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Traumatic sports Injuries to the fingers and thumb are commonly occurring, occasionally career ending, lesions to the competitive athlete, particularly cricket players.

While often neglected, these injuries can occur in both contact and non-contact sports due to the crucial role the hand plays in many sporting activities. Unfortunately, these rarely receive much attention by the trainer or traditional team doctor, and it is only when the pain, swelling and functional deficit persist that the patient is referred to the hand surgeon specialist. The injury is often given the misnomer “jammed finger”, yet a clear diagnosis is rarely established, and this can have disastrous long term consequences to hand function and consequently, athletic performance.

Digital injuries usually occur via an axial impaction mechanism in ball sports, while twisting injuries are seen more in contact sports. Regardless, the injuries can range from simple collateral ligament sprains, to tendon avulsions, or even complex articular fractures. The exact diagnosis will determine treatment and the time of return to sport. Thumb injuries overwhelmingly occur at the critical MCP joint, with ligamentous injuries requiring careful deliberation if operative intervention is needed. Early assessment will allow for the appropriate type and position of protective immobilization, often allowing continued play. More severe injuries, requiring surgical intervention, are also best treated early as this will lead to the best possible result and then allow faster return to competition. Articular fractures of the PIP joint are good examples, in that delayed recognition will completely alter the treatment options. For example, a complex fracture dislocation may be amenable to dynamic external fixation if assessed within first ten days, but delayed evaluation and treatment may then require a less predictable reconstruction, such as hemi-hamate arthroplasty. Arthroscopy, particularly at the finger or thumb MCP joint, provides a less invasive and more accurate way of assessing chronic pain issues at this joint. Acute injury, such as a bony gamekeeper’s fracture, can also be more optimally treated via arthroscopy, avoiding the scar formation that can delay recovery and return of necessary motion.

Finger injuries are commonly seen in Bahamian cricket athletes and early recognition is key. Team physicians, trainers, coaches and cricket players themselves must learn that optimal long term function depends on early, accurate diagnosis and the hand specialist should be involved from the onset.

(Miami): The latest study conducted by the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) shows that more than 1.9 million individuals had a sports-related injury that was treated in the recent years. More than 231,000 soccer injuries were treated, 83 percent of the injuries were among men. Among those injuries were broken and/or dislocated fingers and wrist bone fracture. With so many bones, ligaments, tendons, and joints keeping hands and wrists working, there is ample opportunity for severe injury. In fact, injuries to the hand and wrists are some of the most frequently acquiring inquiries facing athletes today. The most common sports-related hand and wrist injuries can be classified into two main categories, traumatic (acute) and Overuse (chronic). Traumatic (acute) refers to any specific, sharp pain that is of rapid onset or pain that results from a specific traumatic incident such as an athletic injury. Traumatic injuries are more commonly seen in athletes who participate in certain sports that require a higher level of contact (i.e., football, hockey, or wrestling). The most common traumatic fracture injury in the athletic population is found in the fingers and include joint dislocations, sprains, muscle strains, broken bones, tendon inflammation, and ligament tears. “Major fractures of the hand or wrist occur only during high-speed contact or in older athletics who may have osteoporosis. Complex fractures below the elbow can occur and there is a great variation in the fracture patterns. It is important that an upper extremity specialist evaluate these injuries, as recovery of full wrist and hand range of motion is often difficult. Fractures of the upper arm (humerus) may also result from this injury and can even extend into the shoulder joint,” stated Dr Alejandro Badia, Leading Hand and Upper Extremity Surgeon at Badia Hand to Shoulder Center. Overuse (chronic) injuries are more likely to occur in athletes who engage in sports that require them to repeat a particular movement (i.e., baseball, soccer, tennis, or golf). Overuse injuries are likely to be stress induced and include tendon inflammation and dislocation, nerve injury, and overuse stress fractures. Chronic injuries have a higher tendency to develop long-term affects. However, long-term disability is less likely to occur from overuse injuries than from traumatic injuries. An athlete’s performance may significantly diminish, if the chronic injuries are left untreated. Surgery may be required if the overuse chronic injuries persists and continues to develop over time. Athletic hand and wrist injuries can cause great pain and strain both physically and emotionally. Should you experience a hand or wrist injury while participating in any physical sport where an attending team physician is not present, seek immediate medical attention. It is important to be aware of what the immediate symptoms include, yet symptoms are never limited to the following:

• Sever pain and swelling
• Numbness
• Coldness or grayness in the finger, hand, or wrist
• Abnormal twisting or bending of the finger or hand
• A clicking, grating, or shifting noise while moving your finger, hand, or wrist
• Bleeding that doesn’t stop and persists for more then 10 minutes

If mild wrist pain, bruising, or swelling after the injury lingers or does not improve over time, a doctor or a specialty physician should be contacted. Treatment depends on the location, type, duration, and severity of the injury. Some injuries may require surgery, such as ligament tears. The key point to a fast recovery is to seek evaluation by a dedicated upper extremity specialist. The general orthopedic surgeon often addresses simple fractures, but the highly competitive athlete truly needs an optimal result in order to maximise their return to full function. Given timely and precise treatment, there is no reason why a professional or any sportsman should not be able to return to their regular lifestyle after sustaining an injury to their hand or wrist.   Ver Artículo »

(Miami): The latest study conducted by the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) shows that more than 1.9 million individuals had a sports-related injury that was treated in the recent years. More than 231,000 soccer injuries were treated, 83 percent of the injuries were among men. Among those injuries were broken and/or dislocated fingers and wrist bone fracture. With so many bones, ligaments, tendons, and joints keeping hands and wrists working, there is ample opportunity for severe injury. In fact, injuries to the hand and wrists are some of the most frequently acquiring inquiries facing athletes today. The most common sports-related hand and wrist injuries can be classified into two main categories, traumatic (acute) and Overuse (chronic).

Traumatic (acute) refers to any specific, sharp pain that is of rapid onset or pain that results from a specific traumatic incident such as an athletic injury. Traumatic injuries are more commonly seen in athletes who participate in certain sports that require a higher level of contact (i.e., football, hockey, or wrestling). The most common traumatic fracture injury in the athletic population is found in the fingers and include joint dislocations, sprains, muscle strains, broken bones, tendon inflammation, and ligament tears.

“Major fractures of the hand or wrist occur only during high-speed contact or in older athletics who may have osteoporosis. Complex fractures below the elbow can occur and there is a great variation in the fracture patterns. It is important that an upper extremity specialist evaluate these injuries, as recovery of full wrist and hand range of motion is often difficult. Fractures of the upper arm (humerus) may also result from this injury and can even extend into the shoulder joint,” stated Dr Alejandro Badia, Leading Hand and Upper Extremity Surgeon at Badia Hand to Shoulder Center.

Overuse (chronic) injuries are more likely to occur in athletes who engage in sports that require them to repeat a particular movement (i.e., baseball, soccer, tennis, or golf). Overuse injuries are likely to be stress induced and include tendon inflammation and dislocation, nerve injury, and overuse stress fractures. Chronic injuries have a higher tendency to develop long-term affects. However, long-term disability is less likely to occur from overuse injuries than from traumatic injuries. An athlete’s performance may significantly diminish, if the chronic injuries are left untreated. Surgery may be required if the overuse chronic injuries persists and continues to develop over time.

Athletic hand and wrist injuries can cause great pain and strain both physically and emotionally. Should you experience a hand or wrist injury while participating in any physical sport where an attending team physician is not present, seek immediate medical attention. It is important to be aware of what the immediate symptoms include, yet symptoms are never limited to the following:

• Sever pain and swelling
• Numbness
• Coldness or grayness in the finger, hand, or wrist
• Abnormal twisting or bending of the finger or hand
• A clicking, grating, or shifting noise while moving your finger, hand, or wrist
• Bleeding that doesn’t stop and persists for more then 10 minutes

If mild wrist pain, bruising, or swelling after the injury lingers or does not improve over time, a doctor or a specialty physician should be contacted.

Treatment depends on the location, type, duration, and severity of the injury. Some injuries may require surgery, such as ligament tears. The key point to a fast recovery is to seek evaluation by a dedicated upper extremity specialist. The general orthopedic surgeon often addresses simple fractures, but the highly competitive athlete truly needs an optimal result in order to maximise their return to full function. Given timely and precise treatment, there is no reason why a professional or any sportsman should not be able to return to their regular lifestyle after sustaining an injury to their hand or wrist.

Ver Artículo »

MIAMI – According to the latest study conducted by the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS), more than 1.9 million individuals had a sports-related injury that was treated in the recent years. More than 231,000 soccer injuries were treated, 83 percent of the injuries were among men. Among those injuries, broken and/or dislocated fingers and wrist bone fracture. With so many bones, ligaments, tendons, andjoints keeping hands and wrists working, there is ample opportunity for sever injury. In fact, injuries to the hand and wrists are some of the most frequently acquiring inquiries facing athletes today. The most common sports-related hand and wrist injuries can be classified into two main categories, traumatic (acute) and Overuse (chronic).

Traumatic (acute) refers to any specific, sharp pain that is of rapid onset or pain that results from a specific traumatic incident such as an athletic injury. Traumatic injuries are more commonly seen in athletes who participate in certain sports that require a higher level of contact (i.e., football, hockey, or wrestling). The most common traumatic fracture injury in the athletic population is found in the fingers and include joint dislocations, sprains, muscle strains, broken bones, tendon inflammation, and ligament tears.

“Major fractures of the hand or wrist occur only during high-speed contact or in older athletics who may have osteoporosis.  Complex fractures below the elbow can occur and there is a great variation in the fracture patterns.  It is important that an upper extremity specialist evaluate these injuries, as recovery of full wrist and hand range of motion is often difficult.  Fractures of the upper arm (humerus) may also result from this injury and can even extend into the shoulder joint.” – States Dr. Alejandro Badia, Leading Hand and Upper Extremity Surgeon at Badia Hand to Shoulder Center.

Overuse (chronic) injuries are more likely to occur in athletes who engage in sports that require them to repeat a particular movement (i.e., baseball, soccer, tennis, or golf). Overuse injuries are likely to be stress induced and include tendon inflammation and dislocation, nerve injury, and overuse stress fractures. Chronic injuries have a higher tendency to develop long-term affects. However, long-term disability is less likely to occur from overuse injuries than from traumatic injuries. An athlete’s performance may significantly diminish, if the chronic injuries are left untreated. Surgery may be required if the overuse chronic injuries persists and continues to develop over time.

Athletic hand and wrist injuries can cause great pain and strain both physically and emotionally. Should you experience a hand or wrist injury while participating in any physical sport where an attending team physician is not present, seek immediate medical attention. It is important to be aware of what the immediate symptoms include, yet symptoms are never limited to the following:

• Sever pain and swelling
• Numbness
• Coldness or grayness in the finger, hand, or wrist
• Abnormal twisting or bending of the finger or hand
• A clicking, grating, or shifting noise while moving your finger, hand, or wrist
• Bleeding that doesn’t stop and persists for more then 10 minutes

Contact your doctor or a specialty physician if mild wrist pain, bruising, or swelling after the injury lingers or does not improve over time.

Treatment depends on the location, type, duration, and severity of the injury. Some injuries may require surgery, such as ligament tears. The key point to a fast recovery is to seek evaluation by a dedicated upper extremity specialist.  The general orthopedic surgeon often addresses simple fractures, but the highly competitive athlete truly needs an optimal result in order to maximize their return to full function. Given timely and precise treatment, there is no reason why a professional or any sportsman should not be able to return to their regular lifestyle after sustaining an injury to their hand or wrist.

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Gym and fitness 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 particularly true in weightlifters, Cross fit athletes and bodybuilders since these athletes often rely upon allied health professionals such as chiropractic physicians, physical therapists and athletic trainers to make the diagnosis and recommend treatment. This is where the physician and ancillary health specialist can improve their management of these challenging and often obscure injuries.

The common injuries in the hand and wrist

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. In rare cases, this can be seen in doing excessively heavy wrist curls where a great stress is placed on the insertion of the tendon on the distal phalanx at the tip of the finger. 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 and weightlifter.

Blunt injuries can occur to the extensor mechanism as well and the wide range of complex joints in the hand and wrist. Much more common, however, is the chronic and overuse injury in the weightlifter. Repetitive heavy strain on a muscle/tendon unit can lead to microtears in this tissue and lead to the common entity known as tendonitis. This is a very general term and it is important to understand the specifics and severity of the particular lesion. Injuries as common as tennis/golf elbow, wrist tendonitis and rotator cuff strain must be evaluated by a specialist so that the more severe injury can be recognized early and treatment instituted by appropriate health care professional. At that point, the therapist, chiropractor or athletic trainer may be the most apt person to bring the fitness enthusiast back to full gym readiness !!   Dr. Alejandro Badia, Hand & Wrist Surgeon Miami, Florida.

Deep wrist pain can be the most common complaint of avid golfers

Acute injuries to the hand are uncommon in golf while development of painful syndromes can be very common, particularly due to underlying arthritis or tendonitis conditions.

Injuries to the upper limb in golfers are of two major types: The less common acute injury from a poor swing, or the much more common overuse injury or exacerbation of an underlying degenerative condition. The latter frequently occurs since golf is predominantly a game with older participants, and players often demonstrate the common pathologies seen in the mature population.

Ironically, many of these problems are seen much earlier due to the unnatural mechanism required in the upper limb during a golf swing. Acute injuries to the hand are uncommon in golf while development of painful syndromes can be very common, particularly due to underlying arthritis or tendonitis conditions.

Carpal Tunnel Syndrome (CTS)
CTS is a common nerve compression disorder at the wrist that can be more symptomatic after a long 18 hole round. Gripping of the club can worsen symptoms typically described as numbness and a cramping feeling in the hand. The golf activity itself, however, does not cause this problem. Initial treatment includes a night splint, high doses of vitamin B6 or anti-inflammatories. A corticosteroid injection in the wrist is occasionally used but the usual treatment is surgical which involves opening the carpal tunnel taking pressure off the nerve. This procedure can be performed through a small incision in the palm or endoscopically. The endoscopic technique implies use of a small fiber optic instrument and local anesthesia with almost no post-op discomfort. An added benefit is that the golfer can get back on the links within a ten to fourteen day period.

Wrist
Deep wrist pain can be the most common complaint of avid golfers. This pain is often ignored by the player or is inadequately diagnosed by the primary care doctor. Evaluation by an orthopedic surgeon is often critical and will consist of a careful physical exam sometimes followed by xrays and even an MRI. However, when a clear diagnosis and treatment plan are not formulated, the player should seek consultation with a hand and wrist specialist. The complex interplay between bony, ligamentous and soft tissue disorders require evaluation by a dedicated specialist and can often save the time and expense of a lengthy diagnostic work-up that may not even be necessary. (Read more detailed information about the three major regions of wrist pain at the Radius web site: www. radthemag.com)

Tendonitis 
Tendonitis of the fingers or wrist usually requires an injection or occasionally a minor surgical release. It can be a very painful condition and should be addressed promptly to avoid developing weakness in the hand and loss of grip strength. Osteoarthritis in the hand can be greatly exacerbated by vigorous gripping as can be experienced in driving a golf ball. The most common locations are the base of the thumb and the last joint of the digits. Mild symptoms can be managed by oral anti-inflammatories but severe pain and occasional deformity is successfully managed using surgical techniques.

Elbow pain
Elbow injuries are much less common than wrist problems but can be much more resistant to treatment. The condition known as golfer’s elbow is a tendonitis of the flexor region on the inside of the elbow. While the name associates the condition with golfing, it is actually relatively uncommon. Treatment usually includes an injection of corticosteroid and therapy for stretching and strengthening of the flexor muscles. While inappropriately named, tennis elbow is much more common in golfers. This painful condition tends to be persistent and leads to more pain when the athlete tries to extend the elbow, which can lead to limitations in long driving shots where power and good follow-through are necessary. Treatment includes intermittent injections but it is preferable to avoid more than three injections because tendon weakening can be a side effect. Resistant cases may require surgical treatment that has traditionally been done with an open incision and potentially long recovery time. Arthroscopic techniques are now also possible in the elbow and allow for very rapid recovery. Newer technology using radio frequency waves to dissolve the painful inflammatory tissue are also possible.

Shoulder Pain 
Deep persistent pain in the shoulder can affect both young and older golfers alike. The causes, however, can be very different and require a thorough diagnostic process to understand the underlying problem and lead to a solution. Young, active patients often feel that their pain is due to overuse. This may be the case, but it is important to understand why. Current exercise regimens usually emphasize strengthening the deltoid muscles, but the rotator cuff is largely ignored. This practice leads to an instability syndrome that can cause pain and even worse, a mechanical deficiency of the shoulder joint. If shoulder pain is a chronic problem, with no history of a single traumatic event, the patient will usually respond to strengthening therapy that requires diligence on the part of the patient and therapist. 

The most common cause of shoulder pain in older athletes is known as impingement syndrome. Bursitis is often an element of this syndrome and this frequently used term is much more accurate in depicting the problem than the term “arthritis.” Impingement occurs when the overlying bony arch of the shoulder is pressing on or irritating the underlying rotator cuff tendons and bursa. This situation may respond to conservative treatment including a cortisone injection to reduce the bursitis and shoulder therapy to improve the strength of the intact rotator cuff. A complete rotator cuff tear implies that the torn tendon has pulled away from the bone and cannot stabilize the head of the humerus against its cup joint. The patient either will be unable to raise the arm or will be able to only with severe pain. This whole range of impingement problems is characterized by pain with elevation of the arm, pain worse at night, and inability to lie on the side of the affected shoulder. Once the pain is severe enough and does not respond to therapy and other conservative means, surgery is indicated. Some smaller tears can be repaired through arthroscopic means. Most repairs require a onemonth period of immobilization in a sling and several months of postoperative therapy closely directed by the surgeon. The shoulder is a demanding joint and requires patience on the part of both patient and treating surgeon.

Prompt attention to painful conditions of the upper limbs will get you back on the greens and will extend your years of playing time at the game you love. 

Dr. Badia obtained his medical degree at New York University and also completed a Hand and Upper Extremity Fellowship at Allegheny General Hospital in Pittsburgh, Pennsylvania. He is a founding partner of the Miami Hand Center in Miami, Florida, where he conducts a prestigious hand surgery fellowship that has trained surgeons from five continents on small- joint arthroscopy. He organizes a yearly conference in Miami that brings together hundreds of surgeons to discuss hand/wrist joint replacement and arthroscopic procedures. Learn more about Dr. Badia on the Radius website, www.radthemag.com.