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Sports-Related Hand and Wrist Injuries
Matthew Close, DO Primary Care Sports Fellow
Steadman Hawkins Sports SymposiumJune 10th, 2011
Objectives
• Fingers• Thumb• Wrist– Carpals, radius, ulna
• Fractures• Dislocations• Tendon Injuries• Ligament Injuries
Hand Examination
• Inspection– DIP, PIP, MCP
• Sensory• Motor– Extrinsic– Intrinsic
• Vascular• Palpation
Sensory
Finger Injuries
Finger Injuries #1
• 16 yo HS basketball player who presents to training room after “jamming” his L index finger
Mallet Finger
• Forced DIP hyperflexion • Extensor tendon
avulses• DIP rests in flexion• No active extension
• Treatment– 6 weeks DIP extension
(24x7), 6 weeks at night– Surgery for large avulsion
Finger Injuries #2
• 19 yo college football player with painful, swollen, DIP of middle finger after a tackle
Jersey Finger (FDP Avulsion)
• FDP avulsion at base of distal phalanx
• Hyperextension force applied to flexed finger
• Unable to actively flex DIP joint
Jersey Finger (FDP Avulsion)
• Treatment– Dorsal block splint– Hand surgery
Finger Injuries #3
• 15 yo basketball player “jammed” her finger against the ball while receiving a pass
Central Slip Rupture
• Flexion force at PIP• Injury to central slip– May be subtle
• Unable to extend PIP– Fixed boutonniere
deformity if untreated
Central Slip Rupture
• Elson’s Test • Treatment– 6 weeks splinted PIP in
extension (24x7), then 6 weeks at night• Leave DIP and MCP free
– Surgery • failed conservative tx• Large avulsion fragment
Finger Injuries #4
• 15 yo soccer player who “jammed” her finger.
PIP Dislocation
• Axial load, hyperextension
• Dorsal displacement• Volar plate rupture
• Treatment– Urgent reduction– Extension block splinting
for 1-2 weeks at 20-30 deg of flexion
– AROM with buddy tape• Prevent volar plate
contraction
Finger Injuries #5
• 18 yo HS football player had hand stepped on during tackle
Phalanx Fractures
• Distal/Tuft– Subungual hematoma– Protective splint
• Do not immobilize entire fingeruneeded stiffness
• Middle or Proximal– Manage most with
buddy tape– If rotated, displaced,
intra-articular • surgery
Metacarpal Fracture
• Commonly from punching/axial load
• Usually small/ring fingers
• Apex dorsal• Assess deformity– Rotation– Angular
Metacarpal Fracture
• Treatment– Depends
• Intra-articular• Extra-articular• deformity
– Ulnar gutter cast/splint– Buddy tape
• Equal DASH scores
Thumb Injuries
Thumb Injury
• 32 yo professional baseball player sides head first into third, and reports pain at the base of the thumb
Skier’s Thumb (UCL Injury)
• Injury to UCL• Radial deviation to
abducted thumb• TTP ulnar border MCP• Laxity– 30 degrees– >15 deg side to side
difference
• Treatment– Partial
• Thumb spica cast
– Complete• Stener lesion/recoiled UCL• Surgery
Bennett Fracture
• Axial load to adducted thumb• swelling, ecchymosis at MCP• Unstable fracture
– ABd Pollicis longus – ADd Pollicis
• Treatment– Surgery
• PERC pinning (<20% articular surface)
• ORIF (>20%)
Carpal and Wrist Injuries
Wrist Injury #1
• 31 yo professional baseball player with fall on outstretched hand
FOOSH
• Distal Radius• Both bone• Carpal bone dislocation• Styloid fracture
Scaphoid• m/c carpal fx
– 65% waist– 25% prox pole– 10% distal pole
• Snuffbox TTP
• Imaging– Plain films– CT scan
• Treatment– Stable (<1mm displaced)
• SA thumb spica– Unstable (>1mm), prox.
pole• Perc pinning
• Nonunion– 5-10% in non-displaced– Retrograde blood supply
Scapholunate Dissociation
• m/c carpal instability• Tear to scapholunate
interosseous ligament• Pain/weak grip• Progress to SLAC
• XR– Consider clenched fist
PA with ulnar deviation
• Surgery• Ligament repair, K wires
Wrist injury #2
• Disgruntled golfer at Bushwood country club
• ulnar sided hand/wrist pain
TFCC Injury
• Important in loading & stabilizing DRUJ
• “Wrist Meniscus”– Ligament and cartilage
structures• Clinical– pain/snapping at
radioulnar joint with rotation
– Press test• Push up from seated
position-> pain
• Treatment– Injection– Arthroscopy
• Debridement• repair
Hamate Fracture
• Direct force• Repeated microtrauma– Gripping sports
• Volar Pain with palpation
• Standard XR not good– Carpal tunnel view– CT scan
• Treatment– Excision
• Return to sport with padded donut for grip
Questions