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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