When the Clippers announced back on Christmas Day that Paul George had suffered a torn ulnar collateral ligament, it was unclear how to react to an injury that is more synonymous with baseball players — pitchers, to be exact. Even with the update that George will be requiring additional weeks of rest for his right elbow, the confusion hasn’t dissipated.
According to Dr. Luke Nicholson, MD, the reason that there is this level of uncertainty regarding George’s return is partly because torn UCLs simply don’t happen among basketball players. The type of mechanism that causes tension on that ligament is more common in overhead athletes, like javelin throwers and baseball pitchers. Nicholson, an orthopaedic surgeon at Keck Medicine of USC, says that basketball motions — like taking a jump shot, for example — don’t stress the UCL to the same degree because the elbow is being extended, but not subjected to an outward motion.
“It’s a ligament that if it’s injured in a basketball player, it’s usually during an impact on the hand or forearm that causes that valgus motion,” Nicholson told Clips Nation via a phone interview Thursday. “So I think the reason that [George] has to wait for it to heal is because it can be painful while he’s throwing and risk it not healing more.”
The hope is that George can recover without surgery so that he is available for the end of the regular season and the playoffs. Nicholson says that he can’t recall any basketball player who has ever had to have reconstruction surgery on the UCL, which is known as Tommy John surgery in baseball. However, a partial tear can be treated with a surgical repair and an internal brace to stabilize the ligament. That type of procedure would most likely would keep George out six months, which isn’t an ideal outcome either.
Nicholson cautioned that these recovery paths are all speculative without knowing the actual severity of George’s injury, and what his pain level is at this point, especially considering how rare this injury is in basketball. He did, however, provide some general timelines for a return.
“If somebody’s not an overhead athlete, it’s more based on their symptoms and there’s a little less guidance as to what those will be,” Nicholson said. “And so my assumption is that at the three-to-four week mark, they were going to see what his symptoms were at that point. And if he was still symptomatic, most likely, keep an eye out or re-evaluate after another three to four weeks. I think my suspicion, just knowing this type of injury, ligaments do take two to three months to heal. And so my suspicion is that he would be out at least six-to-eight weeks from the time of the injury and that three to four weeks is a fast timetable. But again, I don’t know that they were planning on him coming back then. I think they were just planning to reevaluate him.”
“The timetable to return, that is unknown because it’s a non-common injury in basketball players and it requires monitoring his symptoms, which in his case are pain, which is the main clinical indicator of ligament healing,” Nicholson added. “And so if he still has pain, it’s not healed yet. And so they need to basically monitor for when his pain is resolved, which indicates healing, which typically takes on an average about three months.”
If George’s elbow positively responds to this additional rest period, his return would be well within that prospective two-to-three month timetable. Remember that he originally suffered the injury against Portland on Dec. 6 and isn’t scheduled to be re-evaluated until the beginning of February at the earliest.
The main remaining question is how this even happened to George. Nicholson recalled an incident when Andrea Bargnani tore his UCL on a dunk attempt in 2014. As the doctor noted, when someone attempts to dunk with one hand, that simulates an overhead throwing motion. If that motion is then suddenly stopped while the body weight continues forward, that applies stress to the UCL.
But George didn’t have any missed dunks against the Trail Blazers. What else could have done it?
“So I think scrambling for a loose ball with outstretched hand could do it,” Nicholson said. “I think any contact with an opposing player with the arm extended from the body, if contacting him in the correct direction could do it, but I certainly have no inside knowledge about what it was.”
What we do know is that nothing about the progression of George’s rehab so far is out of the ordinary. The amount of time that he has been out of the lineup is in line with normal ligament healing, and it doesn’t necessarily suggest that he is due for surgery. Unfortunately, that still doesn’t mean we know what comes next.