Summer Sideliners

Common summer injuries of the hand, wrist and elbow

As we hike, bike, raft and climb our way through summer adventure, mishaps are bound to happen.  Some of the most common we see include wrist fractures, tennis elbow syndrome and cuts and lacerations to the hand.

Recognizing and treating mishaps that may occur while maximizing these brief few summer months can make a difference in how ready we are for all that awaits us in the fall.

Wrist Fractures

The wrist is susceptible to injury, often used as a first line of defense to break a fall, shield us from impact and soften a blow.  The wrist is comprised of eight small carpal bones, two forearm bones (radius and ulna) and four articulations or joints – which allow the wrist to bend and straighten, move from side-to-side and twist with a broad range of motion.  A force to the hand and wrist may result in a fracture of any one or several of these bones.  While a fracture to one of the smaller carpal bones may only be visible on x-ray, more common distal radius fractures are usually evident – crooked or deformed in appearance.  A wrist fracture may cause pain and swelling and should be immediately addressed.

Tennis Elbow Syndrome (Lateral Epicondylitis)

Though named for the sport frequently causing the condition in tennis players, Tennis Elbow Syndrome is in fact most often caused by everyday activity and diagnosed in those who have never played tennis.  Affecting the outside (lateral) portion of the elbow, tennis elbow syndrome is considered an “overuse” condition.  It is the result of strain placed on the muscles and tendons that attach to the bone.  Also caused by trauma, tennis elbow syndrome can cause pain with gripping, lifting and grasping.

Cuts and Lacerations

Cuts and lacerations to the hand are very common during the summer months as our hands are integral in most outdoor activity and projects. Tendon lacerations are also often the result of trauma to the hand or fingers.  Tendon lacerations may affect either the flexor or extensor tendons.  These types of lacerations often also result in other deep structure damage and require surgical repair.  The cut ends of a tendon must be brought back together in order for the cells inside the tendon to begin the healing/repair process.  Preventing infection in an open wound is also a primary concern with these types of injuries.

 

Playing with an Injury

When is it Okay to Return to Play?

As fall sports heat up, we begin to see a lot of injuries.  The first question players ask after we confirm their injury is, “how soon before I can play again?

Whether it’s a junior high schooler, college athlete or professional player, this question is asked with the same passion and underlying conviction to do whatever it takes to get back in as soon as possible.  This is their sport and their heart is all in – despite the injured limb and challenge it now presents.

Kinkaid Team Captain and outside linebacker, Harris Green, not slowed by forearm fracture

As an orthopedic physician who wants to ensure the best outcome in their recovery and a team doctor who understands this drive distinct in athletes, it’s important to develop the right treatment plan – some of which might entail permission for immediate return to play.

Green back in the game as fracture heals

While this may seem counterintuitive, certain hand and upper extremity fractures once stabilized and placed in a cast are fine for an immediate resumption of play.  This is particularly true of the younger athlete.  Some of the types of fractures allowing athletes to return quickly back to the game despite their cast or splint include certain finger and distal radius fractures and ligament sprains.

While the position on a team will impact the enthusiasm in our recommendation to allow such return to play – linemen with the capability to restrict their hands in a cast verses a receiver or running back more fully engaging their injured limb – many are as capable to play their position with their injury as they were before.

The type of injury is also a determination – stabilized fractures are more likely to be considered for immediate return to play than ligament or tendon tears.

Now, there are some risks for further damage if the injured limb is hit in such a way and the inflexibility of the cast places other vulnerabilities on the uncasted portion of the limb.  Other risks include refracture, retear of a tendon or displacement of a fracture.

But, the only way to truly avoid further injury is to sit out of the game until the injury is completely healed. And this is rarely an option for an athlete.

So, we ensure that our patients know everything upfront.  And we give them the tools to keep their injured limb as strong as possible – regardless of the decision they make.   Continuing to keep the injured limb strong by exercising the muscles and joints around the injury, in conjunction with cardiovascular exercise for overall physical well-being….is key.  We remain very involved and ready to make any readjustments we need to the treatment.

The Different Types of Fractures

A fracture is a break in the bone. Within the hand and upper extremity it can occur anywhere from the fingertip to the shoulder.

Among the most common fractures and dislocations of the hand and upper extremity include:

  • Finger Fractures
  • Distal Radius Fractures (also called Colles Fracture)
  • Scaphoid Fractures
  • Forearm Fractures
  • Clavicle Fractures (collar bone)

There are a number of different types of fractures – partial or complete, simple or compound, clean or shattered …each with their own classifications.  It is important to first define the type of fracture and its severity before determining the most effective treatment plan.

Fractures are defined by the severity of the break and the impact it imposes to surrounding tissue. Some fractures known as partial fractures may only cause a slight crack in the bone, while others may result in a complete break or shattered bone.

A fracture may also be either open or compound, which is a fracture that pierces through the skin creating an open wound.  A closed or “simple” fracture is a fracture that does not break through the skin.

Other classifications that help determine the best treatment plan for your type of fracture include:

  • Transverse Fracture – A fracture that goes across the bone and is situated at a right angle to the long axis of the bone.
  • Greenstick Fracture – A fracture situated on only one side of the bone, causing a bend but not a complete break. These are most commonly seen in children with more “pliable” bones.
  • Comminuted Fracture – A fracture that results in three or more bone fragments.
  • Intra-articular Fracture – A fracture with joint involvement.

Depending on the severity of the fracture, treatment may entail the non surgical realignment of the bone and casting, also referred to as closed reduction. Or surgical repair utilizing fixation support may be indicated.