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Thumb Ulnar Collateral Ligament Injuries in Athletes

OSU football: Will Spencer Sanders' thumb surgery have lasting effects this season?

“You can imagine if you’re skiing down a mountain and your ski pole gets planted and your thumb gets violently bent away from the hand, that’s how this ligament gets torn,” said Dr. Clay Nelson, a surgeon with Oklahoma Sports and Orthopedics Institute, who did not treat Sanders, but specializes in hand and upper extremity injuries.

“It can happen in any ball sport or to any athlete where the thumb gets bent into an extreme position away from the hand, because the job of that ligament is to connect that joint and keep it stable. But when it gets pulled too far, it gets injured.”

“The internal brace, which uses a high-strength, braided suture material, doesn’t allow the ligament to heal any faster,” Nelson said. “It allows for a shorter rehab, because it stabilizes and protects the ligament while the ligament heals. The ligament takes 10-12 weeks to fully heal, but some of these athletes are getting back to play as soon as 5-6 weeks.”

Thumb UCL Injuries in Athletes Clayton E. Nelson, M.D.

Every season we hear of elite athletes sidelined because of injuries to their hand. Last year Drew Brees and Steph Curry were atop the headlines for notable athletes sentenced to the disabled list while their hands recovered. Although there are many types of hand injuries among athletes, the hand in general is a common site of injury during sports because of its’ exposed nature and tendency to absorb initial contact. Among injuries to the hand, trauma to the thumb is an all too common site of injury for the competitive athlete.

Whether you are throwing a football or swinging a bat, the thumb is an important stabilizer for pinch and grip activities required by many athletes. The most common athletic injury sustained to the thumb is an injury to the ulnar collateral ligament or frequently called the thumb UCL.

UCL injury

A ligament is a soft tissue structure that connects bones to each other at joints. The thumb ulnar collateral ligament helps connect the thumb to the hand on the side near the index finger at the metacarpophalangeal joint. It functions to allow the thumb to act like a post to stabilize the thumb and aid in pinch and grip.

The UCL tends to be injured when the thumb is pulled in an extreme position away from the hand. This is frequently from contact with another player, the ground, or a ball. An athlete who sustains an injured UCL will have pain, swelling and most notably weakness with grip.

UCL injures can be partial or complete tears and can present with varying degrees of instability. It is this degree of instability that usually dictates the treatment options. Some tears are treated with a cast and immobilization while other tears need to fixed surgically.

Frequently, the unstable injuries among athletes will be repaired surgically utilizing bone tunnels and suture to stabilize the ligament back to the bone. Traditionally, this would require a 10-12 week recovery and rehabilitation which previously meant a season ending injury for most athletes.

Thankfully with more recent surgical advances we are now able to return athletes to play much sooner following thumb UCL surgery. With the use of the InternalBrace™ by Arthrex we are typically able to return athletes to play as soon as 5-6 weeks following surgery.

The InternalBrace™is a high-strength braided suture material that protects and reinforces the ligament while it heals. It is important to note that this suture material does not speed up the actual ligament healing process, but it does allow for earlier rehab by protecting the ligament while it heals.

Every season we treat multiple athletes who sustain thumb UCL injuries. Several of these will need surgical treatment. Depending on their sport and position, the timing of surgery may even be midseason. Athletes need to understand that with the proper surgical technique and rehabilitation we can get them back to play fairly quickly and expect excellent long-term results.

It is important to mention that many notable athletes have sustained this same injury and continue to compete at the highest level. Athletes who have recently sustained thumb UCL injuries requiring surgery include Mike Trout of the Los Angeles Angels, Drew Brees of the New Orleans Saints and our very own Chris Paul of the OKC Thunder and Spencer Sanders of the Oklahoma State Cowboys to note just a few.

If you would like more information on thumb UCL injuries or would like to discuss an injury with Dr. Nelson please reach out to us at [javascript protected email address]

You're in good hands at Oklahoma Hand!

Surgical Technique: Thumb UCL Repair with InternalBrace™ Ligament Augmentation