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Sports Injuries of the Hand

An interview with Dr. Michelle Carlson

Michelle G. Carlson, MDAssociate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College

• Overview
• Prevention
  

OverviewA jammed finger during a ball game. A painful elbow after a game of tennis. A sore thumb following a fall while skiing. Injuries like these may not seem serious at first, but left untreated, can put athletes of all levels on the sidelines for months—and have a lasting effect on function.
Sports-related hand injuries range from these apparently "minor" problems to those whose gravity is immediately evident, such as a fracture or dislocation to the wrist or finger joint. As noted, those associated with a specific activity or activities include:

• Skier’s thumb (sometimes referred to as Game Keeper’s Thumb), a high-energy injury in which the ligament at the base of the thumb is torn. This occurs when the patient falls forward and the thumb is bent backward.
  

• Tennis elbow, in which a tendon on the outside of the forearm fails and begins to tear away from the bone. While this injury originates near the elbow, pain may extend down the forearm.
  
  
  
  
• Golfer’s elbow, similar to tennis elbow, this injury affects the tendon on the inner side of the elbow.
• De Quervain’s tendonitis, inflammation of the tendon that runs down the forearm, through the wrist, to the thumb. This injury is brought on by many activities including using a keyboard, golfing and fishing (particularly fly-fishing).
  
  
  
  
• Wrist fractures, which can occur with many athletic activities; one of the most frequently seen injuries in beginning rollerbladers or snowboarders who tend to fall backward on their hands.
  
  
  
  
  
• Jamming a finger, or "basketball finger," occurs during any athletic activity where the hand comes in contact with a ball. This injury ranges in severity from a sprain to a simple dislocation that may be corrected when the patient pulls on the finger to a more complex, serious dislocation or fracture of the joint.
• Tendonitis may also be seen in weight lifters with poor technique or in those who attempt to lift too much weight too soon. Similarly, beginning yoga practitioners may develop the problem by attempting postures that place too much stress on tendons that are not yet ready to accommodate it.
  

A Prompt DiagnosisRegardless of the severity of the injury, prompt attention from an orthopedist can make an important difference in the patient’s long-term recovery and ability to continue participating in sports. "A jammed finger is a good example," explains Michelle Carlson, MD, a specialist in hand surgery at Hospital for Special Surgery. "You can’t really tell the extent of the injury by looking at the finger, so it’s important to get an x-ray." If the finger is fractured, failure to get timely treatment will eventually result in arthritis and considerable pain. Injury to the middle joint of the finger can be particularly debilitating since this joint is essential to making a fist.
"Patients often ask me, 'How do I know if my finger is broken?' Or they will say, 'I could move it, so I thought it was not broken,'" Dr. Carlson adds. "The only way to assess for a break is with an x-ray. Occasionally, patients will delay treatment because they can move their finger, only to eventually find out that they had an injury that, if treated early, would have had an excellent result and now is untreatable and headed to arthritis." TreatmentsFortunately, many of the injuries described can be treated with simple procedures that yield excellent long-term results. Jammed fingers that are dislocated can be relocated, that is, put back in proper alignment, often in the orthopaedic surgeon’s office. If the finger is broken, the joint may need to be immobilized. "Patients need to be aware that even with a simple jam, swelling can last for a long time. It will improve over a period of 6-12 months, but in some cases it never goes away completely," Dr. Carlson says. A program of rehabilitation exercises helps patients prevent or reduce debilitating stiffness.
Skier’s thumb can be treated with a simple procedure in which the ligament is reattached. This operation is done under regional anesthesia (the arm is numbed) and requires no hospitalization. Repairing this ligament is crucial since the thumb is responsible for about 50% of hand function, specifically for any movement that requires opposition, such as holding a cup or using a key. As with jammed fingers, timely treatment is essential. At three months following the injury, the orthopaedic surgeon may not be able to reattach the ligament and more complex surgery may be necessary.
Tendon injuries that result from persistent gripping of a racquet or golf club (or poor technique) or from numerous repetitions during weight lifting may be treated in a variety of ways. The affected joint may need to be immobilized. Therapy to decrease inflammation and swelling can include ultrasound treatments or iontophoresis. In the latter procedure cortisone cream is spread on the skin covering the affected area. A small electric charge is applied to get the cream to sink in and treat the muscles and tendons below. A cortisone injection or other anti-inflammatory medication may also be needed. If these measures fail, surgery to open the tunnel or sheath that the tendon runs through, or in some cases remove the diseased tissue, may provide relief. Following surgery and recovery the patient receives instruction on how to alter their activities to avoid recurrence of the injury.
Treatment for fractures of the wrist or finger joints varies with the severity of the break. High energy, severe impact fractures, are often the most complex and may be comminuted (the bone is broken into many fragments.) These fractures may also be open, that is, the bone pierces the skin, and can carry a greater risk of infection. A range of treatments are available to patients. In the case of severe and otherwise untreatable fractures, including those not treated promptly, joint reconstruction or replacement may be viable options.

Illustration of wrist joint prostheses

PreventionPreventing a sports-related hand injury may not always be possible, but there are steps you can take to reduce their impact if they do occur. Dr. Carlson advises anyone who participates in athletic activities to practice strengthening exercises on a regular basis, always stretch before playing, and to refrain from playing through pain. Stretching and strengthening exercises that protect the hands and wrists are simple to perform and do not require special equipment.

For stretching, Dr. Carlson recommends extending the arm with elbows straight, and curling the hand to move the wrists up and down. Individuals can build strength by squeezing a ball in the hand, doing wrist curls while holding a soup can or a light weight, or extending the fingers against the resistance of rubber bands placed around them.
Dr. Carlson, who is a consulting hand surgeon for the New York Knicks and athletes at St. John’s University, also notes that after seeking treatment, patients should not return to play prematurely. "You may see athletes on television playing with tape or a splint, but they have only done so with their physician’s guidance. They’re not playing through pain that’s undiagnosed," she says.






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