Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 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 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 finger  uneeded 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