Carl Crawford Injury Analysis

Will Carroll defined Crawford's injury as a "subluxating extensor tendon" in his middle finger in today's Under The Knife column. One of the MDs he spoke with compared it to the worst type of fracture. This is definitely true and one comparable that I think of immediately is similar although different and that's Curt Schilling's bloody sock injury from 2004.

Schilling's ankle injury was a subluxating peroneal tendon in the ankle which eventually needed surgery to correct. Schilling's subluxating injury was extremely painful and diminished his effectiveness, power, and control. Crawford's injury is similar in that the tendon will most likely not heal on its own and could require surgery to fix it. The injury will cause a decrease in power, bat control, and of course effectiveness.


(courtesy of ASSH.org)

This is what happens. The area in question is the knuckle at the base of the finger on the back of your hand(right where the other tissue crosses and at the dark circle in the picture above). There is a sheath of connective tissue which basically forms the roof over the tendon in order to keep it place with movement. The other sides are all surrounded by bone and cartilage. If this sheath is torn the amount the tendon can slide around depends on the amount the sheath is torn. If the sheath is completely torn, the tendon can come all the way out (dislocate) and then go back in on its own. If the sheath isn't completely torn, the tendons don't go all the way out but they ride up to the top of one of the side lips, rendering it essentially non-functional.

The most aggregating motion for this is forceful side to side motion while gripping something like a bat. Swinging a bat requires the muscles controlling the fingers to contract forcibly which puts tension on all of the tendons. This tension is what can cause that extensor tendon to sublux.

The sheath when torn reacts just like a tendon when torn. If it is completely torn, it basically never heals without surgery. If it is partially torn, there is a chance that it will scar down, but even then it requires a length of time.

Unlike Schilling's injury, there is no bracing of the fingers which would allow him to play. In order to brace/split the finger appropriately, he would need to have his whole finger stabilized from moving in either direction.

This is why honestly, I don't expect he can avoid surgery. There usually isn't any problems long term, but there is always that small chance that it can recur.