Ligamentous sports injuries
to the hand have been witnessed for an expanding participation in all types of
activities, ranging from leisure sports to competitive athletics, at both the
amateur and the professional level. The prevailing enthusiasm for physical
exercise and proper body conditioning has unfortunately been accompanied by an
increased incidence of sports-related injuries with a variety of disparate
clinical manifestations. This has spawned a host of common eponyms associated
with particular games and specific injuries, and terms such as baseball finger,
tennis elbow, skier's thumb, golfer's injury, boxer's fracture, bowler's
neuroma etc., are familiar terminology.
The
hands, being the principle tools of implementation of most acts, are constantly
being exposed to sudden and often violent physical forces. The compact and
intricately structured yet delicate joints of the hand are extremely vulnerable
to trauma of varying severity. In the heat of competition, with perhaps the
game on the line, scant and often cursory attention is paid to potentially
serious injuries. The common refrain, it's only a sprain or jammed finger, only
hastens the injured player's return to the playing field, with the possibility
of further aggravation and disruption. Not only are elementary principles of
diagnosis and primary care often disregarded, but the optimal and definitive
management of the injured joint is possibly compromised. The sequelae of
chronic pain, swelling and limitation of motion and function are therefore not
surprising.
The
vast majority of injuries to the small joints of the hand result in partial
tears of the ligamentous supporting structures. Even simple dislocations are
easily reducible and generally stable. Partial ligament injuries, once
accurately diagnosed, respond favorably to a short period of protective
immobilisation with consistent recovery of function.
Partial
ligament tears and simple dislocations need to be distinguished from more
serious injuries that cause significant structural disruption and result in
pathological characteristics that either precludes a successful closed
reduction or compromise joint stability, the category of serious joint injuries
includes:
1. Complex dislocations.
2. Unstable fracture-dislocations.
3. Complete collateral ligament disruptions.
Prevention
of an injury is obviously preferable than having to treat it once it has
happened. Unfortunately, most sports-related injuries occur in a split second
and in the heat of the moment. Attention directed towards prevention must focus
on a thorough understanding of the causation and mechanism of athletic injuries
in order to identify specific factors whose elimination or modification would
help to significantly minimise their occurrence. Supervised training and proper
body conditioning are essential requisites for operating safely at peak
performance levels. Inadequate training or lack of physical fitness increases
susceptibility to injury. Similarly, improper playing techniques or faulty
delivery mechanics predispose towards repetitive overuse syndrome. Another
frequently overlooked aspect in the prevention of injury is the use of proper
equipment and safety gear. These should be designed and manufactured on the
basis of a thorough study of the protective needs of individual sports, without
being overly cumbersome or restraining. The last, but not the least important preventive
measure is the dissemination of appropriate knowledge and information to
inculcate increased awareness in the general public, the players and their
training and managing personnel. Usually, these people are the first to
confront the injury, give advice and render initial treatment, and what they do
or may not do will have a major bearing on the appropriateness and quality of
primary care.
Postoperative
rehabilitation is as critical to overall recovery as the operation itself, and
frequently more difficult and demanding. After surgical repairs, the injured
joints are preferentially immobilised for a variable length of time depending
on specific circumstances. Immobilisation of the injured hand should take
cognisance of the 'protective position' whereby the small joints are maintained
in a physiologically acceptable posture that prevents contractures of the
critical capsular and ligamentous structures. The essential elements of the
protective position include extension of the interphalangeal joints, flexion of
the joints and wide palmar abduction of the thumb. Custom fabricated splints
are available in a variety of shapes, sizes, styles and designs, and serve to
function for static or dynamic purposes. They are easily applied, and ensure
adequate protection with minimal unnecessary constraints. Protection of an
injured joint should be maintained until the 'acute inflammatory reaction'
initiated by the injury has completely resolved; this is clinically indicated
by the subsidence of pain and swelling with the restoration of functional
mobility, also rehabilitation following a serious joint injury is a difficult
task that requires cooperation, diligence and perseverance from the patient,
and diagnostic acumen and surgical skill on the part of the physician to ensure
a mutually satisfactory outcome.
