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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Posted in Hand & Wrist, Sports Medicine | No Comments »

Who is Lisfranc? Better question is what…

Written by admin on October 17, 2012 – 3:20 am -

The NFL Injured Reserve has been awash with foot injuries the past two weeks. Cedric Benson, Ryan Kalil and Santonio Holmes all have sustained midfoot injuries, also known as a Lisfranc injury–much more serious than a simple sprain and sometimes requiring surgery.

A Lisfranc injury is an injury to the ligaments and/or bones of the midfoot. This injury can affect one or multiple joints of the midfoot and may include a fracture. Lisfranc injuries are named after Napoleon’s personal surgeon who first described the injury, then common in cavalry officers. The injury was typically sustained when the foot caught in the stirrup and twisted when the cavalryman was thrown from the saddle. Today, football and soccer players are more prone to these injuries because of the twisting and falling mechanisms that occur so frequently in competition.

Symptoms of a Lisfranc fracture include swelling over the top of the foot, bruising on the top and/or bottom of the foot, and pain with weight bearing. Athletes should seek medical attention from an Orthopaedic physician. An x-ray and sometimes an MRI or CT scan will be necessary to determine the alignment of the small bones and joints of the affected foot as well as the integrity of the ligaments.

Non-operative treatment of a Lisfranc injury includes non-weight bearing for 6 weeks in a cast, and progressing to a walking boot for an additional 2-6 weeks. An athlete would not be able to return to athletic competition until he is able to complete sport specific drills without pain.

If an operation is necessary, as it is for Kalil and Holmes, it can take up to six months for full recovery. With this corrective surgery, the bones are put back into place (reduced) and held by plates and screws, which may require removal at a later date.

Prevention of a Lisfranc injury is difficult especially in physically demanding sports like soccer and football, but it is helpful to wear well-fitting, properly designed and constructed footwear (avoid the Clearance bin). Cleats that are too flimsy and flexible may not be able to properly support the foot, increasing susceptibility to injury.

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 or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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Posted in Foot & Ankle, Sports Medicine | No Comments »

See What You Hit

Written by admin on September 24, 2012 – 9:41 am -

Football is one of the most dangerous and violent sports. Though it has been considered the classic “contact sport,” it is more accurate to say it is the ultimate “collision sport.” While concussions currently garner the media spotlight, injuries to the neck and spine are ignored– until disaster strikes. Recently, defensive backs at Catawba and Tulane Universities both suffered severe cervical spine injuries. Last season, at Rutgers University, Eric LeGrand was injured while making a tackle, and he remains paralyzed from the neck down.

The cervical spine is comprised of the first 7 spinal vertebrae. The nerves that exit the cervical spine are vital to both basic and sophisticated body functions including respiration and movement. Cervical spine injuries typically result from an axial load, which is a force that originates at the top of the head and continues longitudinally down the spine. “Spearing” is the term used for a tackle in which the player leads with the head, and the top of the head makes initial contact with the opponent. This type of tackle has been banned in the NFL to ensure the safety of NFL athletes as well as the young players that emulate them. Roger Goodell, commissioner of the NFL, has said that football needs a “culture change” in order to become a safer sport at all levels. Rules changes are welcome, but to decrease the prevalence of these injuries, It is perhaps more important that coaches, parents, and players be educated in proper tackling technique. The NFL has joined with USA Football, the governing body of youth football, to form the “Heads Up Football” initiative to teach proper tackling technique and increase awareness of head and neck injuries. According to Heads Up “The right way of tackling begins with ‘the breakdown’: feet set, hands sunken, the arc of the back straight and the knees bent. The head is up at all times.” A player must always be able to “see what you hit.” If you can’t, your technique is incorrect.

Given the inherent danger of participation in football, it is important to have a well-coordinated medical team present at every game. These medical professionals include the athletic trainers, first responders, team doctors and EMS. Fortunately, these teams were present on the sidelines at Catawba, Tulane, and Rutgers, their skilled, rapid, and coordinated efforts were essential in achieving the best outcomes.

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 or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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Posted in Spine (Neck & Back), Sports Medicine | No Comments »