Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins...
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![Page 1: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/1.jpg)
Sports-Related Hand and Wrist Injuries
Matthew Close, DO Primary Care Sports Fellow
Steadman Hawkins Sports SymposiumJune 10th, 2011
![Page 2: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/2.jpg)
Objectives
• Fingers• Thumb• Wrist– Carpals, radius, ulna
• Fractures• Dislocations• Tendon Injuries• Ligament Injuries
![Page 3: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/3.jpg)
Hand Examination
• Inspection– DIP, PIP, MCP
• Sensory• Motor– Extrinsic– Intrinsic
• Vascular• Palpation
![Page 4: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/4.jpg)
![Page 5: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/5.jpg)
![Page 6: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/6.jpg)
![Page 7: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/7.jpg)
Sensory
![Page 8: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/8.jpg)
Finger Injuries
![Page 9: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/9.jpg)
Finger Injuries #1
• 16 yo HS basketball player who presents to training room after “jamming” his L index finger
![Page 10: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/10.jpg)
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
![Page 11: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/11.jpg)
Finger Injuries #2
• 19 yo college football player with painful, swollen, DIP of middle finger after a tackle
![Page 12: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/12.jpg)
Jersey Finger (FDP Avulsion)
• FDP avulsion at base of distal phalanx
• Hyperextension force applied to flexed finger
• Unable to actively flex DIP joint
![Page 13: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/13.jpg)
Jersey Finger (FDP Avulsion)
• Treatment– Dorsal block splint– Hand surgery
![Page 14: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/14.jpg)
Finger Injuries #3
• 15 yo basketball player “jammed” her finger against the ball while receiving a pass
![Page 15: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/15.jpg)
Central Slip Rupture
• Flexion force at PIP• Injury to central slip– May be subtle
• Unable to extend PIP– Fixed boutonniere
deformity if untreated
![Page 16: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/16.jpg)
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
![Page 17: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/17.jpg)
Finger Injuries #4
• 15 yo soccer player who “jammed” her finger.
![Page 18: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/18.jpg)
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
![Page 19: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/19.jpg)
Finger Injuries #5
• 18 yo HS football player had hand stepped on during tackle
![Page 20: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/20.jpg)
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
![Page 21: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/21.jpg)
Metacarpal Fracture
• Commonly from punching/axial load
• Usually small/ring fingers
• Apex dorsal• Assess deformity– Rotation– Angular
![Page 22: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/22.jpg)
Metacarpal Fracture
• Treatment– Depends
• Intra-articular• Extra-articular• deformity
– Ulnar gutter cast/splint– Buddy tape
• Equal DASH scores
![Page 23: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/23.jpg)
Thumb Injuries
![Page 24: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/24.jpg)
Thumb Injury
• 32 yo professional baseball player sides head first into third, and reports pain at the base of the thumb
![Page 25: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/25.jpg)
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
![Page 26: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/26.jpg)
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%)
![Page 27: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/27.jpg)
Carpal and Wrist Injuries
![Page 28: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/28.jpg)
Wrist Injury #1
• 31 yo professional baseball player with fall on outstretched hand
![Page 29: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/29.jpg)
FOOSH
• Distal Radius• Both bone• Carpal bone dislocation• Styloid fracture
![Page 30: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/30.jpg)
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
![Page 31: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/31.jpg)
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
![Page 32: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/32.jpg)
Wrist injury #2
• Disgruntled golfer at Bushwood country club
• ulnar sided hand/wrist pain
![Page 33: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/33.jpg)
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
![Page 34: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/34.jpg)
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
![Page 35: Sports-Related Hand and Wrist Injuries Matthew Close, DO Primary Care Sports Fellow Steadman Hawkins Sports Symposium June 10 th, 2011.](https://reader035.fdocuments.us/reader035/viewer/2022081514/56649cb55503460f94978dca/html5/thumbnails/35.jpg)
Questions