SPORTS INJURIES OF THE HAND AND WRIST

The hand and wrist are generally involved in any sport and therefore are very prone to injuries. The types of injuries include ligament sprain, tears and fractures.

MALLET FINGER

A minor hit to the tip of the finger can result in a mallet deformity. This can be easily treated in a splint for six to eight weeks.

A higher impact can result in a fracture at the base of the distal phalanx and this requires fixation of the fracture as this is an intra-articular fracture.

COLLATERAL LIGAMENT INJURIES

Collateral ligament injuries involve the sprain or tear of the ligaments that hold the finger joints. This happens when the finger is twisted or forced into an extended position. X-rays are usually required but the patient will present pain and swelling of the joint. This is sometimes associated with bruising. Rest and icing is usually the best way to prevent further injuries. If pain persists for more than a week, it’s usually a tear of the ligament and you should seek professional help. Torn ligaments can cause pain for many months in certain movements of the finger but normal and simple movements are relatively pain free and this may give the patient the complacency that all is well.

CRICKET AND BASKETBALL INJURIES

These injuries can be quite nasty due to the equipment involved. They can include an intra-articular fracture of the proximal interphalangeal joint (PIPJ). This needs assessment and may require surgery if the joint is dislocated or subluxated.

This can be quite nasty injuries and the speed of the ball is fast and the cricket ball is hard and this can result in an intra-articular fracture of the proximal interphalangeal joint (PIPJ). This need immediate assessment and may require surgery if the joint is dislocated or subluxated.

SKIER’S THUMB OR BICYCLE INJURY

This happens when the thumb is caught against a ski pole or the bicycle handle with the body moving forward. A massive force may cause a tear of the ulnar collateral ligament or an avulsion fracture at the base of the proximal phalanx of the thumb bone. In a partial tear of the ligament a thumb spica splint is usually sufficient. In chronic cases or if there is instability of the thumb joint, repair of the ligament or fixation of the fracture is recommended.

Hand Fractures

Hand fractures are very common sports injuries. One of the more common fractures is the boxer’s fracture which is the fracture of the fifth metacarpal neck.

The oblique fracture of the fourth metacarpal is also another common fracture as this bone is the thinnest of all the metacarpals. This is due to a twisting injury such as a finger getting caught in the rugger jersey.

Fracture distal radius usually happens after a fall on an outstretched hand and in a high-impact fall, an intra-articular fracture of the distal radius can happen.

Rock climbing

This is a sport that is gaining popularity in Singapore. One of the most common injuries from rock climbing is the tear of the pulleys of the flexor tendon system. This is due to the stress put upon the two important pulleys in the finger flexor tendon system – the A4 and A2. It is best to support these pulleys during rock climbing with splints or sports tape as shown.

Wrist injuries in sports

Two major ligament injuries seen in sports are the tear of the scapholunate ligament and the triangular fibrocartilage ligaments. This is usually from a major fall on an outstretched hand or repeated use of the wrist in a hyperextended position like in gymnasts or goalkeepers and volleyball players. Scapholunate ligament tears can eventually lead to instability of the wrist joint resulting in weakness and chronic wrist pain. This will subsequently lead to dissociation of the scapholunate joint. (See X-rays below)

These cases will need reconstruction of the scapholunate ligament as shown.

Ulnar sided wrist pain (pain over the little finger side of the wrist) is sometimes associated with tear of the triangular fibrocartilage complex (TFCC). In the early stage of the injury, immobilisation of the distal radial ulnar joint with a splint may be sufficient to treat this condition.

Ulnar sided wrist splint

In the unstable and chronic painful stage, an MRI is usually done to confirm the tear and a direct strong repair of the TFCC is advisable. (See MRI below)

MRI showing TFCC tear

If you would like to learn more about the treatment and the possible outcomes, feel free to inquire here.