Chase Utley of the Philadelphia Phillies – Thumb Injury
Chase Utley, second baseman for the Philadelphia Phillies, slid into second base on Monday night, injuring his right thumb. He apparently tore a ligament in his thumb. Reviewing the video from the injury (http://espn.go.com/video/clip?id=5347188), it appears that Utley may have torn the ulnar collateral ligament of his right thumb. He underwent surgery on Thursday and is stated to be out for 8 weeks. So, let’s take a look at his injury in a little more detail.
The thumb is a very important digit to humans. It allows us to grip items, pinch things, and oppose other fingers. To have this kind of mobility, the thumb relies on a series of ligaments to stabilize the joint. Two ligaments in particular, the ulnar collateral ligament (UCL) and radial collateral ligaments (RCL), play an important role in holding the base of the thumb stable while we use our thumb. With your palm facing the ceiling, your UCL sits on the inner base of the thumb, while the RCL sits on the outer base of the thumb. The UCL stabilizes the thumbs with gripping motions (grabbing a baseball), pinching motions (writing with a pen), and holding sticks (as we do with skiing).
An injury to the UCL is known as a “Skier’s Thumb.” The UCL is injured when there is a force that pushed the tip of the thumb and the thumb outward. The UCL can stretch but not tear, resulting in a sprain. If the sprain does not heal and the player continues to resprain the UCL, this can result in a condition known as a “Gamekeeper’s Thumb.” If the force is great enough, it will tear the UCL, resulting in an unstable thumb. These forces can occur with a fall on an outstretched hand, gripping the steering wheel very tightly during a motor vehicle accident, or falling on a ski pole or hockey stick.
With a tear of the UCL, the thumb will be unstable. If you bend the thumb approximately 30 degrees and force the tip outward, the joint at the base of the thumb will gap open. These patients will have pain, swelling, black and blue marks, and instability when the injury happens. Over time, if the injury is not treated, the pain and instability will remain. The instability will be more noticeable with gripping and pinching motions. These injuries are diagnosed with a physical exam and an xray. An xray of the hand may show an avulsion fracture at the base of the thumb. This is consistent with an injury to the UCL where the UCL has not torn, but it has ripped off a piece of bone. If the UCL is torn through the ligament itself, the xray will appear normal. In these cases, an MRI may be needed.
WHEN TO SEEK MEDICAL CARE
If you think you have injured your UCL of the thumb, you should seek medical attention within a few days of the injury.
Sprains, partial tears, and non-displaced avulsion fractures can be treated with a short arm cast that goes to the tip of the thumb. The cast is worn for approximately 4 to 6 weeks. After this, physical therapy (OT) is required to regain motion and strength of the thumb.
Displaced fractures or ruptures of the UCL can be treated with surgery. During the surgery, the ligament is repaired or the fracture is fixed back to its position. A short arm cast that goes to the tip of the thumb is worn for approximately 4 weeks. After this, physical therapy (OT) is required to regain motion and strength of the thumb.
Athletes treated with surgery for a UCL tear may experience some mild pain and stiffness after recovering from the surgery.
RETURN TO ACTIVITIES
Athletes are typically out of competitive play for approximately 8 to 12 weeks.
For a video animation of “Thumb UCL Injury”, please see the “Education” tab of my website. Click orthopaedics, then hand, then conditions, then Thumb UCL Injury.
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