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In Street Clothes

Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Breaking Down Chris Paul’s Thumb Injury and Surgery

The Clippers continue to be a franchise limited by the overall health of their star players. Since the team first paired Blake Griffin and Chris Paul prior to the 2011-12 season, the dynamic duo at the heart of “Lob City” has missed a combined 124 regular season games due to injury. What makes this situation even more inauspicious is the fact that a majority of Paul’s injuries have occurred on freak plays and were largely unpreventable. Paul missed 18 games during the 2013-14 season after suffering a moderate AC shoulder separation when he hit the floor following a collision with Monta Ellis. Last season he missed Los Angeles’ final two playoff games after suffering a fractured 3rd metacarpal after swiping at the ball on the defensive end. Now, another inopportune steal attempt has left Paul with a torn ligament in his thumb. The damage is extensive enough to warrant surgery and will likely keep him out at least six weeks.

The thumb is made up of three bones, the proximal and distal phalanges and the first metacarpal. At the base of the thumb, the proximal phalanx and first metacarpal unite to form the metacarpophalangeal (MCP) joint. Two ligaments, the ulnar collateral ligament (UCL) and the radial collateral ligament (RCL), stabilize the MCP and prevent excessive motion at the thumb with gripping or pinching. The UCL is the primary stabilizer and sits on the inside of the thumb, near the webbing of the thumb and pointer finger. The RCL attaches on the outside aspect of the thumb and helps prevent excessive side-to-side bending of the joint.

RCL

The UCL is commonly injured in sports generally when a player gets hung up on something like a base in baseball or in an opponent’s jersey. RCL injuries occur less frequently as the specific force needed to place stress on the ligament is less likely to occur. A wide variety of athletes from Washington Nationals outfielder Bryce Harper to Chicago Bears quarterback Jay Cutler have torn the UCL of the thumb. In the NBA notable players to suffer the injury include Hall-of-Fame center Shaquille O’Neal and former Kings point guard Mike Bibby. While the exact ligament involved has not been publicly revealed, the mechanism of injury suggests Paul will now add his name to the long list of those to suffer UCL injuries. However it should be noted this will not be CP3’s first thumb surgery. Paul tore the RCL in his opposite thumb during the 2012 London Olympics and underwent surgery shortly after returning stateside.

Historically the Clippers estimated recovery timeline of six to eight weeks is fair. The average number of missed games for recent in-season UCL repairs is 28.9 games. 29 games translates to roughly eight weeks but Paul and the Clippers will have the added benefit of the extended All-Star break. As a result, an early-to-mid March return seems most realistic. Unfortunately, as Tim Bontemps of the Washington Post points out, the Clippers have a daunting schedule over the next six weeks and will face the dubious task of managing the immediate future without Paul AND Griffin. Griffin, out since December 18, is making progress in his recovery from a knee debridement but has not yet been cleared to play.

There is a sliver of good news, as Paul’s injury does not involve his lower extremities. As a result, the All-Star point guard will be able to maintain his conditioning during his recovery, which should allow for a smoother return to play and help minimize the inherent injury risk that comes with an extended time off. Furthermore, the surgery has a high long-term success rate and should be a non-issue moving forward.

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