Orthopedic Surgery: Play Ball–Carefully
HealthReach, Spring-Summer 2013 | Page 7
Don’t let hand and wrist injuries sideline you this spring
Rebecca Hutchinson had just moved to Washington, DC, when she decided to join a coed dodgeball league as a way to meet people. In her first game, she says, she went to catch a ball and “heard a snapping sound” in her left pinky finger. At work the next day, her finger was so bruised that her boss told her to have it looked at immediately.
At Virginia Hospital Center’s Emergency Department, Rebecca was told that she needed surgery and referred to Cassie Root, MD, an orthopedic surgeon who specializes in hand and wrist injuries.
“It turns out that I had shattered the middle joint of my pinky,” Rebecca recalls. “On the X-ray, I could see a definite space between the two pieces of bone.”
Significant bruising like Rebecca had can be a telltale symptom of a fracture in the hand or wrist. “Bruising means bleeding beneath the skin,” Dr. Root says. “A lot of bleeding often comes from a broken bone, which can be a more significant injury.”
A small-finger fracture such as Rebecca’s is a common sports injury. Fingers can get caught or twisted, producing significant bruising and an inability to move. In many instances, patients are seen initially at an urgent care center or emergency room and given splints. Often, patients may not understand how to use or how long to wear a splint. “Splints can actually be harmful,” Dr. Root explains, “if they’re not used properly and are worn too long. Fingers can’t be immobilized for a long period; otherwise, they won’t move again. If your finger is not better within a few days, you should follow up with a visit to a hand specialist.”
In Rebecca’s case, Dr. Root performed surgery to insert very small, thin screws. “They allow movement sooner and less stiffness of the finger,” Dr. Root says. After surgery, Rebecca wore a customized splint to help her finger heal and had six sessions of physical therapy to help her regain range of motion in her finger.
“The physical therapists here at Virginia Hospital Center are certified hand therapists,” Dr. Root says. “They understand these injuries.” It wasn’t long before Rebecca was back on the dodgeball court. She’s in her fourth season of dodgeball league play now.
“Dr. Root was completely understanding,” Rebecca says. “She was so friendly and accessible. I really looked forward to my weekly checkups with her.”
Another common finger injury is a mallet injury, which can cause a rupture to the tendon on the end of the finger so you can’t fully straighten it. This is common in basketball when a ball — or something else — hits the end of the finger. “This happens not just in sports,” Dr. Root says. “It can also happen when you jam your finger doing simple household chores.” It’s treated with a splint, and occasionally with surgery. “If you don’t have mobility in the finger, then see a hand specialist,” she says.
For skateboarders, Dr. Root most often sees wrist injuries from falling on an outstretched hand. Symptoms of a fractured wrist usually include bruising, swelling and pain, limited motion and an inability to lift things.
“If there’s pain on the thumb side of the wrist, you may have a scaphoid fracture, which can feel and act more like a sprain,” she says. “It’s hard to detect; it’s especially hard to see initially on an X-ray because it doesn’t show up until about 10 days after the injury.”
Golfers and baseball or softball players often fall victim to tendonitis on the non-thumb side of the wrist. This painful condition can produce popping with the rotation of the hand. Treatment is immobilization, activity modification, splinting, occasionally a cortisone injection and physical therapy. Surgery is rarely needed. “Many sports injuries can be treated conservatively,” Dr. Root says, “with cautious use of cortisone injections and physical therapy.”
A dodgeball injury sidelined Rebecca Hutchinson temporarily. Dr. Cassie Root repaired her fractured finger using very tiny screws that allow earlier movement and less stiffness.