Kyle Lowry – What thumb injury did he push through to win the NBA Finals?

The All-Star guard underwent surgery to repair a “torn tendon” in his left thumb on Thursday 18th of July. Lowry expects to return for USA Basketball’s training camp in August (ESPN).

Lowry suffered the thumb injury on his non-shooting hand during the Eastern Conference semi-finals against Philly during a drive to the basket.

He was able to continue playing through the series and the NBA Finals by wearing support around the thumb but reported “during the game, I can’t feel my thumb… the flicking of the passing, the kind of — the ball movement, handling the ball.”

There was no official report on the injury but the “torn tendon” is likely a complication of an ulnar collateral ligament (UCL) injury of the thumb. A UCL injury is a common hand injury in sport. The mechanism for this injury is forced abduction (pulling the thumb away from the body) and hyperextension of the thumb MCP joint. The injury can be colloquially referred to as “Skier’s thumb or Gamekeeper’s (Goalkeeper) thumb” which describes thumb being forced into abduction and hyperextension by either a ski pole or a soccer ball.

With complete tears, a complication known as a Stener lesion can occur. The adductor pollicis is a muscle of the thumb that pulls the thumb inwards (adds the thumb) and inserts at the base of the thumb where the UCL is located. In the case of complete UCL rupture, when the thumb is bent back, the adductor aponeurosis (flat tendon-type structure) slips past the ruptured UCL ligament. Then as the thumb returns to its normal position, the torn UCL portion stays trapped in an abnormal position outside of the aponeurosis and away from the bone – essentially, it remains caught in a position that prevents healing of the ligament and requires surgical intervention to repair the structures.

The term “torn tendon” likely refers to tearing of the tendon of the adductor pollicis muscle as the UCL ruptured which also resulted in a Stener lesion. For Lowry, it’s possible he may be ready to play against Australia during the USA’s exhibition series. Post-op rehab includes wearing a splint full time for 6 weeks, followed by splint weaning and active motion with strengthening at 8-10 weeks and then a protective splint or taping is worn for another 2-3 months during training and games.

Once Lowry’s pain has subsided and his range of motion has completely returned, he can use his hand normally again. This usually takes about 3 months but the good news is that return to protected play can be as early as 2 weeks post-surgery – this is why we can be hopeful of seeing Lowry in a Team USA jersey very soon.

Sources:
1. Mahajan & Rhemrev, 2013. Rupture of the ulnar collateral ligament of the thumb – a review. IJEM
2. Brukner & Khan, 2017. Clinical Sports Medicine 5th ed

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