Jackson M, McQueen MM. Wong TC, Ip FK, Wu WC. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. No study compared different graft types or fixation techniques. Upper extremity injuries in snow skiers. 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). 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 . Table 1. Am J Orthop (Belle Mead NJ). 19. 2003;8:8185. A sprained thumb is a common injury among athletes. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. There were 200 acute injuries and 93 chronic injuries. Your surgeon is the person best able to help you avoid any serious recovery problems. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Would you like email updates of new search results? Am J Sports Med. government site. Please enable it to take advantage of the complete set of features! In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. No study directly compared the different types of graft for UCL reconstruction. Quantitative outcome of surgical repair. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . Purpose. Early diagnosis and treatment. Epub 2020 Jun 29. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. This site needs JavaScript to work properly. This website also contains material copyrighted by 3rd parties. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. J Hand Surg Br. Sakellarides HT, DeWeese JW. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 1976;58:106112. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . National Library of Medicine The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 38. HHS Vulnerability Disclosure, Help The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). Complications, failures, and reoperations are rare after surgical treatment of UCL injury. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. A score of 0 was assigned if the item was either omitted or not performed. J Hand Surg Am. Orthop J Sports Med. 13. 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. 1961;43-A:541546. 34. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Click the topic below to receive emails when new articles are available. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. 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. flexion-extension motion. Orthop Rev. The limitations of this systematic review are reliant on the studies analyzed. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Bostock S, Morris MA. Unilateral injuries: 291 and bilateral injury: 1. The effect of thumb metacarpophalangeal. the splint for protection or at night until twelve weeks after the operation. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. 8600 Rockville Pike Both purely ligamentous and bony avulsion injuries were included. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. 2. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. A p-value of 0.05 was considered statistically significant. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. All but 2 were level IV evidence. Search for Similar Articles Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor. Study data collected and analyzed included subject demographics, number and gender of the subjects, number of nonoperative thumbs, sidedness, dominance, subject age, subject weight, and body mass index, throwing athlete status, mean duration follow-up, UCL injury classification, location of UCL injury (proximal, midsubstance, or distal), number of subjects with Stener lesions, number of subjects with avulsion fractures, mechanism of injury, injury chronicity (defined by 3 weeks based on repair vs reconstruction treatment dichotomy proposed by Smith in 1977),17 length of symptoms, graft type used (autograft or allograft), and implant used. Epub 2021 Sep 7. J Bone Joint Surg Am. government site. In some cases, certain risk factors make it more likely that a bone will fail to heal. MeSH Am J Sports Med. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. 2006;31:6875. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). 27. Mean subject age was 33.9 years. Data range was reported as minimum to maximum absolute values. Data sources: 36. 1992;8:713732. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. You've successfully added to your alerts. 1994;23:797804. 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. 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. 1994;25:2123. Orthopedics. Your surgeon will discuss these options with you. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 2000;16:345357. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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.. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Surgical management of chronic, 42. 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. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. Bailie DS, Benson LS, Marymont JV. Hand Clin. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . 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%). Commonly, the joint will be permanently enlarged due to the scarring of the healing process. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Scores assigned to each item are integers 0 (minimum), 1, and 2 (maximum). Results: Part I of this two-part article focuses on common tendon and . 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Weakened grip or reduced thumb range of motion may occur. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Possible complications include: - The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. 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. Am J Sports Med. Wolters Kluwer Health, Inc. and/or its subsidiaries. Data is temporarily unavailable. 2005;24:217221. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. This site needs JavaScript to work properly. There is currently no consensus on treatment of acute or chronic UCL injuries. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. If it is appropriate, then surgical consent probably happened before the surgery. 15. The injury involves the ulnar collateral ligament (UCL) of the thumb. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. For more information, please refer to our Privacy Policy. 2009;61:623632. 45. Mean subject age was 33.9 years. [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. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Thirty-two thumbs were treated nonoperatively and 261 operatively. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. These exercises may be directed by a physical or occupational therapist. Causes. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. Thumb dominance reported in 8 studies (168 thumbs). UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. Lohman M, Vasenius J, Nieminen O, et al.. MRI follow-up after free tendon graft reconstruction of the thumb. modify the keyword list to augment your search. 4. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Careers. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. A broken thumb can also cause numbness or tingling. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. In addition, this study examined how the rate of ulnar nerve complications varied as a function of surgical exposures, graft fixation techniques, and ulnar nerve management strategies. There were no cases of intraoperative ulnar nerve injury reported. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.15,39 It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.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. All rights reserved. 2009;34:304308. 1998;23:503506. Various levels of pain, bruising, or edema may present at the site of damage. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. All techniques improved clinical outcomes, including pain, motion, strength, and stability. 12. Smith RJ. Instability of the metacarpophalangeal joint of the thumb. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Bethesda, MD 20894, Web Policies It is attached on one side to the humerus (the bone of the upper arm) and on the other side to the ulna (a bone in the forearm). 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. Meta-analysis of the pooled data was completed. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 1989;71:383387. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. Sports injuries accounted for most of the remaining injuries, with only 2.4% acquired as a result of skiing injuries. 24. There were 200 acute injuries and 93 chronic injuries. Melone CP Jr, Beldner S, Basuk RS. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. the thumb. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Acute gamekeeper's thumb. eCollection 2021. gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. J Hand Surg Am. Eurasian J Med. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. Patient Demographics of Thumb RCL and UCL Injuries. You may search for similar articles that contain these same keywords or you may Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Your ligament may need to be reattached to the bone using a bone anchor. It runs from the outer humerus, around the radial head and attaches to the ulna. Kaplan EB. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. The .gov means its official. Metacarpophalangeal joint injuries of the thumb. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Main results: Sports Health. The limitations of this systematic review are reliant on the studies analyzed. Mayo Clinic works with baseball players of all levels, from youth leagues to Major League Baseball, to enhance prevention and treatment of ulnar collateral ligament (UCL) injuries, also known as Tommy John injuries. 1989;14:567573. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). The overall complication rate was 13.8% (11/80). Throwing status reported in 4 studies. If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. The mean time from reported injury date to surgery was 202.4 days (2-5969). and twist using your thumb. Infection is a rare complication of hand surgery. 11. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. Please confirm that you would like to log out of Medscape. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 1996;25:527530. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart search algorithm with PubMed database. Some injuries can be associated with a Stener lesion, which is displacement of the ruptured ligament proximal to the adductor aponeurosis, effectively precluding healing without operative treatment.6, Acute injuries can be treated with immobilization or surgically with direct repair using bone anchors, direct repair using bone tunnels and pullout sutures, or tension band fixation of bony avulsions.79 If an injury is chronic, there are several operative treatment options, including ligament reconstruction with tendinous autograft or allograft, bonesoft tissuebone autograft, or even fusion of the MP joint.1012. 1995;18:11611165. 35. In addition, operative management was hypothesized to result in greater patient satisfaction versus nonoperative treatment. MCP fusion was performed . Ulnar collateral ligament (UCL) injuries occur 10 times more frequently than radial collateral ligament (RCL) injuries. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. Your thumb will be immobilized in a splint and should not be moved until follow up. Downey DJ, Moneim MS, Omer GE Jr. History. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. The range of motion of the MP joint of the thumb following operative repair of the. Epub 2021 Jan 18. A score of 2 was assigned if the item was completely and accurately performed and reported. 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. Figure 46-2 Approach to the ulnar collateral ligament. Long-term results of ligament reconstruction. Thumb sidedness reported in 3 studies (51 thumbs). A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. to maintaining your privacy and will not share your personal information without Epub 2014 Dec 30. There were 61 studies eliminated as secondary for being in a language other than English. 2021 Apr 15;3(2):e527-e533. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 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. [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]. When assessed, most patients returned to their preinjury employment. Clipboard, Search History, and several other advanced features are temporarily unavailable. Eventually this abnormal movement will wear out the joint and it will become arthritic. Both x-ray and magnetic resonance imaging evidence confirmed no increase in MP joint osteoarthritis at up to 75 months, postoperatively. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Conclusions: Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. 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. Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Van Dommelen BA, Zvirbulis RA. Your message has been successfully sent to your colleague. 1996;25:474477. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Rupture of the. Bean CH, Tencer AF, Trumble TE. All authors independently performed the search. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. 1977;59:1421. Injury and Surgical Repair to the Thumb This is an injury to the ulnar collateral ligament of the metacarpo-phalangeal (MCP) joint. This ligament prevents the thumb from pointing too far away from the hand. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. Please enable it to take advantage of the complete set of features! SAGE Open Med. Griffith TB, Ahmad CS, Gorroochurn P, D'Angelo J, Ciccotti MG, Dines JS, Altchek DW, Camp CL. FOIA 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. 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. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. The authors report no funding or conflicts of interest. Orthop Clin North Am. Nonoperative treatment often failed, necessitating surgery. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Studies that duplicated patient populations from the same authors were excluded. 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). Am J Sports Med. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). Please try after some time. 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. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. 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. 2013;23(4):247-254. Bookshelf 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. In general, be guided by symptoms and if an activity hurts, it is probably best avoided. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. 2022 Mar 27;4(3):141-146. doi: 10.1016/j.jhsg.2022.02.008. You will receive email when new content is published. The anti edema management will continue for several weeks. 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).
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