Athletic injuries in the hand and wrist are often misdiagnosed and undertreated for a variety of reasons. Chronic and overuse injuries often go untreated due to the athlete’s reluctance to seek medical attention. This is because in many sports, the athlete can compensate with some of these injuries while this may be more difficult in weight bearing joints such as the knee and ankle. However, a more preventable issue may be the inaccurate diagnoses and inadequate treatment often afforded the hand and upper extremity in athletes. This is where the physician and ancillary health specialist can improve their management of these challenging and often obscure injuries. In many instances, the hand surgeon should be involved at an early stage of treatment and to ensure an accurate diagnosis.
The common injuries in the hand and wrist are often sports specific and often aptly named. For example, jersey finger is an avulsion of the flexor profundus tendon that occurs when the athlete grabs the opponents jersey as they pull away. This leads to a sudden and resisted hyperextension force that avulses the tendon at its insertion site. A strong surgical repair is necessary followed by appropriate therapy to maximize the passive range of motion and later the active flexion. Subsequent strengthening is of obvious particular importance in the competitive athlete. Blunt injuries can occur to the extensor mechanism as well and the wide range of complex joints in the hand and wrist.
Small joint arthroscopy now gives us a more accurate method to diagnose many of these subtle injuries and of course provide treatment. Wrist arthroscopy indications have been well worked out, but newer techniques using metacarpophalangeal and thumb carpometacarpal arthroscopy are evolving. This includes better methods of fixation, radiofrequency probes to ablate and shrink tissue, and improved post-op methods of rehabilitation including splinting techniques and passive range of motion protocols.
These newer techniques will be reviewed in the context of common sports specific injuries.
Alejandro Badia, MD, FACS
Miami Hand Center