On Balance Magazine - Issue 20

Management of common upper limb sporting injuries

In Australia, it is estimated that one million sports injuries occur every year. This extrapolates to a sporting injury occurring in 1 in 17 Australians each year. The financial cost of these injuries has been estimated to be A$1 billion per year.

Accurate epidemiologic statistics on sports injuries have been difficult to obtain due to the fact “emergency care” is often administered on site or on the field, with few athletes seeking the attention of a specialist.

It has been estimated that up to 12% of all sporting injuries involve the hand. The highest risk sports for hand injuries include the following:

• Boxing
• Football
• Volleyball
• Netball
• Gymnastics
• Golf
• Skiing
• Soccer
• Bike riding
• Cricket

In addition to the medial costs attributed to management of these injuries, there are often considerable associated costs in terms of time away from work and graded return to work programs.

Children and adolescents carry the additional risk that the injury may involve the growth plate, thereby posing increased risk of long term complications for this group of patients.

Some of the more common injuries affecting the hand as a result of sporting accidents include the following:

• Nail bed injury
• Mallet finger
• Fracture/dislocation of the hand or wrist
• Ligament injury
• Volar plate injury
• Tendon injury (FDP avulsion)
• Skier’s thumb
• Tendonitis
• Guyon’s canal (Cyclist’s Handlebar Syndrome)
• Overuse conditions (Tennis Elbow, Pitcher’s Elbow)
• Triangular fibro cartilage complex injury of the wrist
• Boutonniere deformity
• Scaphoid/Bennett’s fracture

As with all injury management, early detection, accurate diagnosis and intervention are critical in achieving an optimum outcome and preventing long-term disability or impairment of hand function.

Greater emphasis is now being placed on the multidisciplinary approach to sports injury management, with the ‘team’ often including a sports physician, specialist upper limb surgeon, hand therapist, coach, sports psychologist and team physiotherapist.

Individuals who sustain upper limb sporting injuries are at a higher risk of developing long term problems for a number of reasons:

1. Individuals are often required to return to sport earlier than recommended, therefore increasing the risk of sustaining a secondary injury to the hand.
2. They often conceal the injury for fear it will affect their chances of team selection or completion of the season.
3. They often underestimate the severity of the injury and possible long term complications.
4. The general public and press encourage athletes to “play on”, despite having sustained what may be viewed as a minor hand or finger injury. This is all part of the ‘Hero Worship Phenomenon’ of sporting celebrities.
5. The injuries are often assessed and managed by a coach or physio on the playing field while the team waits, leaving inadequate time for appropriate assessment or treatment of the injury.

The primary challenge facing all health care professionals working in the sports medicine field therefore includes the following:

• Education for all individuals involved with athletes regarding the importance of immediate treatment and follow up of all athletic injuries.
• Improvement in the team approach to management of the athlete and injuries.
• Growth of the athlete’s awareness concerning the importance of consistency in reporting injuries.