Hand Injuries and Prevention

Hand-to-Hand Combat

Hands are used so often in our day, and especially in sports activities, that we often take them for granted. Our wrists take a lot of abuse in our active lives.

The wrist is a complex design involving many moving parts—a set of joints, ligaments and eight small bones and two larger forearm bones. When working properly, it's like a well-choreographed orchestra. But if you injure or disconnect any individual component, then part of that orchestra is playing out of synch; it won't sound or look very good. All parts must be in the right alignment.

Thankfully, today we have some of the knowledge to prevent many injuries. We also have the technology to isolate the individual component that has been injured, and the training and ability get it back in tune with the rest of the orchestra.

The best ways to prevent sports-related hand, wrist and upper extremity injuries:

Wrist guards — For sports such as roller blading, street hockey and skateboarding, wrist guards can help dissipate energy in a fall or slide to prevent serious injury, such as a bone fracture or scraping of the hand.

Gloves — Bicyclists, football players and other athletes use gloves to protect their hands, specifically the nerves, which can become injured if the palm suffers a direct blow. In addition to protecting your nerves, gloves can protect your skin from direct wounds and cuts.

Proper stretching — Especially for sports that involve a lot of upper extremity body work, such as racquet sports, it's important to stretch the forearms, wrists, shoulders, elbows and hands for about five minutes. Sustain the stretches for more than 15 seconds at a time. This type of warm-up can help prevent many injuries. Stretch again following your activity.

Common hand/wrist/arm injury types and treatments:

The most common injuries of the hand and arm include bone fractures, tendon tears and dislocation of joints. These can happen as easily as catching your hand in a jersey, twisting your finger or hand while catching or throwing, or accidentally colliding with another player. Even soccer players, though they don't use their hands in the game, may suffer hand injuries from accidental kicks or falls.

If you have suffered an injury, protecting the area from re-injury is critical, says Tom Fischer, MD, a hand specialist from the Indiana Hand Center. You may desire to get back into the game before you have full range of motion and healing, but it's best to be patient and let the injury heal. If you must play, ask the coach or trainer or your doctor to create a player's splint to protect the injured area. It's not uncommon for a player to neglect follow-up care to a minor injury only to return to play and severely injure the area by not protecting it from re-injury. A previously simple problem may instead require surgery as a treatment, adds Fischer.

"Handy" treatment tips:

Proper diagnosis is the key to most upper extremity treatments. If you are treated for a strain or sprain and you actually have a fracture, you could be at risk. See your primary care physician or visit the emergency room if you suffer a serious injury. (The St.Vincent Emergency Room is capable of treating serious hand and upper extremity injuries.) If the problem is not successfully treated after seeing your doctor, visit a hand specialist, such as those at the Indiana Hand Center. The specialists there work frequently with injured athletes.

St.Vincent Sports Medicine can also answer your questions and direct you to appropriate resources.

• A tendon tear on the back side of the hand can usually be treated in the emergency room, while a tendon tear on the palm side of the hand may require a surgical treatment, especially if the hand is lacerated.
• If a finger joint is dislocated, and a coach or trainer pops it back into place, the joint still needs to be X-rayed to be sure there's not an associated fracture within the joint.  A finger that is bent into a flexed position and doesn't straighten, such as while catching a ball, may be caused by a ruptured tendon. This injury is commonly treated with splints.
• Don't use "buddy tapes" unless you're 100 percent certain of how to use them after being instructed by your doctor. They can twist fingers in an abnormal fashion, causing deformity or stress on an injured structure. Remember diagnosis should precede treatment.
• Surgery may be required if the normal joint architecture is disrupted in an injury.
  If you don't seek proper care quickly for your hand and arm injury, you may develop stiffness, as the bone heals with a deformity instead of in the proper position.
• Open wounds that are not thoroughly cleaned and treated are at risk for infection.
  Almost any hand or upper extremity injury will respond to ice and compression.
  If you have bruising with an injury or a twisting injury with bruising, you should be evaluated—tissues could be torn or broken.
• A "sprained wrist" is not a complete diagnosis. You should know which of your ligaments is affected.
• Undiagnosed or neglected injuries are the least likely to return to normal. Many treatments and surgical options are available, so with proper treatment, your best chance at full motion can be realized.

Common healing times:

• Sprains may take six to 12 weeks to heal and are usually treated with splints.
• Shoulder dislocation heals in about three to four months, often requiring rehabilitation to regain full motion.
• Simple fractures are usually treated conservatively with splints above and below the injured area, and heal within three to four weeks.

The above time frames are general. Your trainer, coach or therapist can be of assistance in getting protective devices so that you might return to sport before complete healing has occurred.

When should you go to an emergency room for treatment of a hand or arm injury?

• If there is an open wound that shows a deformity (i.e. bone sticking out or visible).
• You suspect a bone is broken. (Remember, just because you can move your hand does not mean it isn't broken.)
• You have numbness in the hand that has been wounded.
• You have penetrating wounds.
• You have a large degree of bruising or swelling around a joint, without a direct blow to the injured area. (This may indicate a ligament tear)