May 21, 2025 • 30 mins
Describe the relevant anatomy of the thumb, discuss the evaluation and treatment of various thumb pathologies, discuss the return to play considerations after a thumb pathology
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-Sandy & Randy
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
ups and downs, and we're here toshowcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we havean education episode that I feel
like everyone will give two thumbs up.
(00:23):
Unless they're injured. And then maybe one thumb up, one
thumb down. Yeah.
So if you haven't noticed, we'llbe talking about the thumb.
So this is a CEU episode, so if you're listening to it as it
comes out, it is a free category.
AC EU. If you're listening to it as it
is one of our older episodes, you can purchase it from.
(00:44):
Thank you so much to clinically pressed and athletic training
chat show notes down in the shownotes below where all the
details are how to get your certificate.
It will automatically be generated if you do your quiz
and course evaluation. So just check those out.
And we also have other CE us. So if you are interested in
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(01:06):
to your friends who also need C us.
Yes, definitely. So what are we talking about
today, Randy? Yeah, so we're going to talk
about the relevant anatomy of the thumb because why not?
Because it's rad. Thumbs up.
Get it Rad. All right, moving on, we'll
discuss the evaluation and treatment of various thumb
pathologies and then we'll also kind of discuss some of those
(01:28):
return to play considerations after thumb pathology.
It's interesting, like some of that return to play is like it's
really different based on sport.And like, you know, like in
sports like football, you can kind of get away with a couple
things 'cause you can kind of protect it a little bit better
than say, if you like, play a hand kind of dominant sport.
Absolutely, and it also depends on position.
(01:49):
Though, yeah, it depends on the position for sure.
If your quarterback, you're not going to see your quarterback
with the club. It's a little weird.
Yeah, maybe a splint. But maybe a splint?
Yes. But not a claw depending on what
it is. So let's get started with the
anatomy. Yeah.
So when we talk about thumb injuries, right, it's really
important to understand just theligamentous anatomy of the
thumb. That's really kind of where we
(02:10):
tend to see a lot of these injuries, I mean.
It's such a mobile joint. Yeah, for sure.
And I definitely have seen it with my volleyball athletes.
That's a lot of. People just getting crushed when
they're going up for a block. So our static stabilizers are
the thumb include the UCLRCL, the voltar plate, and then the
(02:32):
dorsal capsule, right? But in particular, we're going
to really talk about and focus on the UCL and RCL.
So both of these ligaments do have two bundles because, you
know, why not? Can't make it easy, just have
one bundle. All right, So the UCL has 2
bundles. 1 is referred to as theproper, and this provides that
valgus stability in flexion. In particular, the maximum
(02:57):
stability is in about 30° of flexion.
So. Keep that in mind as you think
about how do I evaluate this? And then it has what's referred
to as an accessory section or bundle that provides the valgus
stability when you're in extension.
Any any specific angle or just in?
(03:17):
General full, like full MCP extension and it really again,
just really goes on just how theanatomy is and just how they
kind of course around the thumb and the directions that they run
that they really find their roles of being of.
At what degrees do they have stability for the RCL?
It's slightly similar as the UCL.
(03:40):
The RCL is the primary radial stabilizer for the thumb.
What's really important about the difference between kind of
the RCLUCL kind of area is the UCL has a lot more muscular
protection. The muscular attachments around
the kind of the ulnar side of the thumb are a lot more
(04:00):
compared to the RCL. There's really not a lot of
attachments there, so that it's really hard to kind of protect
that joint dynamically. So what does protect it?
So that RCL again has two bundles.
So you have again, kind of the same names.
You have the proper bundle, which is your kind of main
stabilizer again, inflection, and then your accessory, which
(04:23):
is the main stabilizer and extension.
So when you kind of think about evaluation, it's kind of like
your knee, right? You do your valgus and varus at
0, valgus, varus at 30. So same thing for the thumb.
You're just trying to see what bundles are kind of damaged when
you do the evaluation. That's a good point because I
feel like most people just do itin kind of 1.
(04:45):
Yeah. And you, yeah.
When you, you know, it's funny you say that because when I was
reading this, I was kind of thinking it was like, oh, I
should do that, right? Like because I fall into that do
where everybody just. Oh yeah, yeah.
And especially like finger evals, you know, you check for
fracture, check for stability and you're like, OK, like.
Go egg. Let's get them, Chief.
And usually it's like a sidelining evals really quick,
(05:07):
you know. Yeah, for sure.
So yeah, I know that isn't that was kind of an important thing
that I'm like, Oh yeah, that kind of brings in a good point.
And I believe, you know, in our our kind of hand injury when we
talked about fingers, it was thesame thing, right?
You do extension and then you also want to go down into some
flexion to also test it that wayas well.
We will talk about some like Bony injuries.
(05:28):
So kind of getting an idea of the Bony anatomy.
I think like again, I think mostpeople understand the phalanges,
the proximal distal, right. So I'm not we don't need to
necessarily go that far into it.So I think one of the more kind
of noteworthy aspects of the Bony anatomy for the thumb is
that articulation between the first metacarpal and the
trapezium, because this is what's actually creating that
(05:48):
kind of saddle joint. And like you said, that's what
gives us our thumb, the mobilitybecause it.
Is a pretty mobile mobile, right?
Some people have argued this is what makes us human posable
thumbs. Actually, I was just about to
say that. Yeah, yeah, right.
We can open doors, right? So I think that's kind of 1
aspect that's very important. I mean, obviously, we know the
(06:09):
the metacarpal in the first MCP and stuff like that.
But I think very noteworthy is really considering that saddle
joint. So now we kind of have that
baseline of just simple anatomy kind of going into talking about
some of these pathologies. And really when you think of the
thumb, there could be a number of issues that can pop up,
right? But in particular, we're going
(06:30):
to talk about kind of like more kind of Bony pathologies and
then the collateral ligament damage.
So when we talk about Bony, right, we have the dislocation
of the first CMC, that's not Christian McCaffrey for all the
Niner fans out there, it is the Carpo Carpo metacarpal joint,
right? So this is actually that can
(06:51):
that kind of that connection between the first metacarpal,
the trapezium, and this tends tobe rare.
You really don't see a lot of dislocations here.
You're going to see more maybe asubluxation or a sprain being a
little bit more common. And really the mechanism is just
an axial load with a flex thumb,which again, you can kind of see
why it's kind of difficult. It's really hard to kind of land
(07:13):
like that. Well, I had a quarterback who
landed like that and he literally just, no one was
around him. He just stepped back.
We were playing on a grass fieldand he stepped back and fell
backwards and fell like with a flex thumb and literally just
came off. And he was like, my thumb's
broken. And I was like, no, it's not.
(07:34):
And I just popped it back in. And then I was like, and then
he's like, oh, OK, cool. And he went to move it and it
just came back out and I was like, oh, that's weird.
So I put it back and I was like,let's test that.
I was, this is like, I think I was like 6 months certified.
Yeah. And then boom, pops out again.
And I was like, no, no, you're done.
(07:57):
We're sending this. And then what did the what did
the doctor say? He ended up having surgery.
He he tore everything in his thumb he just from falling and
he said he hadn't seen one of those in 10 years and the last
time he saw it was because of a car accident.
That's great. And you saw it at six months
certified? Yeah, there you go.
Very welcome. Yeah, welcome.
(08:21):
One thing to kind of consider with these injuries is it may be
associated with a Bennett's fracture, which is a fracture to
the that proximal end of the first metacarpal in particular
in the actual joint as well. So that's something to kind of
keep in mind and be careful of when they kind of present to
you, right. They may present with kind of an
(08:43):
adducted thumb, and basically more than likely the thumb will
be displaced dorsally. You know how I remember a
Bennett fracture? Because my program director was
named Doctor Bennett. And so the way he taught us,
because Bennett's number one, yeah, thumb side is number 1.
So it's the fracture associated with the first.
(09:04):
Did he make sure to emphasize that Bennett was #1?
Yes. Oh yeah.
That's pretty funny. I still remember it to this day.
I mean, who could forget that? All right, So transitioning to
another dislocation pathology, kind of just keep in mind is
that first MCP joint dislocation, so the metacarpal
phalangeal joint. And again, this tends to be in
(09:27):
kind of that dorsal direction and can result from
hyperextension of the thumb. How they kind of categorize it
is you can have a complex dislocation and this is
something that's like, you can'treduce this like just normally,
right? This is going to require surgery
to actually produce. And how you can kind of tell the
difference is it'll present withlike some puckering of the skin
(09:49):
right at the metacarpal head. So it's almost like it probably
looks like it'll kind of get sucked under.
And I'll kind of give you an indication, hey, I probably
shouldn't try to reduce this on the field.
I think you. Probably they won't let.
You, yeah, they probably won't want you to.
And then a simple category is just something that it doesn't
(10:09):
present that way and you could reduce it on the on the field.
So those are dislocations. We'll kind of talk about a
little bit about the management in the next section.
So don't worry. I didn't forget about that Going
into our kind of ligament pathologies.
You have your UCL sprain and this is kind of the most common
injury in the thumb and some have considered, I think some
(10:30):
have found the most common injury in the hand as well.
I could. I could see that.
Yeah, I feel like it does happenquite a bit.
And really it's anything that's just causes that excessive the
valgus force in the thumb, right?
So this is what's commonly referred to as like skiers thumb
because when you fall, I guess when you fall skiing and your
thumb hits the ground, boom, that.
(10:54):
Would cause a skiers thumb. Right.
So evaluation is pretty simple, right?
You're going to have pain over your UCL, right?
And there might be some laxity with valgus stress tests, right?
The one thing to keep in mind when evaluating these is high
levels of laxity. So when that bad boy really
opens up, right, that could indicate A rupture.
(11:15):
And I think like technically numbers are like, oh, if it has
valgus of over 30°, right? That's like complete rupture.
And like, I don't know how many people are pulling out their
Goni when they're doing stress tests, but basically.
Just make sure that you're doingit at different very various.
Levels, that's true, yes. Various angles of flexion.
(11:37):
But one thing that I actually did learn from the reading and
something to keep in mind, is another indication of a UCL
rupture in the thumb is the presence of a stenor lesion.
And what this is, is a palpable mass right over that kind of
ulnar side of the thumb, right over where the UCL would be.
And basically this is this occurs when the UCL evol
(11:59):
basically an avulsion fracture of the proximal failings.
A Steiner lesion. Yeah.
So you'll actually feel like a amore prominent bump here and
you're like, oh, that's weird. How many of us are feeling our
thumbs right now 'cause I, I am?I I've literally been tapping at
this whole time. So shifting from ulnar to go
into the rad side. This is the rad side of the
(12:21):
episode. It's a lot more rare than the
UCL and. Have you ever seen one of?
These I was gonna say when I started thinking I was like, I
guess I don't have a lot of athletes complain of RCL pain.
I have had people complain of them, but I haven't had any
laxity that I can remember off the top of my head.
Dude, I actually had sorry not to go back to the owner side.
(12:43):
It's not as rad. Literally like a few weeks ago,
one of like one of our incoming basketball guys came in and he
was like, hey, can you take my thumb?
I was like, yeah, I'm going to take a look.
And I'm like, I did the valgus. I'm like, oh boy.
And it moved a lot. Oh, it was basically floating.
I was like, no, that needs more than tape.
(13:07):
Yeah, you're like, sorry, tape won't fix this one.
No. But yeah, so RCL a lot more rare
and again, it just happens with the reverse, right?
It just a various force over just overcomes the RCL.
But interestingly, it can happenwith torsional force too.
So kind of that kind of torsion on the thumb.
(13:28):
OK, you know, what was funny is actually I was trying to think
of the people who I've had like an RCL pain with are usually
like an axial load jam or like something like that or like a
torsional. So.
So that makes sense that that would cause because I can't
(13:48):
really think of anything that would.
I can't think of anyone who's complained to me about a various
force on their thumb. I was gonna.
Say, I feel like that's really hard to do.
I just kind of think of the anatomy of like getting it
caught enough to do that. So yeah, like if axle load I
could see and it gives that way,I could see that, especially
because there's not a lot of dynamic stability on that side.
(14:08):
Too right, Right. Yeah, because it doesn't have
those muscular stabilizers. Evaluation again same thing as
UCLRA instead of algus. You do varus at different at.
Damn it, just going to say. That.
All right, so now the bread and butter, what probably everyone's
here for is the management. We got to manage this thing.
(14:31):
Yeah, yeah, I do it, right. So for your dislocations and I
like, I really don't want to talk about the reduction
techniques, right. I think this is a better thing
to bring up to your team physicians.
Again, NATA put out a great position statement on joint
reductions. So I think that's a great
conversation to have with your team physicians on, hey, how
exactly do we do this? Should we be doing this?
(14:51):
Should you be doing this? Did we do a position statement
on? Did we do that episode?
I think we did an interview episode on it.
With Nicolette, we did a how to talk to your team physician
about reducing dislocations. Yes, Yeah.
So check out check out that episode.
I don't remember what number it is, but I'll try to link it.
(15:13):
It's an. Early one actually, like I feel
like it kind of it was it was a.It was a while ago, yeah.
It was a while ago, going back in the archives a little.
Bit MVP. Nicolette MVP.
But in general, right, if, if the going kind of more long term
kind of follow up with these, ifthey're stable after reduction,
(15:34):
right, it can be treated conservatively.
So it could be casted or splinted for about 6-4 to six
weeks was kind of consistent between all the, between the two
dislocations. We talked about if surgery is
necessary, 'cause it's just evenwith reduction, it's just not
stable like a certain case studywe just heard.
(15:54):
So he was, I was trying actuallyremember it was our last game
and then I went into basketball season.
He was still in a cast through at least part of basketball
season. He he wasn't a basketball
athlete. A lot of these kids like they
played multiple sports. I don't think he was a
basketball athlete. So I'd I'd kind of lost contact
(16:15):
with that, but I remember seeinghim in this freaking giant cast
because he had pins. Yes yeah in it.
And so then the pins had to be casted too.
And he's like this high school kid.
So it was, it was the biggest cast I had seen at the time.
Yeah. So obviously that timetable
after surgery can really increase, right?
(16:36):
How long you're immobilized for and how long before you can do
things. I actually don't even know.
I don't even remember his name. I can't even picture him.
Actually, I can picture his thumb I mean.
You were there for. It was like it was an impactful
time, but I feel like it it was like a fairly short relatively.
Short time I only knew him for season I guess.
(16:57):
Yeah. And you weren't necessarily
there every day, right, Like it was only a couple times a week,
Yeah. So that is hard to try and get
everyone down kind of going towards the sprain something
again a little bit more that we have a little more control of
and kind of management. If you have a a high grade UCL
(17:17):
sprain right really, it's recommended that that's going to
be managed surgically. Especially like thumb, like any
opposition or like. Yeah, it's really important,
right to how we function as humans.
Or if you want to give someone athumbs up again.
Yeah, 'cause yeah. A stable thumbs up, yeah.
Exactly, you don't want thumbs slipping out every time you come
up. You're looking at basically
(17:39):
after surgery, they're going to be in a cast for about 6 weeks.
They'll transition to a splint for an extra for a little bit
longer. Really, they could start kind of
strengthening outside the splintat around week 8 post op, but
you're not looking at unrestricted activity away from
(18:00):
the splint until around 12 to 16weeks.
Now there is some like dependingon the sport and how they're
doing, right, you might be able to get away if it's protected in
the splint for certain sports, they might be able to get away
with it from what I was reading.But again, I think that's a
better conversation with the surgeon and your team physician
of how, how plausible is it thatthis person can play at this
(18:22):
time frame. I know something that we've done
in and Juan talks about it in our football episode is a soft
cast and he's introduced me to those, the soft cast.
And you could just take like it's a soft cast material and
you just make it to them and then you just cut it off and
then you can re put it on with like Coflex.
(18:46):
And it's not like as hard as a traditional cast, but like it's
like a good transitional cause I've used like orthoplast.
I was just about to ask what's the difference?
Like what have you noticed different?
Orthoplast is so stiff like thatyou're not moving that like it's
(19:06):
very hard where the soft cast ithas some give to.
It. So if they need to like catch,
for example, you can like pad itlike I've used it like on a
tight end. That would be a lot better than
like an orthoplast. I would use probably for like an
O line or like D line or someonethat's like really like I really
(19:28):
don't want that thing to move. Whereas like someone who has to
have some give, I'd probably usemore of a soft cast and
depending on like when it is in the in the recovery.
Yeah, yeah, for sure. Right.
And I think that's a good point.Like I, I, I think especially
working football, you've seen a lot of the ways that you could
protect these, especially thumb injuries and get someone to
(19:51):
play. Whereas it's really hard in some
of the sports that I work because they are so hand
dominant that it's really hard to like I, well, I can't make it
too bulky. So this tends to kind of limit
me more than I think you guys have a lot more play on.
OK, what? Can we do?
Right right Basketball 1 inch elastic.
On volleyball, one inch elastic.That's basically what I mean.
(20:13):
I have for volleyball, I have done the ortho orthoplast, but I
just made it a little bit smaller so they they actually
have some thumb motion, but alsoprotecting that MCP.
That worked a lot. That worked pretty well, right?
Again, like, she's not really like a setter, so I'm not really
worried about that. I'm more worried about hey,
(20:34):
let's protect while you're blocking and hitting.
Right. So that actually.
That that that was helpful. Something that Juan's also
introduced me to that just just specifically for that is he does
just like a one inch spica of the orthoplast on the thumb and
that's it and then he tapes it on.
Holy smokes, I like that. Yeah.
(20:55):
I would have to see that, yeah. I'm down, count me in.
It's really small. It's just the the I feel like
that. The people are uncomfortable.
That's interesting. I like that.
You just have to stretch it out a little bit so it's not too.
Yeah, too constrained. Because it once it's hard, like,
yeah, it it's like a ring. Yeah, Yeah, it's, that's what
(21:18):
you, what I pictured, right. So as you kind of, as we've kind
of alluded to, partial tears canbe managed conservatively and
really in general, right, we're really kind of gearing for
immobilization for four to six weeks, right?
So we want to put them in a splint during their recovery
around 4:00 to six weeks. Really grip strength and
pinching shouldn't begin until they either get full range of
(21:40):
motion or at about six weeks time to let that heal.
Returning to sport usually depends on the severity and the
nature of the sport, right? So again, minor injuries, you
could see a return two to four weeks with a splint.
I'm sure it could probably be a little bit sooner if it's very
mild and if you could protect itvery well and then contact
(22:02):
sports again, right? It might need a little bit
longer. They might need to actually be
protected for like 6 weeks rightto prevent it from being re
injured while they're out there.I feel like especially football,
usually if something needs to beprotected, it's like you're
being protected for the rest of the season.
Well, I mean, OK, so when you think about like, think about
(22:23):
that number like 6 weeks, I mean, shoot, your guys's season,
at least for college, is basically ten.
Yeah, that's pretty much the year.
Right, right, right. So.
You might as well just keep it going because then you know what
happens is the day they take it off.
They're going to re injure it and then.
Come back. And at that point, they're used
to it, yeah, Although sometimes they are dying to get out of
whatever, whatever splint. For sure, but then.
(22:46):
Rap but. Then when they are and then it
gave her three injured, then you're kicking yourself like,
oh, she just kept it. On right.
So that's UCL right now going again, we're going back to the
RAD. We're finishing on Rad.
There's not a lot of clear guidance on how to manage a
complete rupture of RCL. So.
I can't like if you managed to rupture your RCL like a lot.
(23:09):
Of damage. Like what else?
Yeah, what else is damaged? Some have advocated for, hey,
maybe it should be similar to the UCL.
You should probably need surgery.
I know if I have someone who's full ruptured, I'm referring
that bad boy just in case. Like, yeah, let's is this
surgery or not? But the protocol for like that
whole management after surgery is similar to UCL, all right?
(23:32):
So it's not really, it doesn't deviate that much.
For partial tears, again, it's very similar, right?
You're going to mobilize 4 to 6 weeks and then you can start
transitioning to a removable splint one that they can kind of
take on and off probably, again,probably mostly for games that
they'll have it on for like an additional 2 weeks.
Nice. Yeah, Some bonus rehab.
(23:55):
Something that we've been doing lately is we took a tennis ball
and we cut a slit in it so it looks like Pac-Man and they have
to pick up marbles. Oh my gosh, I saw you guys doing
that or I saw a video or something and I'm like, that's
genius. I saw it.
I saw it on Instagram. I want to do that now because.
You know what's actually really great?
Look up hand. Like occupational therapists or
(24:18):
like hand therapists and they are like they have you.
I thought I exhausted, I've exhausted my brain of rehab
exercise for the hand. But then you go on Instagram,
there are so many that you can do, especially for some people
who like specialize in this area, I would say.
(24:38):
Like O TS man, that's the that's.
The bread and butter, right? So that and it makes it fun.
It's some, I would say it's somedifferent than the because you
could do like the marble pick upby hand, but then it's like,
what are we doing? Like I feel like that's not
stressing enough for like an athlete.
So what I learned is if the bigger you make the slit in the
tennis ball, the easier it is tosqueeze.
(25:00):
Minimal. So if you if you make a small
slit, obviously it's going to beharder.
So I think I'm going to make another one with a smaller
because I like started with the small and then I was like, oh,
the mouth isn't big enough. And then and like, OK, you know,
like that. Measure twice, cut once.
Yeah, no. Oh, OK, but also like tennis
balls, like dime a dozen. Exactly.
(25:24):
Exactly. Or just go like right outside of
the tennis courts after they're done.
Oh, there's plenty of. Like dead balls.
Yeah, I was just about to say the ones that are dead.
Yeah, they don't. They're going to get rid of them
anyways, right? What I use, sorry not not to go
on tangent, but lacrosse balls, if you have a lacrosse team or
(25:44):
any kind of lacrosse that practices on your campus, just
go out there after they're done.You'll find a good lacrosse ball
somewhere. Or you could just ask them.
But like if you don't know them.You should probably ask them.
Saying sometimes you'll find them in the bushes and you're
like, yes. You're funny, yes.
(26:06):
What is your action item for this?
Thumbs cool, man. You mean like thumbs up, thumbs
up, thumbs up? Cool.
I think from reading this, I think that the management, I
feel like a lot of people don't think of that immobilization
(26:27):
time with one hand injuries, wrist injuries and like thumb
injuries. Like I feel like you look at it
and you're like, Oh yeah, it's sprained.
We can tape that. But then I feel like we're like,
I know for me, like I, it was really hard for me to think of
like, Oh yeah, you should be splinting this when you're not
doing things. You know, I have to say I am a
changed woman from wrist braces.I love them.
(26:50):
They are my favorite piece of equipment.
Yeah, and I think that's one thing like this year, like I
never had like the actual thumb splints, but this past year I,
I, I ordered the braces for it and that has been a game.
Changer, they make such a difference.
Like literally I the way I get by in is I give them the wrist
brace. If that like a wrist sprain.
We could talk about thumb sprains too, but like just
(27:11):
specifically I get more wrist sprains.
So I give them the wrist brace and I say, just hear me out for
24 hours, put it on for 24 hours.
If it works, we can keep it. If it doesn't, then what's 24
hours right? I have not had anyone who hasn't
gotten at least a little bit better in 24 hours.
(27:33):
And most of the time they're like, Oh yeah, I'll keep this on
good because it helps. Well, because you're probably
going to need to keep it on fourto six weeks, so it'll get
comfy. I usually don't keep it on that
long, but yeah, so that's what II make them.
Usually I it's about a week at top tops maybe like 4-5 days
(27:57):
average, yeah. So I would say I don't forget
that time of actually protectingthe tissue.
Like, I know it seems like it's kind of bulky and oh, it's not
cool. And like, you know, the athletes
will complain. Some of them might, maybe not
all of them. Tell them to like wear a a
hoodie like with the sleeves like over their hands.
(28:17):
Yeah, that's what I'd say is don't, don't forget that time to
actually protect the healing ligaments.
And then, yeah, think of some cool creative ways to do rehab
because it you, it feels like you're so limited on hand rehab
and I feel like you're just kindof doing the same thing.
So yeah, like the Pac-Man thing,like that's really cool.
You can only stretch putty so many.
(28:39):
You can only play with the puttyand the webbing for so much.
Or the rice bucket. Or the right or the sand.
Or the sand. I haven't done sand.
Yeah, you can only do that so many times before you're like,
OK. So if you're interested in the
references that Randy used to read on up on this episode, you
can head to our website, which is also in the show notes, where
you will also find a bunch of fun goodies and stuff like
(29:02):
Medbridge, who we work with to bring you C us like promo codes
for them. We have every episode that we do
is education like this Cus or wedo story episodes where we bring
stories from real life athletic trainers.
We are actually doing a story episode next week and because
it's end of May, it will be our last episode of season 5.
(29:29):
That's crazy. So we will be back in August as
we run August through May. We take June and July just to
prep for next season, but we will still be active on our
Instagram, so keep an eye out and we will be at NATA.
(29:50):
So if you're going to NATA, please let us know, we'd love to
meet you. Give us a thumbs up.
We'll we'll know what that means.
Now if I remember, now, if I remember, someone's going to be
like doing thumbs up at me. I'm going to be like, yeah.
As long as you don't give us a thumbs down.
Yeah, that would sting a little.In person, just like walk of
(30:13):
like. Yeah, that one would actually
probably sting a little. Yeah, maybe don't do that,
please. All right.
Do you have anything else? Nope.
Thank you for helping us showcase Athi training behind
the tape. Bye.
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
ups and downs, and we're here toshowcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we havean education episode that I feel
like everyone will give two thumbs up.
(00:23):
Unless they're injured. And then maybe one thumb up, one
thumb down. Yeah.
So if you haven't noticed, we'llbe talking about the thumb.
So this is a CEU episode, so if you're listening to it as it
comes out, it is a free category.
AC EU. If you're listening to it as it
is one of our older episodes, you can purchase it from.
(00:44):
Thank you so much to clinically pressed and athletic training
chat show notes down in the shownotes below where all the
details are how to get your certificate.
It will automatically be generated if you do your quiz
and course evaluation. So just check those out.
And we also have other CE us. So if you are interested in
staying on top of those, it is areporting year and please share
(01:06):
to your friends who also need C us.
Yes, definitely. So what are we talking about
today, Randy? Yeah, so we're going to talk
about the relevant anatomy of the thumb because why not?
Because it's rad. Thumbs up.
Get it Rad. All right, moving on, we'll
discuss the evaluation and treatment of various thumb
pathologies and then we'll also kind of discuss some of those
(01:28):
return to play considerations after thumb pathology.
It's interesting, like some of that return to play is like it's
really different based on sport.And like, you know, like in
sports like football, you can kind of get away with a couple
things 'cause you can kind of protect it a little bit better
than say, if you like, play a hand kind of dominant sport.
Absolutely, and it also depends on position.
(01:49):
Though, yeah, it depends on the position for sure.
If your quarterback, you're not going to see your quarterback
with the club. It's a little weird.
Yeah, maybe a splint. But maybe a splint?
Yes. But not a claw depending on what
it is. So let's get started with the
anatomy. Yeah.
So when we talk about thumb injuries, right, it's really
important to understand just theligamentous anatomy of the
thumb. That's really kind of where we
(02:10):
tend to see a lot of these injuries, I mean.
It's such a mobile joint. Yeah, for sure.
And I definitely have seen it with my volleyball athletes.
That's a lot of. People just getting crushed when
they're going up for a block. So our static stabilizers are
the thumb include the UCLRCL, the voltar plate, and then the
(02:32):
dorsal capsule, right? But in particular, we're going
to really talk about and focus on the UCL and RCL.
So both of these ligaments do have two bundles because, you
know, why not? Can't make it easy, just have
one bundle. All right, So the UCL has 2
bundles. 1 is referred to as theproper, and this provides that
valgus stability in flexion. In particular, the maximum
(02:57):
stability is in about 30° of flexion.
So. Keep that in mind as you think
about how do I evaluate this? And then it has what's referred
to as an accessory section or bundle that provides the valgus
stability when you're in extension.
Any any specific angle or just in?
(03:17):
General full, like full MCP extension and it really again,
just really goes on just how theanatomy is and just how they
kind of course around the thumb and the directions that they run
that they really find their roles of being of.
At what degrees do they have stability for the RCL?
It's slightly similar as the UCL.
(03:40):
The RCL is the primary radial stabilizer for the thumb.
What's really important about the difference between kind of
the RCLUCL kind of area is the UCL has a lot more muscular
protection. The muscular attachments around
the kind of the ulnar side of the thumb are a lot more
(04:00):
compared to the RCL. There's really not a lot of
attachments there, so that it's really hard to kind of protect
that joint dynamically. So what does protect it?
So that RCL again has two bundles.
So you have again, kind of the same names.
You have the proper bundle, which is your kind of main
stabilizer again, inflection, and then your accessory, which
(04:23):
is the main stabilizer and extension.
So when you kind of think about evaluation, it's kind of like
your knee, right? You do your valgus and varus at
0, valgus, varus at 30. So same thing for the thumb.
You're just trying to see what bundles are kind of damaged when
you do the evaluation. That's a good point because I
feel like most people just do itin kind of 1.
(04:45):
Yeah. And you, yeah.
When you, you know, it's funny you say that because when I was
reading this, I was kind of thinking it was like, oh, I
should do that, right? Like because I fall into that do
where everybody just. Oh yeah, yeah.
And especially like finger evals, you know, you check for
fracture, check for stability and you're like, OK, like.
Go egg. Let's get them, Chief.
And usually it's like a sidelining evals really quick,
(05:07):
you know. Yeah, for sure.
So yeah, I know that isn't that was kind of an important thing
that I'm like, Oh yeah, that kind of brings in a good point.
And I believe, you know, in our our kind of hand injury when we
talked about fingers, it was thesame thing, right?
You do extension and then you also want to go down into some
flexion to also test it that wayas well.
We will talk about some like Bony injuries.
(05:28):
So kind of getting an idea of the Bony anatomy.
I think like again, I think mostpeople understand the phalanges,
the proximal distal, right. So I'm not we don't need to
necessarily go that far into it.So I think one of the more kind
of noteworthy aspects of the Bony anatomy for the thumb is
that articulation between the first metacarpal and the
trapezium, because this is what's actually creating that
(05:48):
kind of saddle joint. And like you said, that's what
gives us our thumb, the mobilitybecause it.
Is a pretty mobile mobile, right?
Some people have argued this is what makes us human posable
thumbs. Actually, I was just about to
say that. Yeah, yeah, right.
We can open doors, right? So I think that's kind of 1
aspect that's very important. I mean, obviously, we know the
(06:09):
the metacarpal in the first MCP and stuff like that.
But I think very noteworthy is really considering that saddle
joint. So now we kind of have that
baseline of just simple anatomy kind of going into talking about
some of these pathologies. And really when you think of the
thumb, there could be a number of issues that can pop up,
right? But in particular, we're going
(06:30):
to talk about kind of like more kind of Bony pathologies and
then the collateral ligament damage.
So when we talk about Bony, right, we have the dislocation
of the first CMC, that's not Christian McCaffrey for all the
Niner fans out there, it is the Carpo Carpo metacarpal joint,
right? So this is actually that can
(06:51):
that kind of that connection between the first metacarpal,
the trapezium, and this tends tobe rare.
You really don't see a lot of dislocations here.
You're going to see more maybe asubluxation or a sprain being a
little bit more common. And really the mechanism is just
an axial load with a flex thumb,which again, you can kind of see
why it's kind of difficult. It's really hard to kind of land
(07:13):
like that. Well, I had a quarterback who
landed like that and he literally just, no one was
around him. He just stepped back.
We were playing on a grass fieldand he stepped back and fell
backwards and fell like with a flex thumb and literally just
came off. And he was like, my thumb's
broken. And I was like, no, it's not.
(07:34):
And I just popped it back in. And then I was like, and then
he's like, oh, OK, cool. And he went to move it and it
just came back out and I was like, oh, that's weird.
So I put it back and I was like,let's test that.
I was, this is like, I think I was like 6 months certified.
Yeah. And then boom, pops out again.
And I was like, no, no, you're done.
(07:57):
We're sending this. And then what did the what did
the doctor say? He ended up having surgery.
He he tore everything in his thumb he just from falling and
he said he hadn't seen one of those in 10 years and the last
time he saw it was because of a car accident.
That's great. And you saw it at six months
certified? Yeah, there you go.
Very welcome. Yeah, welcome.
(08:21):
One thing to kind of consider with these injuries is it may be
associated with a Bennett's fracture, which is a fracture to
the that proximal end of the first metacarpal in particular
in the actual joint as well. So that's something to kind of
keep in mind and be careful of when they kind of present to
you, right. They may present with kind of an
(08:43):
adducted thumb, and basically more than likely the thumb will
be displaced dorsally. You know how I remember a
Bennett fracture? Because my program director was
named Doctor Bennett. And so the way he taught us,
because Bennett's number one, yeah, thumb side is number 1.
So it's the fracture associated with the first.
(09:04):
Did he make sure to emphasize that Bennett was #1?
Yes. Oh yeah.
That's pretty funny. I still remember it to this day.
I mean, who could forget that? All right, So transitioning to
another dislocation pathology, kind of just keep in mind is
that first MCP joint dislocation, so the metacarpal
phalangeal joint. And again, this tends to be in
(09:27):
kind of that dorsal direction and can result from
hyperextension of the thumb. How they kind of categorize it
is you can have a complex dislocation and this is
something that's like, you can'treduce this like just normally,
right? This is going to require surgery
to actually produce. And how you can kind of tell the
difference is it'll present withlike some puckering of the skin
(09:49):
right at the metacarpal head. So it's almost like it probably
looks like it'll kind of get sucked under.
And I'll kind of give you an indication, hey, I probably
shouldn't try to reduce this on the field.
I think you. Probably they won't let.
You, yeah, they probably won't want you to.
And then a simple category is just something that it doesn't
(10:09):
present that way and you could reduce it on the on the field.
So those are dislocations. We'll kind of talk about a
little bit about the management in the next section.
So don't worry. I didn't forget about that Going
into our kind of ligament pathologies.
You have your UCL sprain and this is kind of the most common
injury in the thumb and some have considered, I think some
(10:30):
have found the most common injury in the hand as well.
I could. I could see that.
Yeah, I feel like it does happenquite a bit.
And really it's anything that's just causes that excessive the
valgus force in the thumb, right?
So this is what's commonly referred to as like skiers thumb
because when you fall, I guess when you fall skiing and your
thumb hits the ground, boom, that.
(10:54):
Would cause a skiers thumb. Right.
So evaluation is pretty simple, right?
You're going to have pain over your UCL, right?
And there might be some laxity with valgus stress tests, right?
The one thing to keep in mind when evaluating these is high
levels of laxity. So when that bad boy really
opens up, right, that could indicate A rupture.
(11:15):
And I think like technically numbers are like, oh, if it has
valgus of over 30°, right? That's like complete rupture.
And like, I don't know how many people are pulling out their
Goni when they're doing stress tests, but basically.
Just make sure that you're doingit at different very various.
Levels, that's true, yes. Various angles of flexion.
(11:37):
But one thing that I actually did learn from the reading and
something to keep in mind, is another indication of a UCL
rupture in the thumb is the presence of a stenor lesion.
And what this is, is a palpable mass right over that kind of
ulnar side of the thumb, right over where the UCL would be.
And basically this is this occurs when the UCL evol
(11:59):
basically an avulsion fracture of the proximal failings.
A Steiner lesion. Yeah.
So you'll actually feel like a amore prominent bump here and
you're like, oh, that's weird. How many of us are feeling our
thumbs right now 'cause I, I am?I I've literally been tapping at
this whole time. So shifting from ulnar to go
into the rad side. This is the rad side of the
(12:21):
episode. It's a lot more rare than the
UCL and. Have you ever seen one of?
These I was gonna say when I started thinking I was like, I
guess I don't have a lot of athletes complain of RCL pain.
I have had people complain of them, but I haven't had any
laxity that I can remember off the top of my head.
Dude, I actually had sorry not to go back to the owner side.
(12:43):
It's not as rad. Literally like a few weeks ago,
one of like one of our incoming basketball guys came in and he
was like, hey, can you take my thumb?
I was like, yeah, I'm going to take a look.
And I'm like, I did the valgus. I'm like, oh boy.
And it moved a lot. Oh, it was basically floating.
I was like, no, that needs more than tape.
(13:07):
Yeah, you're like, sorry, tape won't fix this one.
No. But yeah, so RCL a lot more rare
and again, it just happens with the reverse, right?
It just a various force over just overcomes the RCL.
But interestingly, it can happenwith torsional force too.
So kind of that kind of torsion on the thumb.
(13:28):
OK, you know, what was funny is actually I was trying to think
of the people who I've had like an RCL pain with are usually
like an axial load jam or like something like that or like a
torsional. So.
So that makes sense that that would cause because I can't
(13:48):
really think of anything that would.
I can't think of anyone who's complained to me about a various
force on their thumb. I was gonna.
Say, I feel like that's really hard to do.
I just kind of think of the anatomy of like getting it
caught enough to do that. So yeah, like if axle load I
could see and it gives that way,I could see that, especially
because there's not a lot of dynamic stability on that side.
(14:08):
Too right, Right. Yeah, because it doesn't have
those muscular stabilizers. Evaluation again same thing as
UCLRA instead of algus. You do varus at different at.
Damn it, just going to say. That.
All right, so now the bread and butter, what probably everyone's
here for is the management. We got to manage this thing.
(14:31):
Yeah, yeah, I do it, right. So for your dislocations and I
like, I really don't want to talk about the reduction
techniques, right. I think this is a better thing
to bring up to your team physicians.
Again, NATA put out a great position statement on joint
reductions. So I think that's a great
conversation to have with your team physicians on, hey, how
exactly do we do this? Should we be doing this?
(14:51):
Should you be doing this? Did we do a position statement
on? Did we do that episode?
I think we did an interview episode on it.
With Nicolette, we did a how to talk to your team physician
about reducing dislocations. Yes, Yeah.
So check out check out that episode.
I don't remember what number it is, but I'll try to link it.
(15:13):
It's an. Early one actually, like I feel
like it kind of it was it was a.It was a while ago, yeah.
It was a while ago, going back in the archives a little.
Bit MVP. Nicolette MVP.
But in general, right, if, if the going kind of more long term
kind of follow up with these, ifthey're stable after reduction,
(15:34):
right, it can be treated conservatively.
So it could be casted or splinted for about 6-4 to six
weeks was kind of consistent between all the, between the two
dislocations. We talked about if surgery is
necessary, 'cause it's just evenwith reduction, it's just not
stable like a certain case studywe just heard.
(15:54):
So he was, I was trying actuallyremember it was our last game
and then I went into basketball season.
He was still in a cast through at least part of basketball
season. He he wasn't a basketball
athlete. A lot of these kids like they
played multiple sports. I don't think he was a
basketball athlete. So I'd I'd kind of lost contact
(16:15):
with that, but I remember seeinghim in this freaking giant cast
because he had pins. Yes yeah in it.
And so then the pins had to be casted too.
And he's like this high school kid.
So it was, it was the biggest cast I had seen at the time.
Yeah. So obviously that timetable
after surgery can really increase, right?
(16:36):
How long you're immobilized for and how long before you can do
things. I actually don't even know.
I don't even remember his name. I can't even picture him.
Actually, I can picture his thumb I mean.
You were there for. It was like it was an impactful
time, but I feel like it it was like a fairly short relatively.
Short time I only knew him for season I guess.
(16:57):
Yeah. And you weren't necessarily
there every day, right, Like it was only a couple times a week,
Yeah. So that is hard to try and get
everyone down kind of going towards the sprain something
again a little bit more that we have a little more control of
and kind of management. If you have a a high grade UCL
(17:17):
sprain right really, it's recommended that that's going to
be managed surgically. Especially like thumb, like any
opposition or like. Yeah, it's really important,
right to how we function as humans.
Or if you want to give someone athumbs up again.
Yeah, 'cause yeah. A stable thumbs up, yeah.
Exactly, you don't want thumbs slipping out every time you come
up. You're looking at basically
(17:39):
after surgery, they're going to be in a cast for about 6 weeks.
They'll transition to a splint for an extra for a little bit
longer. Really, they could start kind of
strengthening outside the splintat around week 8 post op, but
you're not looking at unrestricted activity away from
(18:00):
the splint until around 12 to 16weeks.
Now there is some like dependingon the sport and how they're
doing, right, you might be able to get away if it's protected in
the splint for certain sports, they might be able to get away
with it from what I was reading.But again, I think that's a
better conversation with the surgeon and your team physician
of how, how plausible is it thatthis person can play at this
(18:22):
time frame. I know something that we've done
in and Juan talks about it in our football episode is a soft
cast and he's introduced me to those, the soft cast.
And you could just take like it's a soft cast material and
you just make it to them and then you just cut it off and
then you can re put it on with like Coflex.
(18:46):
And it's not like as hard as a traditional cast, but like it's
like a good transitional cause I've used like orthoplast.
I was just about to ask what's the difference?
Like what have you noticed different?
Orthoplast is so stiff like thatyou're not moving that like it's
(19:06):
very hard where the soft cast ithas some give to.
It. So if they need to like catch,
for example, you can like pad itlike I've used it like on a
tight end. That would be a lot better than
like an orthoplast. I would use probably for like an
O line or like D line or someonethat's like really like I really
(19:28):
don't want that thing to move. Whereas like someone who has to
have some give, I'd probably usemore of a soft cast and
depending on like when it is in the in the recovery.
Yeah, yeah, for sure. Right.
And I think that's a good point.Like I, I, I think especially
working football, you've seen a lot of the ways that you could
protect these, especially thumb injuries and get someone to
(19:51):
play. Whereas it's really hard in some
of the sports that I work because they are so hand
dominant that it's really hard to like I, well, I can't make it
too bulky. So this tends to kind of limit
me more than I think you guys have a lot more play on.
OK, what? Can we do?
Right right Basketball 1 inch elastic.
On volleyball, one inch elastic.That's basically what I mean.
(20:13):
I have for volleyball, I have done the ortho orthoplast, but I
just made it a little bit smaller so they they actually
have some thumb motion, but alsoprotecting that MCP.
That worked a lot. That worked pretty well, right?
Again, like, she's not really like a setter, so I'm not really
worried about that. I'm more worried about hey,
(20:34):
let's protect while you're blocking and hitting.
Right. So that actually.
That that that was helpful. Something that Juan's also
introduced me to that just just specifically for that is he does
just like a one inch spica of the orthoplast on the thumb and
that's it and then he tapes it on.
Holy smokes, I like that. Yeah.
(20:55):
I would have to see that, yeah. I'm down, count me in.
It's really small. It's just the the I feel like
that. The people are uncomfortable.
That's interesting. I like that.
You just have to stretch it out a little bit so it's not too.
Yeah, too constrained. Because it once it's hard, like,
yeah, it it's like a ring. Yeah, Yeah, it's, that's what
(21:18):
you, what I pictured, right. So as you kind of, as we've kind
of alluded to, partial tears canbe managed conservatively and
really in general, right, we're really kind of gearing for
immobilization for four to six weeks, right?
So we want to put them in a splint during their recovery
around 4:00 to six weeks. Really grip strength and
pinching shouldn't begin until they either get full range of
(21:40):
motion or at about six weeks time to let that heal.
Returning to sport usually depends on the severity and the
nature of the sport, right? So again, minor injuries, you
could see a return two to four weeks with a splint.
I'm sure it could probably be a little bit sooner if it's very
mild and if you could protect itvery well and then contact
(22:02):
sports again, right? It might need a little bit
longer. They might need to actually be
protected for like 6 weeks rightto prevent it from being re
injured while they're out there.I feel like especially football,
usually if something needs to beprotected, it's like you're
being protected for the rest of the season.
Well, I mean, OK, so when you think about like, think about
(22:23):
that number like 6 weeks, I mean, shoot, your guys's season,
at least for college, is basically ten.
Yeah, that's pretty much the year.
Right, right, right. So.
You might as well just keep it going because then you know what
happens is the day they take it off.
They're going to re injure it and then.
Come back. And at that point, they're used
to it, yeah, Although sometimes they are dying to get out of
whatever, whatever splint. For sure, but then.
(22:46):
Rap but. Then when they are and then it
gave her three injured, then you're kicking yourself like,
oh, she just kept it. On right.
So that's UCL right now going again, we're going back to the
RAD. We're finishing on Rad.
There's not a lot of clear guidance on how to manage a
complete rupture of RCL. So.
I can't like if you managed to rupture your RCL like a lot.
(23:09):
Of damage. Like what else?
Yeah, what else is damaged? Some have advocated for, hey,
maybe it should be similar to the UCL.
You should probably need surgery.
I know if I have someone who's full ruptured, I'm referring
that bad boy just in case. Like, yeah, let's is this
surgery or not? But the protocol for like that
whole management after surgery is similar to UCL, all right?
(23:32):
So it's not really, it doesn't deviate that much.
For partial tears, again, it's very similar, right?
You're going to mobilize 4 to 6 weeks and then you can start
transitioning to a removable splint one that they can kind of
take on and off probably, again,probably mostly for games that
they'll have it on for like an additional 2 weeks.
Nice. Yeah, Some bonus rehab.
(23:55):
Something that we've been doing lately is we took a tennis ball
and we cut a slit in it so it looks like Pac-Man and they have
to pick up marbles. Oh my gosh, I saw you guys doing
that or I saw a video or something and I'm like, that's
genius. I saw it.
I saw it on Instagram. I want to do that now because.
You know what's actually really great?
Look up hand. Like occupational therapists or
(24:18):
like hand therapists and they are like they have you.
I thought I exhausted, I've exhausted my brain of rehab
exercise for the hand. But then you go on Instagram,
there are so many that you can do, especially for some people
who like specialize in this area, I would say.
(24:38):
Like O TS man, that's the that's.
The bread and butter, right? So that and it makes it fun.
It's some, I would say it's somedifferent than the because you
could do like the marble pick upby hand, but then it's like,
what are we doing? Like I feel like that's not
stressing enough for like an athlete.
So what I learned is if the bigger you make the slit in the
tennis ball, the easier it is tosqueeze.
(25:00):
Minimal. So if you if you make a small
slit, obviously it's going to beharder.
So I think I'm going to make another one with a smaller
because I like started with the small and then I was like, oh,
the mouth isn't big enough. And then and like, OK, you know,
like that. Measure twice, cut once.
Yeah, no. Oh, OK, but also like tennis
balls, like dime a dozen. Exactly.
(25:24):
Exactly. Or just go like right outside of
the tennis courts after they're done.
Oh, there's plenty of. Like dead balls.
Yeah, I was just about to say the ones that are dead.
Yeah, they don't. They're going to get rid of them
anyways, right? What I use, sorry not not to go
on tangent, but lacrosse balls, if you have a lacrosse team or
(25:44):
any kind of lacrosse that practices on your campus, just
go out there after they're done.You'll find a good lacrosse ball
somewhere. Or you could just ask them.
But like if you don't know them.You should probably ask them.
Saying sometimes you'll find them in the bushes and you're
like, yes. You're funny, yes.
(26:06):
What is your action item for this?
Thumbs cool, man. You mean like thumbs up, thumbs
up, thumbs up? Cool.
I think from reading this, I think that the management, I
feel like a lot of people don't think of that immobilization
(26:27):
time with one hand injuries, wrist injuries and like thumb
injuries. Like I feel like you look at it
and you're like, Oh yeah, it's sprained.
We can tape that. But then I feel like we're like,
I know for me, like I, it was really hard for me to think of
like, Oh yeah, you should be splinting this when you're not
doing things. You know, I have to say I am a
changed woman from wrist braces.I love them.
(26:50):
They are my favorite piece of equipment.
Yeah, and I think that's one thing like this year, like I
never had like the actual thumb splints, but this past year I,
I, I ordered the braces for it and that has been a game.
Changer, they make such a difference.
Like literally I the way I get by in is I give them the wrist
brace. If that like a wrist sprain.
We could talk about thumb sprains too, but like just
(27:11):
specifically I get more wrist sprains.
So I give them the wrist brace and I say, just hear me out for
24 hours, put it on for 24 hours.
If it works, we can keep it. If it doesn't, then what's 24
hours right? I have not had anyone who hasn't
gotten at least a little bit better in 24 hours.
(27:33):
And most of the time they're like, Oh yeah, I'll keep this on
good because it helps. Well, because you're probably
going to need to keep it on fourto six weeks, so it'll get
comfy. I usually don't keep it on that
long, but yeah, so that's what II make them.
Usually I it's about a week at top tops maybe like 4-5 days
(27:57):
average, yeah. So I would say I don't forget
that time of actually protectingthe tissue.
Like, I know it seems like it's kind of bulky and oh, it's not
cool. And like, you know, the athletes
will complain. Some of them might, maybe not
all of them. Tell them to like wear a a
hoodie like with the sleeves like over their hands.
(28:17):
Yeah, that's what I'd say is don't, don't forget that time to
actually protect the healing ligaments.
And then, yeah, think of some cool creative ways to do rehab
because it you, it feels like you're so limited on hand rehab
and I feel like you're just kindof doing the same thing.
So yeah, like the Pac-Man thing,like that's really cool.
You can only stretch putty so many.
(28:39):
You can only play with the puttyand the webbing for so much.
Or the rice bucket. Or the right or the sand.
Or the sand. I haven't done sand.
Yeah, you can only do that so many times before you're like,
OK. So if you're interested in the
references that Randy used to read on up on this episode, you
can head to our website, which is also in the show notes, where
you will also find a bunch of fun goodies and stuff like
(29:02):
Medbridge, who we work with to bring you C us like promo codes
for them. We have every episode that we do
is education like this Cus or wedo story episodes where we bring
stories from real life athletic trainers.
We are actually doing a story episode next week and because
it's end of May, it will be our last episode of season 5.
(29:29):
That's crazy. So we will be back in August as
we run August through May. We take June and July just to
prep for next season, but we will still be active on our
Instagram, so keep an eye out and we will be at NATA.
(29:50):
So if you're going to NATA, please let us know, we'd love to
meet you. Give us a thumbs up.
We'll we'll know what that means.
Now if I remember, now, if I remember, someone's going to be
like doing thumbs up at me. I'm going to be like, yeah.
As long as you don't give us a thumbs down.
Yeah, that would sting a little.In person, just like walk of
(30:13):
like. Yeah, that one would actually
probably sting a little. Yeah, maybe don't do that,
please. All right.
Do you have anything else? Nope.
Thank you for helping us showcase Athi training behind
the tape. Bye.
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