Baseball Commentary “Thumb Ligament Injuries: RCL and UCL”

.c om Injury to the hand from sports activities is not an uncommon entity encountered by emergency room physicians, orthopedic surgeons, and hand surgeons. Hand and finger injuries from baseball and softball comprised 2.2% of emergency department visits in one epidemiologic study. The thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) and radial collateral ligament (RCL) are prone to injury under radial and ulnar stress, respectively. Diagnosis and expedient treatment are crucial in high-performance athletes for their timely returning to play. The distinction must be made between injuries in the throwing arm and those in the nonthrowing arm. In general, immediate return to play with a protective splint is permissible for partial tears in the nonthrowing arm. A thumb spica cast or thermoplast splint with the interphalangeal joint (IPJ) free should be used to prevent extensor pollicis longus adhesions. However, for partial tears to the UCL or RCL in the throwing arm, more conservative management is recommended, with 4 weeks of full-time immobilization followed by 2 to 4 weeks of immobilization during play with active range-of-motion exercises off the field. Radiographs are a necessity if a collateral ligament injury is suspected to rule out avulsion fractures that should be treated accordingly. Surgical intervention is warranted for purely ligamentous UCL injuries with Stener lesions, lack of an end point, and side-to-side laxity of greater than 15 . Because of the dorsal location of the abductor