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Sports-Related Hand and Wrist Injuries

Sports-Related Hand and Wrist Injuries

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Sports-Related Hand and Wrist Injuries

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  1. Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10th, 2011

  2. Objectives • Fingers • Thumb • Wrist • Carpals, radius, ulna • Fractures • Dislocations • Tendon Injuries • Ligament Injuries

  3. Hand Examination • Inspection • DIP, PIP, MCP • Sensory • Motor • Extrinsic • Intrinsic • Vascular • Palpation

  4. Sensory

  5. Finger Injuries

  6. Finger Injuries #1 • 16 yo HS basketball player who presents to training room after “jamming” his L index finger

  7. 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

  8. Finger Injuries #2 • 19 yo college football player with painful, swollen, DIP of middle finger after a tackle

  9. Jersey Finger (FDP Avulsion) • FDP avulsion at base of distal phalanx • Hyperextension force applied to flexed finger • Unable to actively flex DIP joint

  10. Jersey Finger (FDP Avulsion) • Treatment • Dorsal block splint • Hand surgery

  11. Finger Injuries #3 • 15 yo basketball player “jammed” her finger against the ball while receiving a pass

  12. Central Slip Rupture • Flexion force at PIP • Injury to central slip • May be subtle • Unable to extend PIP • Fixed boutonniere deformity if untreated

  13. 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

  14. Finger Injuries #4 • 15 yo soccer player who “jammed” her finger.

  15. 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

  16. Finger Injuries #5 • 18 yo HS football player had hand stepped on during tackle

  17. Phalanx Fractures • Distal/Tuft • Subungual hematoma • Protective splint • Do not immobilize entire fingeruneeded stiffness • Middle or Proximal • Manage most with buddy tape • If rotated, displaced, intra-articular • surgery

  18. Metacarpal Fracture • Commonly from punching/axial load • Usually small/ring fingers • Apex dorsal • Assess deformity • Rotation • Angular

  19. Metacarpal Fracture • Treatment • Depends • Intra-articular • Extra-articular • deformity • Ulnar gutter cast/splint • Buddy tape • Equal DASH scores

  20. Thumb Injuries

  21. Thumb Injury • 32 yo professional baseball player sides head first into third, and reports pain at the base of the thumb

  22. 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

  23. 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%)

  24. Carpal and Wrist Injuries

  25. Wrist Injury #1 • 31 yo professional baseball player with fall on outstretched hand

  26. FOOSH • Distal Radius • Both bone • Carpal bone dislocation • Styloid fracture

  27. 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

  28. 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

  29. Wrist injury #2 • Disgruntled golfer at Bushwood country club • ulnar sided hand/wrist pain

  30. 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

  31. 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

  32. Questions