title: Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes.
abstract: BACKGROUND
  Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns.
  
  
  OBJECTIVE
  To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A retrospective review of all thumb injuries on a single NFL team from 1991 to 2014 was performed. All players with a thumb MCP collateral ligament injury were included. Collateral ligament injuries were confirmed by review of both physical examination findings and magnetic resonance imaging. Player demographics, surgical details, and return-to-play data were obtained from the team electronic medical record and surgeons' records.
  
  
  RESULTS
  A total of 36 thumbs in 32 NFL players were included in the study, yielding an incidence of 1.6 thumb MCP collateral ligament injuries per year on a single NFL team. Of these, 9 thumbs (25%) had a simultaneous combined UCL and RCL tear injury pattern confirmed on both physical examination and MRI. The remaining 27 thumbs (75%) were isolated UCL injuries. All combined UCL/RCL injuries required surgery due to dysfunction from instability; 63.0% of isolated UCL injuries required surgical repair ( P = .032) due to continued pain and dysfunction from instability. Repair, when required, was delayed until the end of the season. All players with combined UCL/RCL injuries and isolated UCL injuries returned to play professional football the following season.
  
  
  CONCLUSIONS
  Simultaneous combined thumb UCL and RCL tear is a previously undescribed injury pattern that occurred in 25% of thumb MCP collateral ligament injuries on a single NFL team over a 23-year period. All players with combined thumb UCL/RCL injuries required surgical repair, which was significantly higher compared with players with isolated UCL injuries. Team physicians and hand surgeons treating elite football players with suspected thumb collateral ligament injuries should examine for RCL and UCL instability and consider MRI if any concern exists for a combined ligament injury pattern, as this injury is likely frequently missed.
authors: University of Virginia, Charlottesville, Virginia, USA.
authors: Brian C
authors: BC
authors: Werner
authors: Hospital for Special Surgery, New York, New York, USA.
authors: Nicole S
authors: NS
authors: Belkin
authors: New York Football Giants, East Rutherford, New Jersey, USA.
authors: Steve
authors: S
authors: Kennelly
authors: New York Football Giants, East Rutherford, New Jersey, USA.
authors: Leigh
authors: L
authors: Weiss
authors: New York Football Giants, East Rutherford, New Jersey, USA.
authors: Ronnie P
authors: RP
authors: Barnes
authors: Hospital for Special Surgery, New York, New York, USA.
authors: Scott A
authors: SA
authors: Rodeo
authors: Hospital for Special Surgery, New York, New York, USA.
authors: Russell F
authors: RF
authors: Warren
authors: Hospital for Special Surgery, New York, New York, USA.
authors: Robert N
authors: RN
authors: Hotchkiss
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000453:epidemiology* / Q000209:etiology; D000070637:Collateral Ligament, Ulnar / Q000000981:diagnostic imaging / Q000293:injuries; D017885:Collateral Ligaments / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005538:Football / Q000293:injuries*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000293:injuries*; D015995:Prevalence; D012189:Retrospective Studies; D013933:Thumb / Q000000981:diagnostic imaging / Q000293:injuries*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: National Football League; collateral ligament repair; return to play; simultaneous UCL/RCL; thumb radial collateral ligament (RCL); thumb ulnar collateral ligament (UCL)