The landscape of the NBA season took a bizarre shift over the weekend after three teams lost players to hand and wrist injuries. In the West, the Clippers lost guard JJ Redick following a fall against the Kings while Anthony Davis of the Pelicans was injured following a failed alley-oop. The Nets, struggling to find footing in an abysmal Eastern Conference, will be forced to right the ship without Paul Pierce.
The design of the skeletal structure in the wrist and hand is very intricate. Just distal to the lower arm bones, the radius and ulna, sit the eight carpal bones. These tiny bones form the wrist as well as the carpal tunnel and are connected by a complex network of ligaments. Each carpal bone has a unique shape that allows for it to move given the numerous demands of the joint while serving as an attachment site for various tendons. The first row of carpals is made up of the scaphoid, lunate, triquetrium, and pisiform and the second row is comprised of the trapezium, trapezoid, capitate, and hamate. After the carpals, sit the five metacarpals of the hand. The metacarpals serve as the transitions bones between the fingers and the wrist and several serve as an anchor site for muscle attachment.
As evident from this past weekend, both the carpals and metacarpals are vulnerable to fractures, particularly with a direct blow or a fall on an outstretched hand. However the associated recovery time is dependent on the specific bone broken as well as the nature of the break. If the bone remains aligned, it is considered non-displaced. If the bone shifts positions it is considered displaced and alignment surgery is often required to insure proper healing.
Redick’s injury occurred to a carpal bone, specifically the pisiform bone in his right hand. The pisiform is pea-shaped and located at the base of the pinkie. A pisiform fracture is actually quite rare though its neighbor the hamate is frequently broken, especially in baseball. The conservative treatment for a non-displaced pisiform fracture usually includes up to six weeks of immobilization in a cast. The injured athlete will begin rehab exercises focusing on range of motion and eventually strengthening after cast removal. Unfortunately Reddick suffered another injury during his fall that could slow his return. Redick suffered a sprained ulnar collateral ligament (UCL) at the base of his right thumb. The UCL is the primary stabilizer of the thumb and plays a key role in grip strength. The Clippers have set Reddick’s return at six-to-eight weeks but it’s likely he needs the full two months to regain his shooting touch and return to games.
Davis and Pierce both suffered non-displaced fractures in their hands. Pierce suffered a non-displaced fracture of the 3rd metacarpal in his right hand while Davis suffered a non-displaced fracture in his left 5th metacarpal. Both players will avoid surgery as the bones remain aligned yet Davis will require a longer recovery period.
The second and third metacarpals are tightly anchored to the carpal bones and as a result are generally immobile. However the 4th and 5th metacarpals are mobile to allow for a high degree of motion at the wrist and pinkie. This difference may seem minor but it requires additional time to heal following an injury. Since Pierce’s fracture was isolated to his 3rd metacarpal he is expected to miss two-to-four weeks. In contrast, Davis’ break of the more mobile 5th metacarpal will keep him out for 4-to-6 weeks. The Brow could return on the earlier end of that spectrum given that the injury occurred to his non-shooting hand. Both players will be able to maintain their conditioning levels though that’s a small consolation for both Brooklyn and New Orleans.