Jay Cutler Injury: Bears QB Faces Uncertain Road To Recovery

Chicago Bears QB Jay Cutler suffered an injury on Sunday that will require surgery to the thumb on his throwing hand. SB Nation's Medical Expert details Cutler's prognosis and his road to recovery.

Although Bears coach Lovie Smith announced Monday that he expects quarterback Jay Cutler to return before the end of the season from a fractured right (throwing) thumb, Cutler's ability to return in 2011 - and his effectiveness as a passer upon his return - will depend upon the specific type of fracture he sustained and whether his upcoming surgery will result in complete realignment of the broken bone.

Despite Smith's reassurance that Cutler will return by the end of the season, thumb injuries run a wide spectrum in terms of time for recovery, with those who require surgery sometimes needing 8 weeks or beyond before they're able to return to action.

Although the Bears have not divulged the exact type of fracture Cutler sustained, the most common one requiring surgical repair involves the base of the thumb and often also includes a dislocation of the joint. This type of injury, also known as a Bennett's fracture, takes place where the metacarpal (thumb) bone connects to the the carpal (wrist) bones, also known as the carpo-metacarpal (CMC) joint. Due to the specific location of the fracture, there is some detachment of this ligament that stabilizes the joint from the bone, causing a dislocation of the joint. Unless properly recognized and treated, this type of injury may result in an unstable, arthritic joint with loss of motion and pain.

Patients commonly sustain thumb fractures when a bent thumb undergoes a significant and forceful trauma, and they almost uniformly experience severe pain in the region around the base of the thumb followed by rapid swelling in the area of the thumb and wrist. The biggest concern for Cutler - and any patient with a significant thumb fracture requiring surgery, regardless of its location - is that the fracture site may develop arthritis due to poor realignment of the bone and joint if not treated properly.

There are two main surgical methods for repair of a thumb fracture. The first involves inserting a surgical wire through the fracture site without making an incision; this technique is reserved for fracture-dislocations that are relatively well-aligned. Although this is the least invasive surgical option, the level of stability attained is limited and may predispose to a higher likelihood of long-term complications. In circumstances where the fracture is poorly aligned following the injury, surgeons choose a second option known as open reduction and internal fixation, which involves making an incision and using small screws to re-attach the bony fragments.

Following surgery, patients are placed in a thumb cast for 2-6 weeks, with the length of time depending on the stability obtained during the procedure. Once the cast is removed, the thumb is placed in a splint and rehabilitation takes place until fracture healing is complete. The goals of rehabilitation are to relieve stiffness, restore range of motion, and increase muscle strength. Hand function is usually restored to normal over 1-3 months, although in some patients the thumb may not feel right for around six months.

Athletes are often able to return to action well before the injury has fully recovered, making Smith's timetable for Cutler's return reasonable. However, a key concern with thumb fractures regardless of the treatment option is whether the patient will ever regain the level of function they enjoyed prior the injury. If the bone does not realign properly after surgery, patient may develop arthritis, loss of motion, and a propensity for re-dislocation. Furthermore, if the fracture produces multiple, small bone fragments, damage to the surface of the bones, or significant soft-tissue injury, there is a higher likelihood of arthritis and decreased thumb mobility compared with those that are relatively uncomplicated and easily realigned in the operating room. Thankfully for Bears fans, Smith's belief that Cutler will return before the end of the regular season makes these worrisome possibilities less likely.

Perhaps the biggest issue with a thumb fracture in Cutler's case relates to the position he plays. Someone at almost any other position could potentially return to action even sooner than Cutler will, with a protective device in place to protect the thumb. For a quarterback, the thumb - and especially the base of the thumb - is critical for stabilizing the ball during the throwing motion and maintaining proper spin while in the air. To illustrate the importance of the location of a thumb fracture, Steelers' quarterback Ben Roethlisberger has now suffered two fractures to his throwing thumb since 2005, but he has been able to return to action without any time missed due to the fact that the injuries were high up in the thumb and did not require surgical realignment. Cutler's ability to return to his current form will depend upon the ability of the surgeon to realign the bone to its original position as well as possible, and even after that, he could still suffer from a mild degree of loss of motion that could impact the speed and accuracy of his passes.

For the short term, the Bears will begin their season's stretch run with Cutler out of action, and with only two of their six remaining foes boasting records above .500, Chicago still stands a good chance of making it to 10 wins. Assuming, as Smith believes, Cutler is able to return before the Bears' season-ending game at Minnesota, the question will be whether his recovery has progressed enough to make him effective in a potential playoff game the next week. If not, backup Caleb Hanie, who will start in Cutler's place starting next week and who took over at quarterback when Cutler sustained a knee injury in last year's NFC Championship game loss to Green Bay, will be asked to guide the Bears in January for a second consecutive year.

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