Evaluating the hand injury of Dylan Cozens

Kyle Trimble looks at the possibilities of Cozens hand injury and recovery time

After a week of hopefulness after the NHL draft following a near decade of futility, the Buffalo Sabres still can’t catch a break. The 2019 seventh overall draft pick Dylan Cozens went down a routine hip check by Brandon Hickey during the French Connection 3-on-3 tournament.

Cozens fell awkwardly onto the ice with most of his weight going towards his left hand grasping his stick. He was able to come up, take his glove off and skate to the bench with video showing what appeared to be a deformity in his hand. While Cozens later stated that his thumb was not broken, he was still scheduled to see a specialist Monday and the Sabres announced he’ll undergo a surgical procedure today. Today’s article will attempt to speculate the injury he suffered and timeline for recovery.

To understand the possible injuries, anatomy of the hand must be understood. The hand/wrist is made up of 27 total bones consisting of phalanges, metacarpals, and carpal bones. The thumb has each type of bone and the base of the metacarpal articulates with the carpal bones which allows for various motions of the thumb. In Cozens case, it appears as though he injured the 1st metacarpal bone, the carpometacarpal joint, or the metocarpophalangeal joint.

Due to the availability of social media, we are able to see the video of the mechanism of injury, which was a fall on outstretched hand or FOOSH injury seen below. Our bodies are designed to place our hands out in front to brace falls in order to protect our head and trunk, both containing vital organs. Unfortunately, all 183 pounds of Cozens came down onto his left hand with his hand grasping his stick. After removing his glove, he was unable to move his thumb which indicates that there is a possible dislocation or fracture of the area which required immediate medical attention.

He later stated that the thumb was not fractured when speaking to reporters but it was noted that he kept his hand in his hoodie pocket. Either he is outright lying about the fracture or he is indeed telling the truth and that he suffered a ligament tear or dislocation. Regarding possible areas for dislocation, he could have suffered a metocarpophalangeal joint or skier’s thumb injury.

Skier’s thumb is when the thumb is forcefully hyperextended and hyperabducted due to a direct fall onto the area. This is prevalent in activities where a person is grasping an object such as a skier pole, hockey stick, or handlebar. The thumb gets forced back and injures the UCL or ulnar collateral ligament in the thumb. The ligament can be partially torn such as in the event of a sprain completely torn, or even avulsed in some cases.

Depending on the severity, there could be non surgical options where rest and immobilization is warranted to heal the area, which could take six weeks. With him undergoing surgery, a three to four month recovery can be expected as ligaments are the stabilizers between bones and avoiding stress to the area will be key to proper healing.

Another possibility is a 1st carpometacarpal joint dislocation. This is the joint that is next below that articulates with the trapezium from the picture above. The joint could dislocate with an axial or direct force on a flexed thumb. It’s quite possible that Cozens could have fell directly onto the thumb and the force of the stick being grasped could have forced the thumb to dislocate. This theory is supported by the deformity seen on video as he was coming off the ice.

However, while this may be more possible, I will not go so far as to say this is the culprit as this type of injury, according to literature, is quite rare. It’s estimated that this occurs in 1% of all hand injuries. If he did suffer this injury, the timeline for recovery would be about three to four months as well along with return to full function due to taking the additional time to get back into playing shape.

Cozens states that the injury looks worse than it really is which may be the case. He could have dislocated, had it relocated and the imaging showing that he only suffered partial tears or sprain which would require rest and immobilization to allow for proper healing. He may have suffered a fracture in the metacarpal with initial imaging being negative which led to his original statement. A fracture could require possible surgery to help set the bone for proper healing with a more likely recovery of two months.

We may never know the true extent of what exactly happened as the NHL is notorious for limiting injury specifics. The only way we may be able to glean more information is to see what he can and can’t do as training camp approaches or as any other social media information becomes available.

Regardless of injury, worse case scenario is that he is ready for training camp but may be limited with some activities. As the Sabres are still attempting to identify talent and assess needs, Cozens may benefit from an extra year in Juniors and grow into his body until he is NHL ready. In addition, his youthful age typically allows for the healing times to be on the lower side of the timeline. Overall, this is an injury that is not concerning during this time in the off-season.

Time will tell as to what this plays out to but these injuries, even worse case scenario, are typically not chronic in nature and resolve with proper care. Everything will heal and this will be yet another injury that will be wish to be forgotten too soon for Sabres fans.