Josh Hamilton sidelined by thumb injury
Hamilton’s injury to his left thumb, sustained while sliding into first base headfirst Tuesday (or hands first, as it were), is not his first significant injury to be sustained in that manner. In 2011, Hamilton fractured his right humerus (the long bone of the arm that runs shoulder to elbow) in a diving headfirst slide at home plate. Just as many are questioning his decision to lead with the hands in an attempt to beat out a tag at first base, so did many wonder then why he risked injury for a slide that was not very likely to succeed. (For the record, he was tagged out at home in that attempt.) Hamilton’s fractured arm kept him out of major league play for more than five weeks and, it would seem, served as a warning of the risks involved in the headfirst slide. Yet nearly three years later to the day, Hamilton made a wager with a low percentage of success and a high percentage of risk ... and lost.
The injury Hamilton sustained Tuesday, a torn ulnar collateral ligament (UCL) of the thumb, is a known risk with the headfirst slide, when a player can catch his outstretched thumb on the bag, forcing it away from the rest of the hand and overstretching the ligament.. The UCL spans the inner aspect of the base of the thumb, running from the first metacarpal (the long bone that sits just above the small wrist bones on the thumb side) to the proximal phalanx (adjacent to the first metacarpal, it is the nearest of the two bones that comprise the thumb itself). When the UCL is injured, it can become swollen and painful. A complete tear typically results in instability of the thumb. The Angels announced Wednesday that Hamilton had suffered the injury, noting he will consult Friday with Dr. Steven Shin -- an orthopedic surgeon at the Kerlan-Jobe clinic in Los Angeles who specializes in the hand -- to determine whether surgery is necessary.
Not all tears require surgery, and the decision as to whether surgery is required includes multiple factors, including the degree of tear, the presence of instability and any factors that would prevent the ligament from healing correctly. A major advantage to surgical repair for a complete tear is a more predictable outcome, according to Dr. Hank Holliger, an orthopedic hand surgeon at Resurgens Orthopaedics in Atlanta.
“The ligament ordinarily regains its intrinsic strength by six weeks,” Holliger said, “which also is the usual time away from hitting activities.” There can be some stiffness that persists beyond that point, and the time to return to competitive play can vary. Two to three months is often the standard time frame issued when an athlete undergoes UCL surgery, although the details of the injury and the specifics of the surgery can affect the overall time frame, as does the individual’s ability to heal. Even after the athlete returns, he is often fit with a splint to wear when baserunning. Boston Red Sox second baseman Dustin Pedroia, who underwent offseason surgery to repair his torn UCL, said he will wear such a splint this season but will put it on after he bats. Holliger says he typically protects a thumb for three months after ligament reconstruction, via splinting or simply disallowing headfirst slides.
Is the cost of the headfirst slide too great when it comes to injury risk?
Here are a few other players who have suffered an injury to the UCL and their paths post-injury:
Yasiel Puig, OF, Los Angeles Dodgers: Injured April 5 on a headfirst slide to first base. Puig’s injury is classified as a sprain of his left thumb and he is considered day-to-day. He has been fitted with a splint and is taking batting practice but has not returned to the lineup. Of note: This is not Puig’s first issue with his thumb. He sprained it last April while still in the minors and missed more than a week.
Hanley Ramirez, SS, Los Angeles Dodgers: A torn ligament due to playing in the WBC? Some would prefer their players avoid the WBC just as much as the headfirst slide, but the injury for Ramirez came on a defensive play, while diving for a ball. He underwent surgery to repair the ligament but opened his season just five and a half weeks later, almost three weeks sooner than the initial projection. The good news? His surgeon was Dr. Shin, who will evaluate Hamilton on Friday.
Dustin Pedroia, 2B, Boston Red Sox: Injured Opening Day of 2013 yet managed to play the entire season, although with a little drop in power. He underwent offseason surgery to repair his left UCL and was ready to roll by the start of spring training.
Jason Heyward, OF, Atlanta Braves: Heyward damaged his UCL on a headfirst slide in 2010 but did not suffer a complete tear. His injury did not require surgery (but he was forced to sit out the All-Star Game that year). He missed 18 days with the injury.
The significance of Hamilton’s injury certainly hints at the likelihood of surgery, but there will be no definitive word until Friday. At the very least, the initial timetable issued by the Angels of a six-to-eight-week absence appears reasonable. And while the debate about the value of a headfirst slide will no doubt continue, the hope is that Hamilton has learned by now that the risk clearly outweighs the reward.