2017 AFC Championship

Dr. Flynn: Tom Brady’s injury was no joke, he should be lauded for Sunday night

(Adam Richins for BSJ)

After nearly a week of widespread speculation about Tom Brady’s thumb injury that ranged from minor flesh wound to near-amputation, we finally got to see the quarterback in action. He sailed a few passes early - was that a result of the injury or just part of a closely contested game? He led his team back from a 20-10 deficit to win the AFC title. Thumb seemed okay. After the game, Brady addressed his injury in more detail, admitting that, on Wednesday, he wasn’t sure if he would be able to play Sunday.

We saw photos of his laceration, no longer covered by Kinesiotape, for the first time.

The morning after the game, Brady went on WEEI for his weekly interview and described the moment of the injury:

We ran into each other and my thumb just got bent back. It wasn’t his helmet or anything. Just kind of got bent back. That is why I felt it was a lot worse. The doctors went in and checked it out and we did things just to kind of check on everything and fortunately, there wasn’t any damage that normally comes associated with that. I think we were very lucky.

What Brady is likely referring to there is the fact that most lacerations that occur as a result of the thumb being pulled back happen as a result of an open dislocation of the thumb with significant ligament tearing. An injury like that would require significant bracing of the joint and, often, surgery to repair. It would have been very difficult, if not impossible, for the quarterback to play four days later.

However, the location of Brady’s laceration supports what the quarterback said: he was “very lucky.” The ulnar collateral ligament (UCL) is a tiny rubber-band like structure that stabilizes the thumb. It is critical for gripping a football. The UCL is located millimeters from the location of Brady's laceration. A tear of this ligament could have been a worst-case scenario. Luckily, that was not the case for Brady: reports are that he sprained the UCL but did not tear it.

We do not have confirmation that there was a dislocation of the MCP joint of the thumb, but it is very difficult to imagine such a large laceration occurring without a significant injury to the joint itself as the thumb was pulled back. Brady did say that “it wasn’t his helmet or anything” that caused the cut, making it more likely to have been from extreme stretching of the skin, possibly from the joint being at least somewhat disrupted.

My best guess for what happened for Brady to open up a cut like that has been that the thumb was extended so far back that the joint dislocated — either partially or fully — and the stress on the skin from the stretching, in addition to the fulcrum caused by the underlying bone, caused it to tear. It’s hard to imagine that the skin could tear without some level of dislocation/subluxation of the joint. But not everything in medicine is 100 percent. In an article for MMQB today, Greg Bishop wrote of the injury:

Inside that X-ray room [Brady] noted that the skin hadn’t been sliced open; rather it appeared to have pinched until it ruptured. He asked one of the Patriots’ doctors, “How does the skin split like that?”

“I’ve been doing this a long time, and I’ve never seen this before,” one physician told him, adding that the wrist usually absorbs the kind of impact he took, often leading to dislocation.

It appears that Brady’s thumb impact was as freaky as they come — leading to an injury that doesn’t fit with typical injury patterns.

But this was more than just a cut on a quarterback’s throwing hand. There was, at minimum, a  sprain to the thumb's MCP joint four days before a game and that type of an injury is very painful. It’s a difficult thing for a quarterback to play through and I think Brady deserves a lot of credit for performing as well as he did. The thing is, Brady doesn’t want the credit. In true Patriots’ form, all focus is on the team effort that made Sunday’s win possible.

I made a mistake last night responding on Twitter to many comments that I thought minimized the quarterback’s resiliency. After nearly a week of speculation that Brady’s injury was of epic proportions, I felt like suddenly everyone was sweeping it under the rug as just an overblown paper cut. And I went a little overboard. My responsibility is to bring you accurate, non-sensationalized injury analysis and I strayed from that for a second last night by letting my emotions get the best of me. I’m sorry.

Brady hopes to get his stitches out this week (usually removed around a week after a laceration repair). His thumb should continue to improve every day and I do not see any reason to believe that it should be an issue in the Super Bowl or anything that bothers him in the future.