Lecture on Sports Hand Injuries

Introduction

• Lecture part of the National Fellow Online Lecture Series
• Moderated by Robbie Bowers from Emory Sports Medicine
• Plug for next week's lecture on June 21st, final for the 2022-2023 academic year
• Tonight's lecture by Dr. Eric Latska on Sports Hand Injuries

Housekeeping

• Program supplements individual didactics
• Provides access to diverse and mostly AMSSM members
• Aims to help fellows prepare for the CAQ exam
• Mute microphones, turn off video, questions in the chat
• Link to an evaluation form in chat

Speaker Introduction: Dr. Eric Latska

• PM&R & Sports Medicine, University of Washington
• Director of Diagnostic Ultrasound Curriculum for PM&R, Family, Pediatric Sports Fellowships
• Education: MD from Tufts University, PM&R Residency at University of Washington, Sports Medicine Fellowship at Swedish Medical Center
• Medical care across various athletic levels
• Former Varsity track and field athlete
• Moving to Boston to join Dr. Walter Sussman

Background on Sports Medicine Physiatrist

• One-year Internal Medicine internship + three-year PM&R residency
• Inpatient coverage (TBIs, SCIs, polytrauma)
• One-year Sports Medicine fellowship
• CAQ exam taken by same standard as family/emergency physicians

Overview of Lecture Content

• Covering about 40 injuries in 40 minutes
• Focus on high-yield content for CAQ exam

Injuries Discussed

Distal Forearm & TFCC

• Mechanism: Acute fall on outstretched hand or chronic repetitive ulnar deviation
• Diagnostic tests: Shear/Dorsal Glide, MRI, Arthroscopy
• Treatment: Neutral splint, PT, corticosteroid injection, surgical repair if necessary

Radioulnar joint (DRUJ) Stability

• Diagnostic tests: Piano Key Sign, Blotman Test
• Combined with distal radial fracture = Galeazzi fracture dislocation

Ulnar Abutment/Impaction Syndrome

• Presentation: Older athletes, chronic ulnar-sided pain
• Diagnostics: Positive ulnar variance, MRI shows signal in lunate/triquetrum/ulna
• Treatment: Ulnar head resection or shortening

Distal Radius Fractures

• Types: Colles, Smith, Barton's
• Non-displaced: Splint + cast
• Displaced: Surgical

Gymnast’s Wrist (Distal Radial Epiphyseal Injury)

• Common in young athletes, especially gymnasts
• Diagnostic Imaging: Bilateral x-rays, MRI
• Treatment: Rest, potential for growth plate issues if untreated

Carpal Ganglion Cysts

• Commonly dorsal, can be volar
• Diagnostic: Ultrasound or MRI
• Treatment: Aspiration, corticosteroid injection, surgery if recurrent

Scapholunate Ligament Injury

• Mechanism: Axial loaded wrist in ulnar deviation
• Diagnostic test: Watson’s Test
• Treatment: Splinting, corticosteroid injection, surgery for instability

Lunotriquetral Ligament Injury

• Diagnostic tests: Clamen’s Test, Reagan’s Test
• Treatment: Conservative or surgical if unstable

Lunate & Perilunate Dislocations

• Mechanism: High velocity foosh injuries
• Diagnostic: Lateral x-rays
• Treatment: Open reduction, surgery

Kienbock’s Disease

• Avascular necrosis of the lunate
• Presentation: Dorsal wrist pain
• Diagnostics: MRI

Scaphoid Fracture

• Common in younger athletes
• Diagnostic: MRI for non-displaced, contrast for proximal pole fractures
• Treatment: Splinting or surgical

Hamate Hook Fracture

• Diagnostic test: Hamate pull test
• Treatment: Rest, possible surgical excision

de Quervain’s Tenosynovitis

• First dorsal compartment issue: APL & EPB
• Diagnostic test: Finkelstein’s/Eichoff’s Test
• Treatment: Splinting, corticosteroid injection

Intersection Syndromes

• Proximal: First and second compartments
• Distal: Second and third compartments
• Treatment: Corticosteroid injection

ECU Tendinopathy/Subluxation

• Diagnostic test: ECU Synergy Test
• Treatment: Conservative or surgical for subluxation

Carpal Tunnel Syndrome

• Diagnostic: Ultrasound/MRI, Electrodiagnostic studies
• Treatment: Bracing, corticosteroid injection, carpal tunnel release

Cyclist’s Palsy (Ulnar Nerve)

• Cause: Handlebar compression
• Diagnostic: EMG, ultrasound
• Treatment: Bike fit adjustments, gloves, possible surgical decompression

Wartenberg’s Syndrome

• Superficial radial nerve compression
• Cause: Tight wristbands
• Diagnostic: Finkelstein’s reproduces paresthesia
• Treatment: Removing compression

Various Sports Finger Injuries

CMC Osteoarthritis

• Diagnostic test: CMC Grind Test
• Treatment: Splinting, corticosteroid injections, arthroplasty

Metacarpal Fractures

• Bennett & Rolando fractures

Mallet Finger

• Terminal extensor tendon tear
• Diagnostic: Lateral x-ray
• Treatment: Extension splinting, surgical if displaced fracture

Flexor Tendon Injuries (Jersey Finger)

• Flexor Digitorum Profundus tear
• Cause: Grabbing opponent’s jersey
• Diagnostic: MRI or ultrasound
• Treatment: Surgical

Extensor Tendon Injuries (Central Slip)

• Boutonniere deformity
• Diagnostic test: Elson’s Test
• Treatment: Splinting or surgery if chronic

Trigger Finger

• Presentation: Tenderness at volar MCP joint, catching sensation
• Diagnostic: Ultrasound shows thickened A1 pulley
• Treatment: Corticosteroid injection, potential surgical release

Pulley Injuries (A2/A4)

• Occur in rock climbers using crimp grip or open hand grip
• Diagnostic: Ultrasound showing bowstringing
• Treatment: Rest, splinting, surgery if multiple tears

Takeaway Points

• Understanding mechanisms behind common sports hand injuries
• High-yield diagnostic tests and imaging modalities
• Appropriate treatment protocols

Conclusion

• Review essential slides for visual aid and reinforcement
• Questions & discussion

Key Images/Slides

• Sports-specific injuries summary
• Anatomical location diagnosis summary