Sports Injury: The Thumb

June 20, 2022

Thumb Injury Treatment in Columbus, OH

The most important part of our arms must be our thumbs. Providing over 50% of total hand function, they play a crucial role in sport regardless of age or ability level.  Whether a student-athlete working to get better at lacrosse, the weekend warrior trying to get a few golf strokes, or the professional volleyball player perfecting your craft—all rely specifically on thumbs which can be prone to injury.

The thumb can be torqued in ways that can injure the ligaments during stick sports such as lacrosse, field hockey or golf.  In volleyball, setting the ball torques the thumb as well.  A common injury to the thumb is an ulnar collateral ligament (UCL) tear; also called “skier’s thumb” or “gamekeeper’s thumb”.  Similar to the knee, the thumb’s ligaments aid in stability so that it can do its job and do it with strength. Some ligament injuries can heal on their own with time and immobilization followed by rehabilitation in order to get the joint moving again.   Typical immobilization may last around six weeks.  There are situations when the ligament is torn too badly and the only way for it to heal properly is with surgery.  The goal of surgery is to tighten and repair that ligament back to its usual home and allow it to heal in the appropriate position.  The procedure is performed as an outpatient (go home the same day as surgery) and is done at our Hand Center.  It requires a small incision over the thumb near the web space and a device called a suture anchor which helps anchor the ligament back down to the bone from where it was torn.   Splints are utilized after surgery and post -operative splinting lasts around 4-6 weeks.  Returning to sports depends on which sport and how healing is progressing. Usually full unrestricted sport movements that stress the thumb are avoided for 2-3 months after surgery.  The thumb metacarpophalangeal joint (the joint affected by UCL tears) can become stiff with either non-operative or operative treatment and a hand therapist is crucial after appropriate ligament healing in order to work with regaining motion and strength to the thumb.  Patients can expect 80-90% of their normal motion to be returned on average.

Sometimes, the ligament was torn and either isn’t treated right away or despite appropriate treatment, doesn’t heal strongly.  Those instances are called chronic UCL injuries of the thumb.  In these situations, patients may require a reconstructive procedure in which we borrow expendable tissue (typically the palmaris longus tendon in our wrists) and use it to make a new UCL.  It is also an outpatient surgery, and the palmaris tendon is secured to the bones in the thumb in the position of the old, now incompetent, UCL to make a new one for the patient.  The post-operative immobilization is similar to acute repair situations however healing can take slightly longer.  It is worth putting aside the lacrosse stick or volleyball for a little while to provide a stable and strong thumb for the future.