Dr. Alejandro Badia, MD, FACS, and world-renowned Hand & Upper Limb Surgeon, President of the ISSPORTH (International Society for Sport Traumatology of the Hand), will visit Barbados the first week of December. Dr. Badia will offer a free Medical Conference for local medical professionals and another one for patients and professional athletes.
Athletic injuries in the hand and wrist are often misdiagnosed and under treated 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 are currently being refined at the Miam Hand Center arthroscopy laboratory as well as other clinical research centers.
Alejandro Badia, M.D, F.A.C.S.
April 12, 2008
Sean Edey is a gifted golf player from the island of Barbados. He is so promising that at 19 years of age he’s already an accomplished member of the golf team at Bethune-Cookman University of Florida, where he attends on an athletic scholarship. So when he started having pain in his left wrist in the summer of 2007, Mr. Edey was concerned about the discomfort and its effect on his golf game.
“I tried giving it a rest,” he says. “I looked for help, was given injections, but by December it was still hurting.”
That’s when he went to see Alejandro Badía, M.D., hand and upper extremities surgeon and chief of hand surgery at Baptist Hospital of Miami.
“He had a ligament tear in between two small and very important wrist bones, a condition which is very difficult to diagnose, even with a magnetic resonance imaging (IMR) test. I only can diagnose it clinically, that is, with a physical exam and then confirm it with an arthroscopic exploration,” says Dr. Badia. “Mr. Edey’s wrist ligament was indeed torn and frayed. It was not terrible but it was enough to cause bone instability, which means that the position between those bones was dislocated producing an abnormal movement. This is painful for someone when they put weight on the hand, do strenuous movements with it and, of course, play golf.”
Fortunately, through the same arthroscopic exploration procedure, Dr. Badia fixed problem that is known as a scapholunate ligament tear.
“I debreded the area, removed the defrayed edges to encourage new blood supply and pinned the two bones together,” explains Dr. Badia. “What is great with arthroscopy is that it’s a minimally invasive procedure, done under local anesthesia, as an outpatient. It leaves no scars. I reach the inside of the wrist through two small holes through which I slide a tiny camera and the cutting and cleaning instruments.” After surgery the patient wears a cast to immobilize the area for eight weeks, which allows for new ligaments to form. Once the cast is removed, the patient begins physical therapy and rehabilitation.
“I see these types of lesions frequently because much of my practice is related to complex wrist problems,” says Dr. Badia. “It is often difficult to diagnose. When patients complain of wrist pain, they’re sent for X-rays and, unless something is obvious, they receive a splint or physical therapy. But these things do not work if it’s a ligament tear.”
Four months after the surgery Mr. Edey rejoined his golf team.
“I took part in the Barbados Open at the end of last June, in the Caribbean Championship last August and in three college-level tournaments,’ says Edey. “My wrist healed so well that I’m going to be playing year round!”
“It’s obvious”, concludes Dr. Badia, “that if you have wrist pain for more than three months you should go to a hand and wrist specialist for an evaluation. Yet, the most common is going to four or five different doctors before coming to the hand specialist. Wouldn’t it be more efficient and even cheaper to start off going to him directly?”