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NBA Injury Analysis: Thumb's Down for Chris

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

Chris Paul

The Clippers will be forced to navigate the next month and a half without their All-Star point guard. Paul suffered a significant thumb injury early last week in a win over the Thunder. While attempting to defend OKCís Russell Westbrook, Paul tore the ulnar collateral ligament (UCL) in his left thumb. Two days later, Paul went under the knife to have the extensive damage corrected and is expected to miss at least six weeks.

The most mobile of the digits, the thumb is comprises three bones: the proximal and distal phalanges and the first metacarpal. These three bones form three separate articulations along the length of the thumb. One of these joints, the metacarpophalangeal (MCP) joint, is formed where the proximal phalange and the first metacarpal meet near the base of the thumb. The MCP is fortified by two ligaments: the UCL and the radial collateral ligament (RCL). Together these bands of connective tissue help prevent excessive motion at the thumb, particularly with gripping or pinching. The UCL acts as the primary stabilizer and sits on the inside of the thumb, near the webbing of the thumb and pointer finger. The RCL attaches on the opposite side of the joint and helps prevent unwarranted lateral motion.

The UCL is the more commonly sprained of the two and is often injured when a player gets hung up on something or caught in an opponentís jersey. RCL injuries occur less frequently, as the specific force needed to place undue stress on the ligament is less likely to occur. MLB players frequently suffer UCL sprains when getting stuck on the base following a headfirst slide. Bryce Harper, Dustin Pedroia and Yadier Molina are just a few major league players who have torn the UCLs in their thumbs.

NBA players to suffer the injury include Shaquille OíNeal, Joakim Noah, Mike Miller and former Kings point guard Mike Bibby. While the Clippers havenít revealed the exact ligament involved, the mechanism of injury suggests Paul also suffered a UCL tear.

According to precedent set by these and other players to suffer similar injuries, the Clippers estimated recovery timeline of six to eight weeks appears reasonable. The average number of missed games for recent in-season UCL sprains that required surgery is approximately 29 games or roughly eight weeks. Paul should be able to return in quicker fashion considering he will have the added benefit of the extended All-Star break.

Paul should be fine moving upon his return. The surgery has a high success rate and heíll be able to maintain his conditioning during his allotted recovery time. Furthermore, Paul does have a bit of familiarity with the process as well, as this isnít his first thumb surgery. He previously tore the RCL in his opposite thumb during the 2012 London Olympics and underwent surgery before the season began.

Austin Rivers and Raymond Felton will be expected to man the point with Paul out, with Rivers entering the starting lineup.

Pau Gasol

Paul wasnít the only hand injury last week, as the Spurs lost Gasol to a broken fourth metacarpal on Thursday in a pregame accident. The break required surgery the following day and the Westís second best team will now look to fill the gap left by the veteran big man.

The five metacarpal bones form the bulk of the hand and bridge the carpal bones of the wrist and the long bones of the fingers. The distal ends of the metacarpals form the knuckles of the hand. This positioning makes the metacarpals vulnerable to breaking especially following a direct blow or an axial load. For this reason, metacarpal fractures are often known as a Boxerís fracture. This appears to be what happened to Gasol when he collided with teammate Kyle Anderson during warmups.

The recovery time for metacarpal fractures is dependent on multiple factors, including the specific metacarpal involved. Breaks of the second or third metacarpals, located below the pointer and middle fingers, are easier to manage since these bones are anchored to the wrist and are essentially immobile. However, the fourth and the fifth metacarpals, located beneath the ring and pinkie fingers respectively, have much more mobility to allow for extra motion at the wrist and pinkie. Unfortunately, this mobility often results in a prolonged recovery.

Treatment options can also affect recovery time, though this doesnít seem to have a major influence on recent NBA players who suffered isolated fourth metacarpal fractures. The difference in the number of games missed for NBA players who avoided surgery and those who ended up in the operating room is negligible. The average number of games missed for these cases, which includes Jonas Valanciunas, Kevin Love and Michael Kidd-Gilchrist, is 17 games. Furthermore, the Spurs have plenty of experience managing this exact injury, as Matt Bonner, Kawhi Leonard and Tony Parker have all endured fourth metacarpals in recent seasons. The average missed time for these three cases is 15 games, though none of them required surgery.

David Lee replaced Gasol in the starting lineup and has collected back-to-back double-doubles while averaging 12.0 points, 13.5 rebounds, and 1.0 blocks. Heís worth a pickup in all formats.

Fast Breaks

J.J. Barea: For the third time this season, Barea has suffered a lower leg strain at or around his calf. His latest strain is in a different area than his previous injury but is expected to sideline him through the All-Star break. The injury further solidifies Seth Curryís fantasy value and could elevate the status of veteran Devin Harris. Curry has been a productive player since joining the Dallas starting units, scoring in double figures in five of the Mavsí last six games. Curry is averaging 13.5 points, 2.3 made three-pointers and 1.7 steals per game over that stretch.

Rudy Gay: The Kings forward will miss the remainder of the season with a torn Achilles tendon. Gay has had a long history of Achilles-related problems but nothing this severe. He will undergo surgery Monday, and his recovery could very well carry over into next season. Garrett Temple is worth a speculative add in most leagues with Omri Casspi also out with a plantaris strain.

Blake Griffin: The loss of Paul will be slightly offset by the return of Griffin. The All-Star forward is expected to return Monday in Atlanta or Tuesday in Philadelphia after missing 16 games following a knee debridement procedure. Griffin likely will be eased back into the rotation, so scale back your initial expectations.

Jeremy Lin: The Nets point guard is expected to miss at least three more weeks after aggravating his hamstring strain. Lin has appeared in just 12 games this year due to recurring problems with his left hamstring and now likely will sit through the All-Star break. Heís become too untrustworthy to merit a fantasy roster spot and will carry a considerable amount of injury risk for the remainder of the season.

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