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