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Getting A Grip On Thumb Injuries

Ulnar collateral ligament surgery most common procedure for thumb injuries

  • Date: 4/9/2012

By Gary Gillis

Andrew BaileyWere you aware that a thumb injury can lead to severe headaches? It doesn't happen all that often, but in the case of Red Sox closer Andrew Bailey, the injury (and subsequent surgery) that will keep him out of the lineup until mid-season created one big headache for both new manager Bobby Valentine and general manager Ben Cherington. Sore thumbs and baseball are not a good mix.

"Having use of your thumbs is actually critical to our normal daily functions," explains Dr. Charles Day, Chief of Hand and Upper Extremity Surgery at Beth Israel Deaconess Medical Center. "You need a strong, stable thumb to hold a cup of coffee, to hold and dial a cell phone, to grip and hold a steering wheel."

Now, if you or I were to injure a thumb, it would be an inconvenience for sure, but as the dry cleaner can attest, I'm equally adept at spilling coffee on myself with either hand. Pitching requires a bit more from that opposable digit.

"Think about all of the factors that are necessary to deliver an effective pitch at the major league level," suggests Dr. Day. "You have to have the correct arm motion to generate the velocity, a consistent step towards the plate and strong drive off of the pitching rubber, and you need the right release point in order to put that pitch where you want to go. All of those can be perfect but if the grip is off or unstable, the whole process unravels."

Bailey underwent surgery to reconstruct his ulnar collateral ligament. It's the most common thumb injury that requires surgery. Bailey and the Sox aren't sure exactly when the injury occurred, but a fall after a collision at first base during a March 21 exhibition game against the Pirates might be the cause.

"Falls are a very common way to sprain the ulnar collateral ligament," explains Dr. Day. "We instinctively put out our hands to break a fall and if the thumb gets caught or pulled back, the ligament is often injured. If it is a slight sprain, the ligament will be sore but usually will heal on its own, without even requiring immobilization."

Dr. Day says the body is actually pretty good at mitigating some injuries. When ligaments get stretched, the pain nerves start firing and we naturally try to pull back to prevent further injury. Depending upon what joint is being stressed, muscles might kick in to help us stabilize ourselves. However, pulling back can be hard to do if you're headed over the handlebars or you stumble on a sidewalk.

"If it's a significant tear - which is technically still a sprain, just a higher level of severity - that's when surgery is indicated," says Dr. Day. "After the repair, you've got to allow the necessary time for the ligament to heal completely and then begin work on rehab to regain the range of motion and flexibility in the joint."

So what's the best way to avoid a sprain? Often, the advice is to build up the muscle surrounding a joint to increase the stability, but "We use our hands so much that the intrinsic muscles are generally pretty well kept up," states Dr. Day. "For somebody like Andrew Bailey, he will have to build up his strength after having his hand immobilized. He will no doubt have an excellent plan for rehab, but he won't be able to do very much for a while."

Personally, I wanted to improve my odds of staying healthy, so I asked the good doctor about one of my favorite activities and here's the good news.

"Well, I guess that picking up and using the remote qualifies as exercising your thumb," Dr. Day surmised.

Finally, a workout I can commit to.

Posted April 9, 2012