Q&A: The Effect of Thumb UCL Reconstruction on a Basketball Shot

Mandatory Credit: Bob DeChiara-USA TODAY Sports

I love answering questions. As such, I recently took to Twitter to see if anybody had any that I could answer. The one below stood out immediately.

Before we dive in too far, a quick anatomy lesson. ‘UCL’ is an acronym for ulnar collateral ligament, of which there are actually a few located throughout the upper extremity. The most widely known is the UCL in the elbow, which is repaired during Tommy John surgery.

However, each thumb and finger has at least one as well.

“Collateral” refers to the location of the ligament whereas “ulnar” specifies which side the ligament is on; is it on the side of the ulna – hence ulnar – or radius – “radial.” Beyond the UCL in the thumb, most of the collateral ligaments in the fingers aren’t given further specification.

The purpose of the UCL, no matter where it’s located, is to provide stability to the joint by resisting valgus stress. In the elbow, that means holding bones together on the inside while a baseball is being thrown.

In the thumb, it means preventing it from bending too far away from the pointer finger. A rupture of the UCL of the thumb is often referred to as Skier’s Thumb because it is most often occurs when falling on an outstretched hand, such as when falling in skiing.

There are few NBA players who have suffered UCL injuries as of late with the most recognizable being the Boston Celtics’ Marcus Smart (who is still recovering) and the Houston Rockets’ Chris Paul who tore his last year as a member of the Los Angeles Clippers. Players usually return in 6-to-8 weeks after surgical intervention to reconstruct the ligament.

Now, back to the question.

I think it’s probably most often a rust problem. It would take anybody a while to return to game shape following 6-to-8 weeks of recovery; the shooter has to, in a sense, relearn how to best utilize his lower kinetic chain — i.e. legs and hips — throughout the game to not only provide the power for a good jump shot but to also propel the player up and down the court at an efficient rate.

To boil it down way too simply, if the player can’t use their lower body efficiently, the upper body compensates, which often leads to flat shots and increased fatigue.

I think that’s where the majority of the issues lie.

That being said, the act of shooting places a compressive force on the inner thumb (i.e. the UCL), which I imagine could be painful. Shooting shouldn’t place too much, if any, direct stress on the ligament itself, but the weight of the ball and the force needed to be produced by the wrist and finger flexor muscles to propel it forward would push the thumb bones together under the UCL, which could elicit pain.

I could see how that would be a factor in any shooting woes.

Additionally, it’s possible for the thumb to have range of motion restrictions as the thumb is held in a specific position while the reconstructed ligament heals. Immobilization causes loss of motion, which takes longer to normalize than it does to lose. Any loss of thumb motion, even if it’s just a little, could throw off shooting mechanics, which could negatively impact shooting performance.

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