Prevention of Ligamentous Sports Injuries to the Hand and Some Factors about Postoperative Rehabilitation

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.
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