Week 1 was so exciting that we’re covering another notable NFL injury. Dallas Cowboy quarterback, Dak Prescott, was injured late in his team’s loss to the Tampa Bay Buccaneers. He underwent surgery on a fractured thumb on Monday and in more recent news, was NOT placed on the Cowboys IR. We asked our resident hand expert, Jason Furia, OTD, CHT, for his take on Dak’s injury and prognosis. (Disclaimer: Without knowing exactly what Dak’s injury and plan of care is, the following comments should be taken as general knowledge and fun and not actual medical advice.)
Per reports, Dak sustained the injury when he hit his hand on another player. What are the most common fractures that quarterbacks see?
Contact injuries can happen to any bone, but the bones in the hand are actually less susceptible to a direct fracture due to their small size. There is also the possibility of an avulsion fracture which occurs when there is stress across a joint but the stabilizing ligament or tendon stays intact. The soft tissue ends up pulling a chunk of bone away from where the ligament inserts.
The team is saying that it will be 6-8 weeks following surgery until he returns. Does that seem like a realistic timetable?
Six to eight for this injury is a quick return to contact sports and unlikely for a non-professional athlete. However, with internal fixation (surgery to stabilize the bone with pins, plates or other hardware), stability is greatly improved. Fixation will stabilize a fracture and keep it in a perfect position to heal. Reports say, “pins and plates”, but that specific hardware is not always used together for this type of injury. It is sometimes a plate and screws which stay in permanently unless there is a problem. This provides a great amount of stability immediately. However, this also requires a large chunk of bone to screw into which is often not available in small bones such as those in the hand.
Sometimes a pin is placed into the bone and through the fracture stabilizing it, allowing it to heal in the appropriate position. This pin is often left sticking out of the skin and is later removed without surgery. The pin can also be kept under the skin and left in for longer periods of time to provide stability then removed with a simple surgery at a time determined by the surgeon. This is less likely but possible.
What sort of modalities/exercises will Dak need to do to get his throwing hand back to full function?
Since the injury was to Dak’s throwing hand, he will need to make sure to regain the range of motion in his thumb. There is a priority on restoring extension to allow his hand to get around the ball. He will also need enough range of motion in flexion in order to grip the ball.
It will also be very important for him to strengthen all of the muscles of the wrist and hand. The reason for this is twofold: 1. To reactivate the neuromuscular pathways to get that precise touch required to throw a ball accurately, and 2. To develop enough strength to hold the ball and dynamically stabilize the fracture.
Will he need any sort of bracing/splinting/taping when he returns to play?
He may require bracing/custom splinting to provide additional stability if he is able to throw accurately with it on. If he cannot throw accurately with a splint or brace, another option is taping to support the area and absorb the impacts of hit. This option provides less support and greater mobility.
Meet the Expert
Jason Furia is a Certified Hand Therapist and the Clinic Director of Excel Physical Therapy in Springfield. After earning his degree in Occupational Therapy from Kean University in 1997, he immediately began working with hand and upper extremity patients completing a two-year mentorship at the Hand Rehab Center of Northern New Jersey. Jason went on to become a Certified Hand Therapist in 2003 and eventually earned his Doctor of Occupational Therapy from the EIM Institute for Health Professions in 2017. Learn more about Jason here.