Hand Injuries

Authors: Nancy Vang, Yer Vang, Marilyn Herrera, Desirae Young, Jose Arellano

Overview

Our article is about hands injuries in young athletes. Hand injuries are very common in children. The children’s bones are still growing and are weak. The growth plate in children can impact treatment and return play guideline.Growing bones are more fragile than mature bones. Children are more likely to fracture bones. The injuries to the hands and fingers not only affect function, skills and athletic participation but also self-esteem and confidence. Children are very playful and are not cautious so they have many type of hand injuries such as the jersey finger, mallet finger, skier’s thumb(gamekeepers thumb) middle phalangeal fractures, proximal phalangeal fractures, and boxer’s fracture.

Injuries and Treatments

There are many fractures that can occur in the hand. It’s interesting how the hand can break in many ways. There are 7 fractures that can occur: Jersey Finger, Mallet Finger, Skier’s Thumb, Middle Phallangeal Fractures, Proximal Phallangal Fractures, Boxers Fractures, and Dislocations.

Jersey Finger

Forced extension of the distal phalanx while actively flexing at the distal interphalangeal may cause a rupture of the flexor digitorum profundus tendon which causes jersey finger. There may be pain, swelling, and a popping sensation. The finger that was injured should be treated immediately and referred to a orthopedic surgeon. They may return to physical activity 6-12 weeks after surgery.

 
Mallet Finger

An axial  load or forced flexion placed  against an actively extending finger can lead to a rupture of the extensor digitorum tendon. This is known as mallet finger. If there is no avulsion, the injured joint needs to be splinted in full extension for 6-8 weeks with additional 6-8 weeks of splinting during sports. If there is an avulsion, the finger needs to be put in a dorsal splint  in full extension for 4 weeks. Some athlete in reliable condition can return immediately with appropriate extension splinting.

Skier's Thumb (Gamekeeper's Thumb) 

Hyperabduction of the thumb metacarpal-phalangeal joint can produce a rupture of the ulnar collateral ligament. This is known as skier’s thumb because it mostly occurs to skiers who fall while holding their ski poles.For treatment, the hand should be put in a thumb spica short arm cast for 4-6 weeks. If there is avulsion fractures, the athlete needs to be referred to orthopedic surgeon immediately. The athlete may return to activity after complete casting with subsequent splinting or bracing for sports activities for another 2-4 months.

Middle Phalangeal Fractures 

Middle phalangeal fractures can result from direct trauma and twisting forces. If there is pain, swelling, deformity and tenderness, it may indicate fractures. A doctor can examine it and evaluate it for rotation, angulation, and displacement. If the fracture is not displaced or angulated, it can be splinted for 3-4 weeks and buddy taped. If this is the case, the athlete can return immediately to activity. If the fracture is unstable, the athlete need to be referred immediately to an orthopedic surgeon.

Proximal Phalangeal

Proximal Phalangeal fractures may be indicated by pain, swelling, and deformity at the base of an athlete’s finger. They are hard to treat with close management and need to be inspected by x-ray.  The examiner needs to check for shortening, displacement, or angulation. These fractures need to be treated with immobilization for 3-4 weeks. The wrist needs to be in slight extension.

Boxer's Fracture

Boxer’s fracture can result from poor punching techniques that create an axial load on the fourth and fifth metacarpal. There may be swelling, pain, and there may be rotational and angular deformity. These kinds of fractures can be closely examined with PA radiographs. The assessment of rotational deformity is very important because these fractures require reduction and stabilization. They can be temporarily immobilized with ulnar gutter splints with MCP joints flexed at 70 degrees. They can return to play while casted or with splinting 4-6 weeks after cast is removed.

Dislocations

Most dislocations are dorsal and are caused by hyperextension of joints with simultaneous axial load. If there is pain, swelling, or the inability to move joint, it may indicate a dislocation. X-rays can check if there is also a fracture involved. If no fracture is present, traction with pressure can be applied to slowly put back the joint. Radiographs after joint is back in are recommended to check for anatomic alignment of the joint. After reduction,  the finger should be splinted at 30 degrees of flexion at the injured joint. These injuries require 2-3 weeks of splinting. ROM activities are highly encouraged to prevent stiffness and permanent loss of ROM. If going back to sport activities, buddy-taping for 4-6 weeks is recommended.

Conclusion

As student athletic trainers, this article provided many insights to our role. It provided different hand injuries to learn about. The article also gives information about how hand injuries affect the epiphyseal plate. It made us learn how serious a hand injury can be, and how it can require surgical attention. In the future, we will examine these injuries more carefully to see how dangerous they can really be. To expand our knowledge even more, we can observe even more hand injuries

Hand Injuries in Young Athletes, Rachel A. Coel, University of Colorado, Physician Perspective, July 2010