Sports Specialists Must Be Prepared for Athletes' Wrist InjuriesSports medicine specialists such as orthopedic surgeons, physical therapists, and athletic trainers will find this article of interest. Sports-related wrist injuries are reviewed from top to bottom in order to prepare these health care professionals to help affected athletes recover quickly and successfully.
Examination of the wrist and hand requires good knowledge of anatomy and understanding of biomechanical function. The authors use line drawings, photographs, X-rays, and CT scans to aid in presenting these concepts. For example, ligaments on all sides of the wrist (front, back, sides) link the many bones of the wrist together and hold them in place next to the bones of the forearm. Damage to any of these soft tissue structures can disrupt thumb, wrist, or forearm function.
The most common soft tissue injuries include tears of the scapholunate ligament, triangular fibrocartilage complex (TFC or TFCC), and extensor carpi ulnaris (ECU) tendon rupture. Each of these injuries leads to shifts in the adjacent anatomical structures resulting in additional problems.
Disruption of the scapholunate ligament allows two bones (the scaphoid and the lunate) in the wrist to shift and unlink from each other. Athletes who fall on an extended and slightly tilted wrist sustain this type of injury. The tilt is called an ulnar deviation -- the hand is tilted toward the pinkie (little finger) side, which also happens to be on the same side as the ulna (one of two bones in the forearm). If the force of the injury is severe enough, the injury can extend through to other nearby ligaments causing a dislocation of the lunate carpal (wrist) bone. This additional injury is referred to as a perilunate dislocation.
A particularly difficult injury to diagnose is the triangular fibrocartilage complex (TFC or TFCC) tear. This group of ligaments and cartilage forms a triangle along the ulnar side of the wrist holding several bones in place. The athlete with a TFC tear presents with a very painful wrist with loss of grip strength and tenderness to palpation (touch with pressure). X-rays and MRIs may be needed to confirm the diagnosis and direct treatment.
Another injury mentioned (the extensor carpi ulnaris subluxation) creates a tear in the sheath or lining around the extensor carpi ulnaris (ECU) tendon. This sheath plays an important role in maintaining stability of the wrist where the radius (forearm bone on the thumb side) attaches to the wrist. A sudden, acute rupture of the ECU sheath is reported most often in tennis players, golfers, and baseball players.
With all of these soft tissue injuries, the goal is to get the player back in the game as soon as possible. Early recognition of the problem and immediate treatment can help keep the injury from becoming severe and/or chronic. In some cases, a period of rest and immobilization may be necessary. Nonsteroidal antiinflammatory drugs (NSAIDs), steroid injections, and physical therapy are the mainstays of conservative (nonoperative) care.
If the athlete does not get better, then surgery may be needed. Most of the surgical procedures can be done arthroscopically. The final (and most accurate) diagnosis can be made during the arthroscopic exam. Some players will do everything the can to put off surgery until the end of the season. This is called deferral of treatment and may not be advised. But coach, therapist, trainer, and surgeon work together to make the best recommendations.
Some of the factors that will guide the decision include severity of injury, stability of the joint, type of sport, and position played. Of course, consideration is given to what might happen down the road if treatment is delayed putting the player at increased risk of another injury or reinjury. Pressure to return-to-play should not override player safety and health (both physical and mental health).
Depending on the sport, some athletes can return-to-play with a cast on the arm, wrist, and hand. But if reconstructive surgery was done to repair the damage, then the player is on the bench for six to eight weeks or until X-rays show that everything has healed up nicely and the wrist is stable once again.
Because sports-related wrist injuries are common, the authors presented this review to help sports health care specialists be prepared to recognize, evaluate, and treat these injuries. Delayed diagnosis, deferred treatment, or mistreated injuries can end an athlete's career or end a college player's scholarship opportunities. Reviews such as are presented in this article can assist sports medicine specialists keep up with details and information needed to handle common wrist injuries encountered during practice or competition.
Neal C. Chen, MD, et al. Sports-Related Wrist Injuries in Adults. In Sports Health. November/December 2009. Vol. 1. No. 6. Pp. 469-477.
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