Hand and Wrist Sports Injuries

Introduction

Hand injury.jpg

With so many bones, ligaments, tendons, and joints keeping hands and wrists working, there is ample opportunity for injury. In fact, injuries to the hand and wrists are some of the most common ailments facing athletes.

  • Approximately 25% of all sports-related injuries involve the hand or wrist.
  • If managed properly most athletes can expect their injury to heal without any significant long-term disability.[1]
  • Incidence is growing not only due to the competitive level of high school and collegiate athletes but also due to the activity level of the general population.
  • Hand and wrist injuries are common and can have a significant impact, especially if initially disregarded with a resultant delay to treatment[2].

Types of Injuries

Common injuries generally fall into two different categories: traumatic (acute) or overuse (chronic).

Traumatic Injuries

More likely for those who play sports that involve a significant amount of contact with other players. Sports such as hockey, football, or wrestling tend to result in more traumatic injuries, including:

SuturedFinger2.jpg
  • Muscle Strains
  • Joint Dislocations
  • Tendon Inflammation
  • Ligament Tears
  • Fracture Injuries in the Fingers (image on right- fractured phalanx with stitches).

Chronic Injuries

These injuries are more common in sports that require repetitive motions. Baseball, tennis, and golf are sports that carry a risk of chronic injuries.

  • Tendonitis (Tendon Inflammation, Irritation, or Tear)
  • Tendon Dislocation
  • Nerve Injuries
  • Stress Fractures

While chronic injuries are less likely to result in long-term disability than traumatic injuries, it is still vitally important to assess and treat correctly.

When left untreated, chronic injuries can impact an athlete’s performance. Surgery may be required– especially in cases where the injury persists and other treatment options have proven to be unsuccessful.[3]

Common Sports Related Injuries

Knowledge of common sports-related injuries and therapeutic strategies can help the physiotherapist effectively treat the athlete considering their sports, position, and timing during season. Read the links for a comprehensive evaluation.

Wrist
Displaced distal radius fracture.jpg

Wrist fractures are among the most common broken bones in athletes. Landing from a fall onto an outstretched arm, for example, can lead to a wrist fracture that requires treatment.[2] (See x-ray on the right)

Radial-sided wrist injuries

Scaphoid fracture

Scapholunate ligament tears

Radial-sided tendinopathies  

  • de Quervain’s tenosynovitis
  • Intersection syndrome, also called Oarsman’s wrist, is caused by friction at the crossing of the tendons of the first extensor compartment as they pass over the tendons of the second extensor compartment (extensor carpi radialis longus and brevis) or a stenosing tenosynovitis within the second extensor compartment itself. Pain is elicited with extension and radial deviation approximately 4–8 cm proximal to the radial styloid. Without careful attention to the location of pain, this can be misdiagnosed as de Quervain’s tenosynovitis
  • Tendonitis of the flexor carpi radialis is due to repetitive wrist flexion or acute overstretching of the wrist as can be seen in volleyball or water polo. Pain develops from tendon thickening as it runs in its tunnel adjacent to the carpal tunnel. Pain typically courses from the radial palmar wrist crease towards the base of the second metacarpal made worse by resisted wrist flexion.
Ulnar-sided wrist injuries

Extensor carpi ulnaris injury - Abnormalities of the extensor carpi ulnaris (ECU) covers an array of pathologies seen in golf, baseball, hockey, tennis players, and other racquet sports. Injury may present as acute or chronic encompassing tendinosis, subluxation, dislocation, or rupture causing pain with or without mechanical symptoms on the ulnar side of the wrist. The pathophysiology involves repetitive microtrauma or a sudden traumatic episode during wrist flexion, supination, and ulnar deviation such as the nondominant hand in a double-handed backhand in tennis or the leading hand in the downward phase of a golf stroke.[2]

Hamate bone (left hand) - animation.gif

Ulnar abutment

Triangular fibrocartilage complex tears

Hook of the hamate fractures (image on right is the hamate bone)

Hand/finger injuries

Thumb ulnar collateral ligament tears - Ulnar collateral ligament (UCL) injuries of the thumb are extremely common and often seen in skiing, basketball, and football. Injury occurs from an abduction moment at the thumb metacarpophalangeal joint (MCPJ) such as a fall onto an outstretched hand with the thumb abducted. An acute thumb UCL injury has been dubbed a skier’s thumb in contrast to chronic attritional insufficiency of the ligament which is referred to as a gamekeeper’s thumb.[2]

Metacarpal/phalangeal fractures - Accounting for 10% of all fractures presenting to the emergency department, metacarpal and phalangeal fractures are common injuries. Injuries occur from falls, direct blows, or crush during sporting activity, although stress fractures have rarely been noted in racquet sports. Incidence is highest in contact sports such as football, lacrosse, and hockey.

Metacarpal fractures - Metacarpal base fractures occur from an axial load with the wrist in flexion. e.g. Bennett and reverse-Bennett fractures are used to describe the characteristic fractures of the thumb and small finger metacarpal.[2]

Phalangeal fractures - Shaft fractures of the proximal and middle phalanges can occur in a variety of patterns, but buddy taping and/or protective splint wear in acceptable alignment can allow fast return to play. Extra-articular fractures without rotational malalignment, less than 15°of angulation, and less than 6 mm of shortening are indicated for conservative treatment. Operative fixation with open versus closed reduction using either K-wires, screws, or plate and screws as fixation is sometimes required, especially when there is digital malrotation.[2]

Traumatic Extensor Hood Rupture

Mallet Finger Injury.jpg

Extensor Tendon Injuries of the Fingers and Hand

Flexor Tendon Injuries

Pulley ruptures - Closed annular pulley ruptures occur most commonly in rock climbers due to the high demand placed on the flexor tendon system in the hanging and crimping positions e.g. Trigger Finger Pulley ruptures typically involve the A2 or A4 pulleys and occur most often in the middle and ring fingers. Previous work has evaluated the force required to produce an A2 pulley tear and loads experienced during these vulnerable maneuvers finding they are at particular risk for climbers.

Wrist Exercise Handout.jpg

Mallet finger (see image on R)

Assessement
Assessment of nerve injury during hand or wrist injuries
Treatment

Treatment depends on the location, type, duration, and severity of the injury. (see individual page links). The best option is after taking into consideration the specific injury, consideration of short- and long-term damage, deformities, and stiffness.

Options include:

  • Physical therapy, (image on R shows examples of exercises)
  • “Buddy-taping” (taping the injured finger to a neighboring one for support), splints, braces, casts etc.
  • Medication
  • Surgery is needed for some injuries, such as ligament tears
  • Medication[1]
Prevention
Wicket keeping gloves along with the inner gloves.jpg

Wearing wrist guards, gloves, and stretching are just a few ways to help prevent a traumatic hand or wrist injury. To prevent overuse injuries ensure sport persons take breaks to rest the hands or wrists, use proper posture and technique, and utilizing protective equipment.[1]


References

  1. 1.0 1.1 1.2 American society for sports medicine Hand and Wrist Injuries EXPERT CONSULTANT: Dan Matth Available from:https://www.sportsmed.org/aossmimis/STOP/Downloads/SportsTips/HandandWristInjuries.pdf (last accessed 15.3.2020)
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. Journal of orthopaedic surgery and research. 2016 Dec 1;11(1):99. Available from:https://josr-online.biomedcentral.com/articles/10.1186/s13018-016-0432-8 (last accessed 15.3.2020)
  3. Rebound Common Sports-Related Hand and Wrist Injuries Available from:https://www.reboundmd.com/news/common-sports-related-hand-and-wrist-injuries (last accessed 15.3.2020)