Hand and wrist injuries

• Injuries to the hands and wrist are common in

athletes. Injuries include acute fractures,
dislocations, ligamentous, and tendon injuries,
as well as more chronic injuries such as sprains
and strains.
 Sprains
Sprains are damage to ligaments. A ligament is
a type of tissue that connects bone to bone.
There are different grades of sprain from a
minor tear to complete rupture. Treatment and
recovery time will depend on grade of sprain.
 Thumb Sprains
Breaking a fall with the palm of your hand or taking
a spill on the slopes with your hand strapped to a ski
pole could leave you with a painful thumb injury. The
ulnar collateral ligament may be sprained. This
ligament acts like a hinge and helps your thumb to
function properly. If you sprain your thumb, you could
lose some or all of your ability to grasp items between
your thumb and index finger or to grasp well with the
entire hand.
 Wrist Sprains
When you fall forward, as when you trip running
or rollerblading, your natural response is to put
your hands out in front of you to catch yourself.
Unfortunately, this natural response causes you to
land on your palm, bending your wrist backwards,
and possibly stretching or tearing the ligaments
connecting the bones in your wrist. The resulting
injury is a wrist sprain.
 Injuries to the Bone
Bones can be fractured and dislocated. A fracture is a
crack or break in a bone. It is commonly referred to as
broken bone. A dislocation is when a bone is pushed out
of place so that they no longer line up correctly at the
joint. This can decrease the ability to move and cause
pain.
Finger Fractures
The most common fracture of the metacarpals is a
boxer's fracture. A boxer's fracture usually occurs when
you strike an object with your closed fist. With a boxer's
fracture, the fifth metacarpal joint (the one at the base
of your littlest finger) is depressed and the surrounding
tissue is tender and swollen
 Wrist Fractures
Scaphoid fractures account for many wrist fractures. The
scaphoid bone is one of eight small bones that make up
the wrist. Wrist fractures are common both in sports and
motor vehicle accidents. The break usually occurs during a
fall on the outstretched wrist. The angle at which the wrist
hits the ground may determine the type of injury. The
more the wrist is bent back (extension), the more likely the
scaphoid bone will break. With less wrist extension it is
more likely the lower arm bone (radius) will break. 
Scaphoid fractures are not always immediately obvious.
Many people with a fractured scaphoid think they have a
sprained wrist instead of a broken bone because there is
no obvious deformity and very little swelling.
 Dislocations of the PIP Joint
One of the most common injuries to an athlete's
hand is an injury to the joint above the knuckle, the
proximal interphalangeal (PIP) joint. Injuries to the PIP
joint occur when the finger is either hyperextended
(forced backwards) or forced into flexion (downward
into a bent position). Injuries to the PIP joint may
include fractures, dislocations, and fracture
dislocations.
 Soft Tissue and Closed Tendon Injuries
Tendons are a type of connective tissue that attaches
muscle to bone. A common injury of the tendon is
called tendonitis, an irritation of the tissue.
DeQuervain's Syndrome
DeQuervain's syndrome is a common injury in
racquet sports and in athletes who use a lot of wrist
motion, especially repetitive rotating and gripping.
 De Quervain's Tenosynovitis
The overuse of the hand may eventually cause
irritation of the tendons found along the thumb side
of the wrist. This irritation causes the lining around
the tendon to swell, making it difficult for the tendons
to move properly.
 Bennett fracture-A base of the thumb
metacarpal fracture.
 A Bennett fracture is a fracture  of the base of the
thumb resulting from forced abduction of the
first metacarpal. It is defined as an intra-articular two-
part fracture of the base of the first metacarpal bone.
The most common mechanism of injury is an axial
force (compression) applied to the thumb whilst in
flexion.
 On physical examination Bennett's fracture of the
first carpometacarpal joint may present with:
visible deformity if the fracture is displaced
pain and swelling +/- ecchymosis over carpo
metacarpal joint of the thumb
tenderness to touch
warmth over the area in acute phase
decreased pinch grasp and decreased grip strength.
Diagnosis made by x-ray and ct scan.
 Non-operative treatment in a thumb spica cast for
3-4 weeks can be considered in stable, non-
displaced fractures.
• Operative treatment is recommended for
unstable fracture patterns and intra-articular
displacement of >1 mm. While open reduction
and internal fixation with a screw or K-wire are
both common practice, screws are often
preferred as K-wires must be removed after
union.
 Untreated or malreduced fractures can lead to
secondary osteoarthritis. Osteoarthritis or malunion
can cause significant pain and functional decline.
Generally, hand fractures are treated by
immobilization with a cast or splint regardless of
whether surgical or conservative treatment was
required.
Most wrist fractures heal in 8 weeks. For metacarpal
bones and phalanges it can take 4-6 weeks.
 Hand Fractures
A hand fracture is a break in one of the bones in the
hand. This includes the small bones of the fingers
(phalanges) and the long bones within the palm
(metacarpals). A broken hand can be caused by a fall,
crush injury, twisting injury, or through direct contact in
sports.
In most cases, a hand fracture will heal well with
nonsurgical treatment. Depending on the type and
location of the fracture, this may include wearing a cast,
splint or buddy straps for a period of time. For more
serious fractures or for fractures that do not line up
properly, however, surgery may be required to realign
the broken pieces of bone.
• Symptoms
• Signs and symptoms of a hand fracture may include:
• Swelling
• Bruising
• Tenderness or pain
• Deformity
• Inability to move the finger
• Shortened finger
• The injured finger crosses or “scissors” over its
neighbor when making a partial fist.
• Surgical Treatment
• Some hand fractures require surgery to realign and
stabilize the fracture fragments. This includes open
fractures in which pieces of bone have broken
through the skin.
• Your doctor will make an incision to help reposition
the bone fragments into their normal alignment.
Small metal devices—such as wires, screws, pins,
staples, and plates—may be used to hold the pieces
of fractured bone in place.
After surgery, you may have to wear a splint or cast for a period of time
in order to protect the fracture. If the bone changes position during
healing, your finger may lose some function. Your doctor will talk with
you about when it is safe to begin range-of-motion exercises and to
resume your activities after surgery