SPORTS INJURIES

Injuries caused playing tennis or skiing may not seem serious at first, but left untreated, can put athletes of all levels on the sidelines for months—and have a lasting effect on function. Sports-related hand injuries range from these apparently “minor” problems to those whose gravity is immediately evident, such as a fracture or dislocation to the wrist or finger joint. As noted, those associated with a specific activity or activities include:

• Skierʼs thumb (sometimes referred to as Game Keeperʼs Thumb), a highenergy injury in which the ligament at the base of the thumb is torn. This occurs when the patient falls forward and the thumb is bent backward.

• Tennis elbow, in which a tendon on the outside of the forearm fails and begins to tear away from the bone. While this injury originates near the elbow, pain may extend down the forearm.

• Golferʼs elbow, similar to tennis elbow, this injury affects the tendon on the inner side of the elbow.

• De Quervainʼs tendonitis, inflammation of the tendon that runs down the forearm, through the wrist, to the thumb. This injury is brought on by many activities including using a keyboard, golfing and fishing (particularly flyfishing).

• Wrist fractures, which can occur with many athletic activities; one of the most frequently seen injuries in beginning rollerbladers or snowboarders who tend to fall backward on their hands.

• Jamming a finger, or “basketball finger,” occurs during any athletic activity where the hand comes in contact with a ball. This injury ranges in severity from a sprain to a simple dislocation that may be corrected when the patient pulls on the finger to a more complex, serious dislocation or fracture of the joint.

• Tendonitis may also be seen in weight lifters with poor technique or in those who attempt to lift too much weight too soon. Similarly, beginning yoga practitioners may develop the problem by attempting postures that place too much stress on tendons that are not yet ready to accommodate it.

Regardless of the severity of the injury, prompt attention from an orthopedist can make an important difference in the patientʼs long-term recovery and ability to continue participating in sports. If the hand, wrist or finger is fractured, failure to get timely treatment will eventually result in arthritis and considerable pain.

Fortunately, many of the injuries described can be treated with simple procedures that yield excellent long-term results. Jammed fingers that are dislocated can be relocated, that is, put back in proper alignment, often in the orthopaedic surgeonʼs office. If the finger is broken, the joint may need to be immobilized. A program of rehabilitation exercises helps patients prevent or reduce debilitating stiffness.

Skierʼs thumb can be treated with a simple procedure in which the ligament is reattached. This operation is done under regional anesthesia (the arm is numbed) and requires no hospitalization. Repairing this ligament is crucial since the thumb is responsible for about 50% of hand function, specifically for any movement that requires opposition, such as holding a cup or using a key. As with jammed fingers, timely treatment is essential. At three months following the injury, an orthopaedic surgeon may not be able to reattach the ligament and more complex surgery may be necessary.

Tendon injuries that result from persistent gripping of a racquet or golf club (or poor technique) or from numerous repetitions during weight lifting may be treated in a variety of ways. The affected joint may need to be immobilized. Therapy to decrease inflammation and swelling can include ultrasound treatments or iontophoresis. In the latter procedure cortisone cream is spread on the skin covering the affected area. A small electric charge is applied to get the cream to sink in and treat the muscles and tendons below. A cortisone injection or other antiinflammatory medication may also be needed. If these measures fail, surgery to open the tunnel or sheath that the tendon runs through, or in some cases remove the diseased tissue, may provide relief. Following surgery and recovery the patient receives instruction on how to alter their activities to avoid recurrence of the injury.

Treatment for fractures of the wrist or finger joints varies with the severity of the break. High energy, severe impact fractures, are often the most complex and may be comminuted (the bone is broken into many fragments.) These fractures may also be open, that is, the bone pierces the skin, and can carry a greater risk of infection. A range of treatments are available to patients. In the case of severe and otherwise untreatable fractures, including those not treated promptly, joint reconstruction or replacement may be viable options.