انگوٹھے UCL مرمت

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective and objective functional results [2].
• The technique of thumb ulnar collateral ligament repair using suture anchors and suture tape augmentation preserves native ligament proprioception [1].
• The technique of thumb ulnar collateral ligament repair using suture anchors and suture tape augmentation provides additional stability during early healing phases [1].

Anatomy & Pathophysiology¶

Thumb Anatomy & Function¶

• The thumb has a more proximal and lateral position than the other digits, allowing movement inward and outward from the palm [4].
• The thumb ray is the shortest of the five rays of the hand and is clearly separated from the fingers [4].
• The web space of the thumb is the largest and deepest of the hand's web spaces [4].
• The thumb is described as the master digit of the hand, representing the dominant element that gives value to all other digits [9].
• The thumb metacarpal is independent and articulates with the trapezium [9].
• The thumb ray has considerable mobility and independence, which is greater than that of the fifth ray and the other fingers [9].
• The thumb possesses two phalanges, whereas the other digits have three [4].

Vascular Anatomy¶

• The "princeps pollicis" artery is the terminal branch of the radial artery that crosses the first intermetacarpal space and runs along the ulnar side of the first metacarpal bone [10].
• In the classical layout, the princeps pollicis emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [10].
• At the metacarpophalangeal joint level, the princeps pollicis divides into two terminal rami known as the collateral palmar arteries of the thumb [10].
• The collateral palmar arteries run along the digital tunnel symmetrically and are of equal caliber [10].
• The collateral palmar arteries head distally to finally unite in the pulp arcade [10].
• Only 15% of anatomical dissections of the thumb's palmar arteries fall into the classical "typical" category [10].
• In the second segment of the thumb (between metacarpophalangeal and interphalangeal creases), the main artery is the ulnar collateral artery [10].
• The ulnar collateral artery is more often easier to dissect than the radial collateral artery and its size enables a more reliable microanastomosis [10].
• A subtendinous anastomosis situated at the level of the neck of the first phalanx acts as a moderator between the two collateral arteries [10].
• In cases where the palmar ulnar collateral artery is absent, the dorsal artery takes its place by means of a branch through the subtendinous arcade [10].
• In the pulp segment, the two arteries are of similar size and run through the thick fatty subcutaneous padding [10].
• The dorsal arteries of the thumb originate from the palmar arteries (princeps, commissural, or anastomoses of the superficial arcade) at the level of the first metacarpal [10].
• The ulnar dorso-collateral artery generally stems from the "princeps pollicis" onto the medial border of the neck of the first metacarpal [10].

Cutaneous Anatomy¶

• The palmar surface of the hand forms a cutaneous unit extending from the distal transverse crease of the wrist up to the transverse crease at the base of the digits [5].
• The oppositional crease of the thumb constitutes the oblique axis of the hand and subdivides the palmar integument into two separate zones [5].
• The skin of the radial portion of the palm covers the thenar eminence and is relatively well vascularized and mobile [5].
• The skin of the ulnar and distal portion of the palm covers the hypothenar eminence where the skin has poor mobility [5].
• The central triangular part of the palm has fixed, poorly vascularized skin that covers almost directly the superficial palmar aponeurosis [5].
• The integument of the palmar face of the thumb is subdivided into phalangeal units separated by two digital flexion folds [5].
• When a digit is completely flexed, the integument of adjacent phalanges comes into contact in the zones of the flexion creases, establishing areas of cutaneous contact in the form of a diamond [5].
• The sides of the diamond-shaped cutaneous contact zones do not undergo variations in length during movements of flexion and extension [5].
• Incisions made along the lines of the diamond-shaped cutaneous contact zones present a minimal chance of retraction [5].
• The palmar surface of the thumb web is flat and precipitously interrupted, with skin densely adherent to the commissural skeleton [5].
• The commissural skeleton of the thumb web is formed by the distal transverse ligament, which is by far the deepest and the most mobile [5].
• The necessary skin to cover the thumb distal to the metacarpophalangeal joint is about 9 cm wide and 8 cm long [8].
• Skin loss of the thumb and first metacarpal requires a graft or flap of 13 cm wide and 12 cm long [8].

Surgical Approach Considerations¶

• Distal palmar incisions are transverse, while proximal palm incisions tend to be more longitudinal with the distal end curving radially [11].
• Incisions in the more proximal palm should parallel the thenar crease [11].
• The most important structure in the thenar area is the recurrent branch (motor) of the median nerve, which should be exposed and protected if its exact location is in doubt [11].
• Anatomic studies show that there is no single longitudinal incision in the proximal palm that completely avoids the palmar cutaneous branches of the median and ulnar nerves [11].
• Midlateral incisions suitable for fingers are also suitable for the thumb, with the radial side being more accessible [11].
• A radial midlateral incision on the thumb can be extended by curving its proximal end at the midmetacarpal area and creating a flap on the palmar surface [11].
• Care should be taken to avoid the dorsal branch of the superficial radial nerve to the radial side of the thumb during midlateral incisions [11].

Pathophysiology & Repair Outcomes¶

Investigations¶

• Clinical evaluation of the injured or dysfunctional hand and wrist requires combining patient history with a careful physical examination to pinpoint or narrow the scope of possible pathologic processes [3].
• Diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology but can be expensive, time consuming, and often nonspecific [3].
• A careful physical examination is essential to direct care and future testing if indicated [3].

Treatment¶

• Thumb UCL repair using suture anchors and suture tape augmentation preserves native ligament proprioception [1].
• Thumb UCL repair using suture anchors and suture tape augmentation provides additional stability during early healing phases [1].
• Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective functional results [2].
• Acute surgical repair of the torn ulnar collateral ligament can achieve good objective functional results [2].

Complications¶

• Suture anchor and suture tape augmentation preserves native ligament proprioception [1].
• Suture anchor and suture tape augmentation provides additional stability during early healing phases [1].

Recovery¶

• Suture anchor and suture tape augmentation techniques preserve native ligament proprioception [1].
• Suture anchor and suture tape augmentation techniques provide additional stability during early healing phases [1].

Key Evidence¶

• [L5] The technique preserves native ligament proprioception while providing additional stability during early healing phases. [1] (10.1016/j.eats.2025.103957)
• [L4] Acute surgical repair of the torn ulnar collateral ligament can achieve good subjective and objective functional results. [2] (10.1016/0020-1383(94)90179-1)

References¶

[1] Thumb Ulnar Collateral Ligament Repair Using Suture Anchors and Suture Tape Augmentation. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103957

[2] Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Injury. 1994. DOI: 10.1016/0020-1383(94)90179-1

[3] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[4] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[5] Exam Of The Hand Wrist 2Ed. Functional cutaneous units.

[8] Exam Of The Hand Wrist 2Ed. Planning skin cover of the hand and forearm.

[9] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.

[10] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[11] Campbell S Operative Orthopaedics 4 Volume Set. RESULTS OF SUTURE OF THE SCIATIC NERVE > PALMAR INCISIONS.