HAND SURGERY AND THE SPORTSMAN
Every sport has its injuries. Some sports have more than others. The hand is involved in most sports and, even in the sports where you are not allowed to use your hands, like soccer, the hand becomes the instinctive first line of contact to lessen a fall or reduce an impact.
The hand serves as an instrument to facilitate hitting a ball by holding a club, racket or bat, maintaining balance for the gymnast, catching or hitting a ball, clinging to a bike that is rocketing down the hill or to bowl the “googly” that traps the batsmen LBW in front of the wickets.
It is therefore no surprise that just as much as hands are used in sport, they are constantly exposed to the risk of high and low energy injuries, whether it is a fall on an outstretched hand or being hit by a fast bowler’s bouncer! These things happen and should not discourage participation in your favourite sports! Sporting injuries happen very quickly, without warning and commonly take an extended time to heal. But the good news is that, with a dedicated hand surgery team and a motivated patient, most patients can return to normal pre-injury performance. It takes hard work and dedication to ensure that realistic goals are achieved.
Any fall on an outstretched hand in the younger active population can create a wrist fracture. Scaphoid fractures are seen commonly in these scenarios. Skateboard injuries, cyclists coming off their bikes or ice skaters, commonly present with scaphoid fractures. There are a few friendly variations of these fractures although the most common (65%) of these fractures go through the waist of this boat shaped bone. These fractures take a long time to heal (approximately 6-10 weeks). The thought of immobilisation in a cast for this long period, creates significant anxiety in the sportsman. It is important to note that these fractures are susceptible to delayed or non-union (up to 16%), but also to avascular necrosis (where the bone dies), in less than 8% of patients. It is currently globally agreed that even with 1mm displacement, operative fixation of the fracture is the most appropriate management. It is vital for this bone to unite, to maintain its function facilitating the intricate biomechanics of wrist movements. Operative fixation has the advantage of reducing the fracture in the correct position and putting a screw across the fracture that will prevent it from displacing, thereby facilitating the uniting process.
Not even the best gloves can stop the high energy of a cricket ball or a flying hockey ball that can crush the bones underneath as it compresses the finger against the cricket bat or hockey club. Any bone can break, in any pattern and the higher the energy, the more the damage. Simple cracks or undisplaced fractures are better left alone. With initial buddy strapping and early mobilisation by a hand therapist, these fractures heal uneventfully. However, if the fracture is communited or shortened and rotated or even open (fracture with open wound), surgical fixation is required. The advantage is that the repaired fracture can be mobilised fairly soon, although any surgical intervention poses risks.
Rugby players and even cricket players have their fingers twisted or bent backwards with the force of the ball or tackles. The most common dislocation of the finger is usually the second joint of the finger called the proximal interphalangeal joint (PIPJ). The reason is that the knuckle joint (metacarpophalangeal joint) has more stabilising structures and is therefore a more stable joint. When the PIP joint dislocates, there is a combination of soft tissue tears (volar plate and collateral ligaments) with or without a fracture of the middle phalanx. Some of the dislocations reduce immediately and the only evidence of a dislocation is a swollen, painful finger which may persist for many weeks. Other dislocations are reduced off the field and this provides great relief. These injuries, more than any other in the hand, need attention by the hand surgery team. They can cause significant troubles later if they are not appropriately managed in the early days. Many people present after six weeks with a stiff, bent finger that cannot straighten.
Occasionally, soccer or rugby players present with what is called, a jersey finger. These injuries, as the name suggests, occur when the finger gets stuck in the opponent’s jersey. The tip of the finger is forcefully bent backwards whilst the flexor muscle contracts strongly to try and grip onto the opponent’s jersey. Something has to give way, and the strong flexor tendon, which attaches to the last bone on the finger, might tear or pull out of the bone. This is a devastating injury that requires surgery and prolonged rehabilitation.
Golfers are not excluded from injuries. Hitting a thick divot might compress the swinging hand against the handle and create a fracture in a tiny pea-like wrist bone called the pisiform.
Cyclists can get any injury in the book, as there is no predictable way of falling. Cyclists, especially mountain bikers, tend to break their fall with an outstretched hand. This can fracture anything from the clavicle (collar bone), dislocate the shoulder, break the forearm bones and more commonly, cause a scaphoid fracture. Long distance road cyclists, can present with compression nerve syndromes where nerves are squashed for prolonged periods in certain positions. The ulnar nerve can be compressed in Guyons’s canal at the wrist as the ulnar side (side of the little finger) of the wrist rests on the handle bar. This presents with numbness and pins and needles in the little finger side of the hand. The extensor carpi ulnaris tendon running on the back of the wrist can become inflamed (tendonitis) in a similar way that athletes get Achilles tendonitis. It is therefore pivotal that the cyclists’ bike is ergonomically set up to prevent any of these strains.
It is important to understand that any injury disrupts the delicate anatomy of the hand, and even more so, changes the normal movement (biomechanics) of the hand. The hand needs to be nurtured and the balance between immobilisation and mobilisation is the golden key to ensure a good outcome. Swelling and incorrect splinting can have devastating effects on the hand, something no sportsman can afford. Patience is a virtue, and no sport in the world, at any level, can justify a premature return to the sports field.
Please come and see us if you have any worries or questions. Our system is well geared to cater for the acute injury with a multi-disciplinary approach. Furthermore, our hand therapist will guide you through the rehabilitation process and ensure the best possible outcome for you to return to your favourite sport!