The Minnesota Twins announced Tuesday afternoon that starting pitcher Ervin Santana underwent a successful capsular release and debridement procedure to the third metacarpophalangeal (MCP; middle finger) and that he is expected to miss 10-to-12 weeks while recovering.
The MCP joint forms the “knuckle” and is the meeting place of the metacarpals (long bones that make up the bulk of the hand) and phalanges (bones of the fingers). The primary motions that occur at the MCP joint are flexion (making a fist), extension (making a “five”) and axial spin.
Around nearly every joint in the body exists a capsule, which is comprised of ligamentous-like tissue that helps hold the joint together as well as keep the lubricating fluids within. These capsules can become tight for a variety of reasons, including but not limited frequent, repetitive use of the hand as well as previous injury. The resulting stiffness often produces an appropriately named condition known as “Stiff Finger.” Often pain accompanies the stiffness.
These conditions can be, and often are, treated conservatively through bracing/splinting, physical/occupational therapy, and, as the Twins stated was the case with Santana, with injections of either viscosupplementation (helps with joint lubrication) or glucocorticoids (“cortisone shot”). Surgical management is considered if conservative treatment fails to decrease the player’s pain and increase the range of motion of the MCP joint.
Surgery typically involves “releasing,” or cutting, the capsule from the dorsal (back) aspect of the hand and checking the player’s passive range of motion while they are unconscious. If the player still lacks range of motion further structures are “released.”
Santana also underwent debridement, which typically involves trimming any bone spurs or loose tissues in the joint which may also be contributing to the pain and stiffness.
Physical therapy typically isn’t initiated for 3-to-4 weeks, at which point gentle stretching is initiated. The player is typically in a dynamic splint, which also for some movement of the fingers, for upwards of 6-to-12 weeks. After 10-to-12 weeks the splint is removed and more aggressive range of motion and strengthening exercises are resumed if full range of motion has yet to be obtained.
All things considered, an MCP release with debridement is a pretty straightforward procedure and one that Santana should bounce back from. The healing process is rather long, but as long as full range of motion is returned, there shouldn’t be many, if any, lingering effects.
