruction and the fall of ulnar collateral ligament repair. 2 0 obj Rehabilitation Guidelines aY_dM\\Kq[SZ 6| F8$b2d`FVw028WYMlS:/2]pI*uIR>75f/Vz&) q3R`?.Xn:$ hw7tJw?8yZ |%1_. stream 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 It's pretty neat to see how it has taken on a whole world of uses, including in the knee and ankle. At 10 to 12 weeks, return to . |1WwD >(E>[ X\j&7< 6whY+}v39v/1/wJU-nGQ v JCJX*?=XrtbgS#Nl|wk\6Ac /{h6*!(K6abZ}6M3RUl+pm@k=do3aCyF*wrVN7DixiDaLb^x)G. ?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_ endobj Z\m>~?)I|%X$;-5X&gV+Kms?XRC5%x_ui6q |KdeW7mQUY3s`NB) =gY|6:51c_t]]MixSTB %PDF-1.7 The goal is to Practice this exercise for about 5 minutes. hbbd```b`` "gA$d^ endobj 128 0 obj <>stream (} oA%Yv:JzFQA 0X"5o A%U- MLZ;?3%RO8?DnQN['y]{_5%x@iSt>K2! ( E`\Boy 'n"%QBiClMVmfzKRbq"j>Ws$ %PDF-1.5 Non-weight bearing to operative extremity. <> endobj No driving. <> 0 % rt$mZE%'l6gIM*9;J1HIo1Z5F`$y-J+"kI.h&pjIhcLS[Ks9Ol|2:}Uu>i4~]t5sY=Bpnjb.-q M=q]9B!EOc6,Oq%4M 5eZ?DwEH 6h3)N1gzSVuQFoaxsARd. 9f(I#]F)jQ#qbgMkZVcqhLL9{3qjU2s7)#t&"lCn'_|m+L(J:vGagJ}nab<4WGSlc.t)rT)B4"& iaS?DVn##oI&70x~o >I9XbiV`J"mE,R6,qQz"n@d,dSqd{]kE=Jxf0@.,M8^sqAGa[)^-6^`sAI@Q|p4&.grv-P_8 | sHSlC:">)n2oAGV?vtE6f?r83bSXk8[~@t(zQXA>)V|@)} 1&%_qU}VuA (nKS"(;VB| >`UVtXb#xEpF,Z%ZX["'XP 1 0 obj 4 0 obj Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint (gamekeeper's thumb). The UCL may be strained or torn (partially or completely) producing a weakened grasping or pinching ability of the thumb. Hrut LF?L . EXHIBIT(S) - D (Motion #1) EXHIBIT D - Verified Bill of Particulas and Responses to Various Demands Redacted per 22 NYCRR - EXHIBIT D - Verified Bill of Particulas and Responses to Various Demands Redacted February 09, 2023. 4 0 obj Open your fingers to stretch the rubber band. Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol Phase I: Immediate Post-Op (Weeks 0-2) . % 1-3 Candidates for repair are most commonly young er (pre-professional) and present 2019 Apr;49(4):253-261. doi: 10.2519/jospt.2019.8215. | Find, read and cite all the research you . endobj Postoperative protocol. !V!B;nkGL#_cz5asG) 0<>;Qm4P]3@41oJ5i~o;sJvQv9f r4A-C -Z]>T]Fo % %PDF-1.7 &Dam[L1-J" iiBUq[{0R 3xVoEouUja,Jd> k '! %PDF-1.6 % This internal brace surgery was developed by surgical company Arthrex. 2 0 obj hbbd```b``3@$S=d`6;dq7.`.df`\0LE-`6H rlg4okAdaHMH Traditional custom-fitted thumb spica orthosis In a recent cadaver study by Gil et. It was grossly incompetent and irreparable. /&E-{BpR`buqyxw{y1E2vzy!`reY,$OcvCnbv_]pyu_//~0]8~t2Vj-/U 4 0 obj <>>> 3 0 obj 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. |C&K 0g-Pf4/.B{s. 1 0 obj %%EOF 3 0 obj <> Elbow Ulnar Collateral Ligament (UCL) Repair Rehabilitation Protocol Kelly Holtkamp, M.D. <> Key Timeframes: (Dr Meister/TMI Protocol) Plyometric Phase: 12-14 weeks. The InternalBrace <>/Metadata 102 0 R/ViewerPreferences 103 0 R>> 1. Whilst both terms are often used interchangeably, the skier's thumb refers to the cause as being acute injury. Rehabilitation following UCL repair with internal brace is accelerated by comparison to Tommy John Surgery.