Primary care of hand and wrist athletic injuries

Acute athletic injuries to the hand and wrist encompass a wide spectrum ranging from simple sprains to severe fractures or soft-tissue disruptions that can permanently threaten the normal function of the extremity. Although finger injuries are more common in ball-handling sports, injuries to the wrist and metacarpal region are more common in gymnastics, contact sports, and racquet sports. Adolescent high school football players appear to be particularly vulnerable, with up to 35% of all reported injuries in this group involving the hand and wrist.(33) An important distinction between adult and adolescent/juvenile athletes is the presence of growth plates (physes) in the latter that are responsible for longitutinal bone growth. The physes are found at the proximal end of each phalanx and at the distal end of each metacarpal, except in the thumb metacarpal where it is found at the distal end. They are also found at the distal ends of the radius and ulna at the wrist region. in the skeletally immature athlete, the physes are less resilient to stress than are the surrounding ligaments and fibrous joint capsules. This can account for some differences in the injuries noted between the two groups given the same mechanism of injury (ligament tears/dislocation in adults versus epiphyseal separation fractures in juveniles). This article deals with some of the more commonly noted sports-related injuries to the hand and wrist to help the team physician make the correct diagnosis and establish the most effective treatment plan, so that the athlete may achieve maximum results and ultimately return to full participation.