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

Understanding Clint Capela’s Thumb Surgery

The Houston Rockets are in the midst of a rollercoaster season. The team struggled out of the gate losing 14 of their first 25 games, capped by a stunning loss at the hands of Mavericks rookie Luka Doncic. However, the team rebounded winning 12 of their next 13 games and currently sits at 5th in a highly competitive Western Conference.  While a Super Saiyan James Harden has been the driving force behind the Rockets turnaround, center Clint Capela has been a worthy sidekick to the reigning MVP. Sadly, Capela is expected to miss a prolonged period of time after spraining his thumb in a recent loss to the Magic. The ligament damage was significant enough to warrant surgery, sidelining Capela for at least four weeks.

The thumb is comprised of three bones, the proximal and distal phalanges and the first metacarpal of the hand. At the base of the thumb, the proximal phalanx and first metacarpal 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 joint, particularly while 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.

UCL thumb sprains occur regularly in sports, most often when a player gets hung up on something like a base in baseball or in an opponent’s jersey. RCL injuries are relatively uncommon as the specific force needed to sprain the ligament occurs less frequently. The exact ligament damaged by Capela has not been revealed but based on the mechanism of injury a UCL injury seems most likely.

An assortment of players in other professional sports, including Bryce Harper, Mike Trout, and Andy Dalton have missed time following surgery to repair a UCL tear. Fortunately, studies in both baseball and football reveal players have a high return to play rate following surgical intervention and the long-term ramifications are minimal. The MLB study noted players missed an average of eight weeks recovering.

The InStreetClothes.com/SMART database reveals a similar timeline for NBA players who underwent an in-season UCL repair. Since the 2005-06 NBA season, the average number of missed games for in-season UCL repairs is 26.2 games or roughly seven weeks. Players in this assessment include multiple big men including Larry Sanders and Shaquille’ O’Neal as well as Capela’s teammate Chris Paul.

Fortunately Paul’s inclusion on the list is an encouraging sign that Capela could return ahead of schedule. CP3 missed just 14 games after tearing the UCL in his thumb, the quickest return to play of the examined players. Paul’s case carries multiple similarities to Capela’s injury, including the timing. Paul’s injury occurred on January 16, 2017 with surgery occurring two days later. Capela’s injury occurred on January 13, 2019 and surgery was carried out four days later. Even more importantly, the same doctor, Dr. Steven Shin, performed both procedures.

Dr. Shin is the director of hand surgery at the Kerlan Jobe Orthopedic Clinic in Los Angeles and has pioneered a type of thumb surgery that lends itself to an abbreviated rehab window and a quicker return to play. Dr. Shin’s method was highlighted by ESPN Injury Analyst Stephania Bell during the 2017 MLB season after Mike Trout was sent under the knife. The technique involves a ligament repair and the additional of an internal brace. The addition of the synthetic tape reinforces the injury site and often allows the injured athlete to begin functional movement earlier.

If Dr. Shin did perform a UCL repair with an internal brace augmentation, Capela could realistically be back following the All-Star break. A quick return to the lineup would be a welcome boost for a team that has already had its fair share of injuries. The Rockets ranked 24thin the NBA for total number of games lost to injury or illness during the first half of the season and have been forced to play extended stretches without Paul and his backcourt mate Eric Gordon.