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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

Lateral epicondylitis is a tendonitis commonly known as “tennis elbow”, although the majority of people with lateral epicondylitis have never played tennis. The condition causes pain on the outside portion of the elbow over a bony prominence named the lateral epicondyle. Pain occurs with activities such as grasping, pushing, pulling, and lifting. As the process progresses, the pain may occur with limited activities or even at rest. Of note, a separate entity termed golfers elbow, or medial epicondylitis, causes pain on the inside of the elbow.

Anatomy
The lateral epicondyle is where the Extensor Carpi Radialis Brevis (ECRB) tendon inserts. This tendon attaches to the muscle that allows your wrist and fingers to extend.

Diagnosis 
The diagnosis is usually made based on the history that the patient describes to the healthcare provider, and a physical exam. There will be localized tenderness in the region of the lateral epicondyle. Pain is also often reproduced with the patient extending their wrist under resistance.

X-rays may be done to rule out other causes of elbow pain; however, these are typically normal. Very rarely are other imaging modalities, such as MRI (magnetic resonance imaging) needed.

Treatment – Nonsurgical 
Treatment Nonsurgical treatment mainly focuses on addressing the symptoms, but do not resolve the cause of the pain. Rest and proper stretching is the first step, combined with anti-inflammatory medications. Stretching is focused on the wrist extensor muscles. First, the extensor muscles are stretched with the elbow held in flexion, and later with the elbow extended. Finally, strengthening exercises are performed, focused on the extensor muscles.