Major League thumbs

 

Last year, the Baltimore Orioles went the whole season without any thumb problems. Knuckles on wood, they can repeat that this year. But …

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“Whether minor or major, we normally have some instance of looking at or treating a thumb once a season. But a full-blown tear doesn’t happen but once in three or four years,” says the team’s head athletic trainer, Richie Bancells.

The thumb rehab prescribed depends on how the injury affects a given player, his position. If his position depends on throwing, it will take longer to rehab. Bancells recalls having an outfielder with such an injury. The trainer was sitting in a room with the front office administrators, who were pressing him to get this player back in the outfield. They did not realize that rather than working for a baseball franchise, they might be surviving in a mango grove, swinging through branches with one arm, palming ripe fruit with the other, if the human thumb had not developed to function as it does. “Do you really need a thumb to throw the ball?” they asked. Yes, Bancells told them. Yes, you do. And even if his is a non-throwing position, a player still has to grip the bat. Grips require thumbs.

Players most commonly injure themselves by tearing the ulnar collateral ligament. With a gloved hand, the glove wraps around something in such a way that it sprains the ligament. Or the sprain occurs during a dive to a hand that isn’t gloved. Maybe a player slides head-first into a bag and hooks his thumb onto the bag, spreading the thumb farther away from the rest of the hand than it’s supposed to go. Depending on which direction the thumb was pointing when it hooked, it can lead to a sprain or many times a tear of the ligament, which necessitates repair, which means you have to sew the ligament back.

This type of injury can be longer than the typical 3-month problem. With surgery, it could take three to four months before the guy is back on the field. The amount of time it takes to come back correlates to the therapy that player must perform. It depends on the degree of his sprain and the work he must do. That could mean three weeks, or six to eight weeks.

Beyond tears and sprains, you can also break a thumb. Or a hematoma can develop under the thumbnail after getting hit by a pitch. In that case, Bancells cauterizes the blood vessel break. “Blood comes out, and the player feels much better,” he says. “But the cauterizing tool looks like a medieval torture device.”

A player’s thumb risks lacerations from being stepped on with cleats. And hitters’ thumbs risk getting jammed, when the ball hits closer to the lower, handle part of the bat, vibrating the hand, especially inside the palmar surface and thumb. “It doesn’t feel real good.” For that, there is Direct Protect, which is like a donut you put your thumb through that goes between the thumb and the bat.

Even something not major, small on the surface, such as a split nail, a blister under the nail, or an ingrown nail can put, say, a pitcher down and force him to miss a start or two.

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Then there is something Bancells comes across that is of a chronic nature. The catcher can get banged in the hand he’s catching with. “Some pitchers throw a ‘heavy ball.’ If the catcher does not catch cleanly, say, with his hand lower than his wrist and below the left knee, the ball bangs on the thumb something awful. You can have a number of problems, including soft tissue contusions, occlusions in blood vessels, and bone bruises. The worst part of the injury is he’s going to have to catch the next night. It’s sort of like hitting your thumb with a hammer. You know how that feels. It’s like doing that day after day.”

With this injury, the trainer has the affected catcher alternate hot and cold whirlpools. And he custom-makes a thumb guard to wear in the catcher’s mitt. “With Orthoplast, you can heat it in hot water, then form and mold it to anything. I bring them in and apply an underwrap to protect their skin from the heat. I put the mold on the thumb, then put the thumb in the glove so it forms to the exact shape.”

He wraps from the thumb all the way to the thenar eminence, which is the fleshy part of the hand at the base of the thumb. “(The Orthoplast) acts as a really good guard. We’ve used it as a preventative.”

I ask if a lot of guys want to wear one profylactically, or if they’re more reactive than proactive. He laughs. “You’ve always got the guys who are reactive.”

Richard Bancells began his career with the Orioles’s Rookie League affiliate in 1978 as athletic trainer for the Class A Bluefield Orioles. He’s spent his entire Major League athletic training career with the Orioles, the last 18 years as head athletic trainer.

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5 thoughts on “Major League thumbs

  1. I found your site on google blog search and read a few of your other posts. Keep up the good work. Just added your RSS feed to my feed reader. Look forward to reading more from you.

    – Randy Nichols.

  2. Been catching all my life and am a student Physio nearing graduation now… Any good resources for Thumb IP chronic problems in a catcher? Diagnosis, treatment/management, etc.

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