What's going on with Marcus Smart's thumb? Checking in with Dr. Flynn

The Celtics were dealt a couple of tough blows to their rotation on Monday after Daniel Theis (torn meniscus) and Marcus Smart (sprained thumb) were declared out indefinitely.

There are a lot of unknowns surrounding both injuries at the moment, so I thought it would be a great time to get some informed insight from Boston Sports Journal medical expert Dr. Jessica Flynn on the injuries involved and the decisions team doctors are likely weighing right now in treating both players.

MARCUS SMART

What we know: The Celtics announced on Monday that Smart has a sprained right thumb but do not yet know the severity of the injury. Shams Charania of the Vertical reported that Smart has a tendon tear and is out indefinitely. Both Charania and David Aldridge reported that Smart is seeking a second opinion on his thumb injury.

Treatment: According to Dr. Flynn, the likely options (depending on the severity of the injury) would be rest or surgery. Surgery to replace a ligament tear could sideline Smart for up to two months.

With the uncertainty of reports between the Celtics and Charania, I went to Dr. Flynn to try to get some clarity on thumb injuries and what Smart and the doctors might be weighing as he seeks additional opinions.

Q: So the Celtics say this is a sprained thumb and one report says it's a tendon tear. Is this just semantics and are both really saying the same thing?

Dr. Flynn: I think it's actually a problem with semantics. I don't think said report is using the right terminology. A sprained thumb could be a sprain of a ligament. A ligament is a little rubber band that connects two bones together. In the thumb, the crucial ligament is the UCL (ulnar collateral ligament). When that is torn, the thumb is really unstable and you lose your ability to bend it in certain ways, including what you do when you use your thumb and forefinger to make the okay sign. You lose that ability because that joint isn't stable anymore. That's what Jacoby Brissett dealt with, making it hard to grip a ball. If that's a problem and that's fully torn, that's something that needs surgery. If they are also calling it a sprain, it could it be a little partial tear of that ligament. In which case he could be in a cast or in a splint for awhile and they could try to heal it without surgery. Either way, if it's the UCL, it's going to be a lengthy recovery.

Q: One report referred to a torn tendon in Smart's thumb. Is that totally separate from the UCL?

Dr. Flynn: Yes. I question the tendon report. I can't imagine a torn tendon near the thumb, it just doesn't really make sense to me. Probably a ligament is what he was referring to.

Q: That's what confused me. A lot of players have dealt with a torn thumb ligaments. Chris Paul had surgery on his last year and was out 6-8 weeks. Is that what we are looking at?

Dr. Flynn: Yes, that's a 6-to-8 week recovery.

Q: What's the biggest challenge for Smart's doctors right now as they debate a treatment method in a tight time window?

Dr. Flynn: I think the challenge is deciding sort of how torn it is. If it is a ligament tear, then assessing how torn it is and assessing how stable the joint is. If it's unstable, then I think it's a tough thing to play through. Every player is going to react to the same injury differently. They palm the ball differently, etc. Their game changes. I think if the UCL ligament is totally torn and he can't function, then the answer is easy, he has surgery. There are certain UCL injuries that have to have surgeries right away, where the ligament tears and it gets stuck, so he has to get fixed.

It's pretty obvious on an exam, except if it's a partial tear, it's harder to tell. Just like the ACL, it's harder to tell because it's not like it's all gone, it just feels a little looser and you don't know if that's normal or not. I'm guessing the MRI showed it.

It's not like Jacoby Brissett where they need him to play a game, right? They just don't need a warm body. They need him to be available so it's not as easy as playing a little bit and then you have surgery.

Q: So if he did have a partial tear and didn't want surgery, is that a situation where he could rest it and try to play through it and it could get worse?

Dr. Flynn: Yes. If it's a partial tear of the UCL, then he should not play through it. He should rest and try to fully heal it. Then, they can reassess how stable the joint is and make a decision whether or not he needs surgery at that point. It's not a good idea to play on a partial tear and just push through it.

DANIEL THEIS

What we know: He suffered a torn meniscus on Sunday night against the Pacers in his left knee.

Treatment: He is debating surgical options. Typically, a player either has the meniscus repaired (longer recovery timetable but better long-term prognosis) or trimmed (i.e. removed). Jimmy Butler recently elected for the latter in February and is shooting to be back in 4-to-6 weeks (best-case scenario). Many players don't have the option of repair, according to Dr. Flynn, since it depends on the location of the injury.

This is noteworthy because if Theis undergoes the same procedure as Butler, he could hypothetically be cleared to return at some point in May if his recovery goes well. Note that Brad Stevens did not definitively declare him out for the year just yet in his comments to the media yesterday.

"He's out for the foreseeable future, most likely out all season," Stevens explained. "It's too bad. He's had an incredible rookie year in my opinion. He's obviously down and he's weighing surgical options right now and (we'll) go from there."

I talked with Dr. Flynn about the Theis injury to further examine his options.

Q: When Theis is debating surgery options, what exactly is he looking at?

Dr. Flynn: You repair it or you trim the part that's torn. Those are the two surgical options. A third option is to play on the torn meniscus, which is not a good idea and isn't happening.

Q: Do most people get the meniscus removed or repaired after a tear?

Dr. Flynn: The question is: Is this a repairable tear? Most meniscus tears are not repairable. Basically, they have to be in a specific location: It's just the very outer rim of the meniscus that has a blood supply. You need a blood supply to actually heal. In a young person, that outer rim still has a really good blood supply, so we recommend repairing it when it's possible. Repairing it now compared to a partial meniscectomy (removal or trim or meniscus), won't affect anything long-term. Either way, he'll be ready to play next season and either way, his season will probably be over. The timing of the injury, while it sucks for the Celtics, it makes the decision making a little bit easier as far as which procedure goes. If it is a tear that can be repaired, I expect he'll have it repaired and be ready to go by fall.

Q: So if he's forced to have the meniscectomy (trim of meniscus), that would leave an outside shot of him returning during the postseason if the Celtics go on a deeper run?

Dr. Flynn: It's possible but unlikely. 4-6 weeks is the minimum recovery time for a trim.