Sports-related Hand Injuries and Their Management

Introduction:

Sports are an integral part of our regular lives. However, sport-related injuries are also common among athletes and children. Around 25 percent of sports-related injuries involve hands. Apart from the hand, such injuries often include the elbow and wrist. Factors like acute trauma, chronic injury, and chronic overuse are responsible for such injuries. Such injuries can be soft tissue injuries involving ligaments, tendons, and muscles or hard tissue injuries like fractures.

What Are the Fractures Related to Sports-related Hand Injuries?

A fracture or discontinuation of bones is observed due to acute traumatic injury.

Different fractures seen in hand injuries are;

1. Distal Radius Fracture: Distal radius fracture is the most common type of wrist fracture. This type of wrist injury is seen due to trauma to the forearm. This fracture is common in sports like hockey, ice skating, and in-line skating. This type of fracture is often accompanied by injuries like radio-ulnar joint injury (joint between two bones of the hand), and elbow fracture. The most common complications are swelling and pain in the wrist, limited range of motion, pain and tenderness at the fracture site, and hematoma (accumulation of blood inside the skin). A closed displaced distal radius fracture can be treated by closed reduction with immobilization. However, complicated fractures require surgical interventions.

2. Dorsal Cortical Triquetral Fracture: Triquetral fractures of the dorsal cortex are the second most common carpal fractures (fractures of the wrist bones). Many dorsal triquetral fractures are commonly misdiagnosed as wrist sprains. These injuries have traditionally been considered avulsion fractures of the dorsal capsular ligaments of the triquetrum. Still, some researchers say the injury results from the triquetrum striking the distal ulna. Physical exams are often non-specific, except for tenderness and swelling in the wrist. However, an examination could reveal tenderness over the triquetrum and the dorsal capsular fragment, as validated by the lateral radiograph. The primary treatment approach involves immobilization for around two to three weeks.

3. Scaphoid Fracture: Scaphoid fracture is the most common type of fracture of the carpal bone. This type of fracture is mainly seen among football players or cricketers. The hyperextension wrist injury typically happens in a pronated, radially deviated hand. Symptoms include severe pain, swelling, and a limited range of wrist motion. It is often associated with a scaphoid nonunion following a past wrist sprain. Athletes may also experience radial-sided wrist pain and intense tenderness in the radial fossa (a depression in the lateral side of the dorsum of the wrist), axial loading of the thumb, or pincer grasp.

4. Hook of Hamate Fracture: The hamulus, also known as the hook of the hamate, is a bony projection that acts as a pulley for the flexor tendons when performing a power grip. Fractures of the hook of the hamate are commonly observed in sports such as baseball, golf, and tennis. This type of injury is caused by the transfer of force from the bat, club, or racquet to the palm, resulting in a fracture. This type of fracture is complex to diagnose due to the absence of specific symptoms.

5. Metacarpal and Phalangeal Fractures: Around 10 percent of the fractures related to sport-related injuries are this kind of fractures. Injuries like falls, direct blows, or crushes during sporting activity cause it. Such injuries are common in sports like football, lacrosse, and hockey. The common complications associated with such fractures are; swelling, ecchymosis (a skin discoloration due to accumulation of blood), and limited range of motion. Nonoperative treatment is suitable for fractures as where proper alignment can be preserved through immobilization. When conservative methods are not effective, surgical intervention is necessary. Athletes may opt for operative fixation to expedite their return to sports.

What Are the Soft Tissue Injury in Sports-related Hand Injuries?

The soft tissue complications are mainly tendon and ligament injuries seen in sports-related wrist injuries.

These injuries are,

1. Scapholunate Ligament Tear: The scapholunate ligament connects the scaphoid and the lunate bone. In cases of scapholunate ligament injury, the scaphoid becomes disconnected from the lunate, leading to asymmetrical movement of the two carpal bones. This type of injury is often associated with a fall on a wrist that is extended and deviated towards the ulnar side. Such injuries are more common in sports like football or rugby. Common symptoms of this kind of ligament tear include pain, difficulty in movement, and a clicking sound in radial deviation. Wrist immobilization and arthroscopy are the probable treatment options.

2. Radial-sided Tendinopathies: These are chronic hand injuries of the tendons due to overuse. The most common type of tendinopathy related to wrist injury is de Quervain’s tenosynovitis. Continuous thumb extension and abduction may result in the thickening of the abductor pollicis longus and extensor pollicis brevis tendons causing this type of complication. Tendonitis of the flexor carpi radialis results from repetitive wrist flexion or acute overstretching of the wrist. It is often seen in sports such as volleyball or water polo. The pain originates from the thickening of the tendon as it passes through its tunnel adjacent to the carpal tunnel. Usually, the pain travels from the radial palmar wrist crease to the base of the second metacarpal, exacerbated by resisted wrist flexion. Immobilization of the hand and wrist, cold compression, stretching, and medication can cure such complications.

3. Extensor Carpi Ulnaris (ECU) Subluxation: This tendon injury is seen in golf, baseball, hockey, and tennis. The tendon travels through a protective covering in the lower part of the forearm and connects to the base of the fifth metacarpal. This sub-sheath also plays a role in maintaining stability in the distal radioulnar joint. A sudden tear in this protective covering or weakening of the covering leading to significant displacement of the tendon can occur. Tenderness in the ECU groove and discomfort during extension and ulnar deviation are common signs of tendinopathy. Subluxation may cause a snapping sensation during supination and an ulnar deviation of the wrist.

Conclusion:

Sports-related hand and wrist injuries are ubiquitous. They are seen in sports like football, volleyball, basketball, tennis, hockey, and golf. Bone injuries include complications like distal radial fractures, scaphoid fractures, and metacarpal and phalangeal fractures. Soft tissue injuries include ligament and tendon injuries. Surgical interventions, immobilization, and proper rest are necessary treatment modalities in such cases.