Thumb Ligament (Ulnar Collateral Ligament) Injury

Written by admin on October 29, 2012 – 10:08 am -

Chris Paul of the Los Angeles Clippers, Henry Blanco of the Arizona Diamondbacks, and Jeremy Bridges of the St. Louis Cardinals are three of many professional athletes who have recently sustained injures to the ulnar collateral ligament of the thumb. Paul is on schedule to return to regular season play on October 31st versus the Memphis Grizzlies–10 weeks after surgical repair and rehabilitation of his Ulnar Collateral Ligament. It may be difficult to contemplate that such a small ligament can cause such a detrimental effect on an athlete’s season, but as the key stabilizer of the main joint of the thumb, the UCL is the sine qua non of thumb stability and grip strength. It is usually torn by forceful hyper-abducting of the thumb. Hyper-abduction is bending backwards toward the radius bone of the forearm (or away from the hand). This is typical of a fall onto one’s hand with fingers outstretched or when a football player’s right thumb is caught in the jersey of an opponent moving to the player’s left.

Partial tears are more common and can be managed with bracing or casting for several weeks. Complete tears require operative intervention. The surgical procedure is simple and is a direct repair of the ligament to its normal attachment site using bone anchors (screws with suture attached). The screws are countersunk into the bone the sutures are passed into the end of the ligament and tied. This pulls the ligament back to its normal attachment site. The thumb is immobilized for 4-6 weeks, followed by an additional 2 weeks of protected range of motion, so that 8 weeks following the surgical repair the athlete is ready to return to play. Non-operative of treatment UCL injuries requires functional bracing for 4-12 weeks (depending upon severity) and daily active range of motion exercises. Athlete’s often choose the surgical option for its shorter rehabilitation time, and lower likelihood of chronic instability of the metacarpal-phalangeal joint.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, ATC/LAT is a post graduate fellow at GOSM… For more information, visit us at www.atcfellowship.com

References

Godges, DPT, MA, OCS, J. (n.d.). Thumb ulnar collateral ligament repair and reabilitation. Retrieved from http://xnet.kp.org/socal_rehabspecialists/ptr_library/04WristandHand Region/26Hand-ThumbUlnarCollateralLigamentRepair.pdf

Katolik, L., Friedrich, J., & Trumble, T. (2008, November). Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques.. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18971729.

Rotoworld. (2012, August 7). Player page – henry blanco. Retrieved from http://www.rotoworld.com/player/mlb/2449/henry-blanco

Rotoworld. (2012, September 2). Player page – jeremy bridges. Retrieved from http://www.rotoworld.com/player/nfl/742/jeremy-bridges

SportingNews NBA. (2012, October 20). Chris paul trying to break hesitation after recovering from hand injury . Retrieved from http://aol.sportingnews.com/nba/story/2012-10-20/chris-paul-hand-injury-update-los-angeles-clippers-team-usa-stats-roster-schedul


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Orthokine Therapy: Modern Day Fountain of Youth?

Written by admin on October 1, 2012 – 9:52 am -

Orthokine therapy is a new sports medicine treatment recently receiving widespread interest and acclaim. It was developed primarily for the treatment of osteoarthritis (OA) by German doctors, Dr. Peter Wheling and Julio Reinecke, PhD., of Dusseldorf, Germany. Little is known about this experimental technique, and there is scant data to support its efficacy, but anecdotal reports have been, high-profile and promising. Much like the mythical fountain of youth, the technique, its clinical mechanism, and its results are shrouded in mystery. Similar to Platelet Rich Plasma Therapy (PRP therapy), whose mechanism and effect has been discussed at great length, and is now widely-recognized in the public consciousness as the standard musculoskeletal rejuvenation therapy, Orthokine therapy is also an autologous treatment provided as an injection of the patient’s own blood. There are no foreign materials or substances used, so risk of adverse side effects is minimal, and the injections are well-tolerated.

In theory, proteins commonly found in patient’s blood –such as Interleukin – 1- Receptor – Antagonist (IL -1Ra) – possess inherent anti-inflammatory and analgesic properties that serve to protect and to preserve the cartilage in an arthritic joint against degradation by osteoarthritis.

During the Orthokine procedure, blood is obtained from the patient using a syringe containing beads that will enhance and/or release the production of these cartilage-protective proteins. The blood is stored at body temperature for up to 9hours, during which time, the concentration of the joint preserving proteins, have increased up to 100 times greater than normal. After the incubation period, the sample is centrifuged to isolate the enriched serum of proteins from the other elements of blood. It is then divided into numerous vials that may be used immediately or frozen for future treatments. The serum is then injected into the affected joint to decrease pain, increase range of motion, and decelerate the progression of degenerative joint disease, and (hopefully) improve the joints longevity. The practitioners report almost immediate improvement and symptom resolution for 2-4 years.

Orthokine therapy is being used throughout Europe but is not yet FDA approved for use in the United States. Professional athletes such as Kobe Bryant and Alex Rodriguez are among those who have traveled to Europe to receive the Orthokine therapy with the hopes of alleviating pain, enhancing their performance and extending their athletic careers.

It is unclear whether Othokine is the long-sought OA treatment (minimally invasive, long-lasting, relatively inexpensive to provide), the next innovation, or just the latest “snake oil” cure-all. It is certain, however, that despite the lack of clinical data, many more modern day Conquistadors will travel to Europe to imbibe this latter day fountain of youth, following the examples of the superstar “Ponce de Leon” that preceded them.–at least until it is “discovered” again somewhere else.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, ATC/LAT is a post graduate fellow at GOSM… For more information, visit us at www.atcfellowship.com

References
Wehling, P. D. P. (2012). Molecular orthopaedics. Retrieved from http://www.wehling-hartmann.de/en/wir-ueber-uns/
Wheling, P. D. P. (2007). Osteoarthritis: The individual osteoarthritis therapy. Retrieved from http://alfa-arthro.com/dokumenti/BookletOA_Pat_05062007.pdf


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