Injuries of the fingers and thumb in the athlete

MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review

Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.

Comparative outcomes between surgical treatment and orthosis splint for mallet finger: a systematic review and meta-analysis

Mallet finger is a commonly encountered condition in daily practice. However, there is currently no consensus on whether surgical intervention or conservative treatment with orthosis splint is superior. In this systematic review and meta-analysis, we compare the treatment outcomes between surgery and orthosis for bony and tendinous mallet finger. We searched PubMed, Embase, and the Cochrane Library according to the PRISMA guidelines from inception to January 15, 2021. The primary outcome was distal interphalangeal (DIP) joint extension lag angle, and secondary outcomes were DIP joint flexion and range of motion (ROM) angle. A total of 297 studies were initially identified, of which 13 (ten retrospective non-randomized controlled studies (non-RCTs) and three RCTs) were included in the final analysis. The results of this systematic review and meta-analysis showed that there was no high level of evidence supporting the superiority of surgery over orthosis in the treatment of mallet finger. Based on the available evidence, surgical intervention and conservative treatment with splint may offer similar clinical outcomes in both bony and tendinous mallet finger.

[Postoperative imaging of the musculoskeletal system - hand]

BACKGROUND

Postoperative imaging is essential to document the surgical outcome of the musculoskeletal system of the hand.

OBJECTIVES

Common radiological findings in the postoperative musculoskeletal system of the hand are explained in the context of the preoperative findings.

MATERIALS AND METHODS

For important surgical procedures of the hand, classifications, surgical procedures, and complications are presented. Diagnostic criteria in postoperative radiography and computed tomography (CT) imaging are described for each indication group.

RESULTS

Clinical information and postoperative findings are systematically presented for fractures of the radius, scaphoid, metacarpal and phalanges, scapholunate dissociation, perilunate injuries and for procedures of arthrodesis and arthroplasty in the hand. Complications are pointed out.

DISCUSSION

Precise reporting in postoperative radiography and CT imaging of the hand is based on a well-defined order, a standardised examination technique and on synoptic evaluation of clinical and radiological criteria.

Pediatric hand ultrasound: common indications, injury, inflammation and masses

Ultrasound is a uniquely valuable tool for evaluating musculoskeletal problems in the pediatric hand. Acute and chronic injuries involving tendons and ligaments of the hand can be quickly assessed and can guide surgical decision-making. Using ultrasound, palpable lesions and masses can be evaluated for cystic and solid components aiding in differential diagnosis. Additionally, ultrasound provides evaluation of acute versus chronic changes of inflammatory arthritis, assessing disease severity and subclinical synovitis and serving as an adjunct to medical management. This review will cover common indications and ultrasound findings of the pediatric hand, focusing on common injuries, inflammatory arthritis and masses. Important anatomical features of the hand will be discussed as well as imaging technique and evaluation in the pediatric patient.

Management of Finger Joint Dislocation and Fracture-Dislocations in Athletes

Although finger joint dislocations are generally thought of as benign by many athletes and assumed to be a sprain, these injuries represent a spectrum that includes disabling fracture-dislocations. Failure to recognize certain dislocations or fracture-dislocations may result in permanent deformity and loss of motion. Simple dislocations are frequently amenable to early return to play with protection; however, more complex injuries may require specialized splinting or surgery. Delay in diagnosis of unstable proximal interphalangeal fracture-dislocations may require reconstruction or fusion. Early diagnosis and appropriate treatment are essential to ensure optimal functional results.

Extensor Tendon Injuries in the Athlete

An athlete's hands are susceptible to a variety of acute and cumulative traumas depending on their chosen sport. Depending on the timing of the injury, the immediate requirements of the athlete, and future aspirations, treatment strategies may need individual customization. This article offers a brief review of the anatomy and complex function of the extensor mechanism, discusses the etiologies of various extensor injuries, and outlines the multiple treatment options and expected outcomes.

A biomechanical comparison of the modified Bunnell pullout and Teo intraosseous suture techniques for attachment of tendon to bone

We compared the biomechanical properties of the Teo intraosseous suture technique with the modified Bunnell pullout technique in a cadaver model after a tendon to bone repair. Thirty-six fresh-frozen cadaveric fingers were assigned randomly to three groups (Teo, Bunnell and control groups). They were loaded cyclically from 2 to 15 N at 25 mm/min, for 500 cycles. Gap formation at the repair site was assessed every 100 cycles and then specimens were tested to failure. The Teo group had an approximately 30% smaller gap every 100 cycles and needed 30% more energy to obtain a 2 mm gap than the modified Bunnell group. Displacement after 500 cyclic loads was significantly lower in the Teo group than in the Bunnell group. For the failure of the Teo suture, it was necessary to apply 31% more load than the Bunnell technique.

Injuries to the Collateral Ligaments of the Metacarpophalangeal and Interphalangeal Joints: Sonographic Appearance

Injuries to the collateral ligaments of the metacarpophalangeal (MCP) and interphalangeal (IP) joints are commonly encountered in both athletes and nonathletes. They require prompt evaluation to ensure proper management and prevent loss of joint motion and permanent disability. Imaging is often required to confirm the diagnosis and assess injury severity. This review article aims to provide physicians with guidelines for sonographic assessment of the collateral ligaments of the MCP and IP and related injuries. Sonographic features of ligament injuries ranging from sprains and partial-thickness tears to full-thickness tears are described. Specific lesions of the ulnar collateral ligament of the thumb MCP joint, such as gamekeeper's thumb, skier's thumb, and Stener lesions, are also included. In conclusion, sonography is effective in evaluating the collateral ligaments of the MCP and IP joints and related injuries and represents a valuable tool for diagnosis.

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture

Background:

Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.

Methods:

Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed.

Results:

The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons.

Conclusions:

Sports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.

Spontaneous painful subungual thumb haematoma

We present the case of a 56-year-old man who presented to our accident and emergency department 15 years after a work-based injury to his left thumb.In January 2017, the patient was woken up acutely with excruciating pain in his left thumb with no preceding trauma. On clinical examination, only a subungual haematoma was noted. Radiographs of the effected thumb demonstrated a round, lytic lesion with an accompanying hairline fracture on the distal phalanx of the left thumb. The radiologist suggested a differential diagnosis of enchondroma should be considered.The patient was referred for a routine plastic surgery outpatient appointment. Curettage sampling of the lesion was performed and a cement filler was used to prevent further pathological fractures.The biopsy report stated that the sample contained normal bone tissue with no evidence of enchondroma or other malignancy and the patient was discharged without any further complications.

Traumatic avulsion of the flexor digitorum profundus tendon. Jersey finger, a 29 cases report

Traumatic avulsion of flexor digitorum profundus (jersey finger) is an uncommon injury. Our study aimed to describe functional outcomes of jersey fingers after surgical treatment. From January 2004 to 2014, we performed surgery on 32 patients who had jersey finger. Twenty-six of these patients were male and 6 were female with a mean age of 37.2years (range 16-68). Of the 32 cases, 11 were sports injuries, 16 presented on the ring finger and 13 on the little finger. Using the Leddy and Packer and Smith classifications, 16 of the injuries were type I, 4 were type II, 5 were type III, 7 were type IV. The mean time between injury and surgery was 6.8days (range: 0-32). The surgical techniques used were anchor, pull-out, or an association of both these techniques. Prior to the patient discharge, functional outcomes were evaluated. Twenty-nine patients were evaluated in total and three patients were lost. Of the 29, the average time between surgery and discharge was 36.6months ranging from 4.5 to 118months. According to the Buck-Gramcko classification, six patients had an excellent result, six had a good result, seven had a satisfactory result and ten a poor result. The mean Quick DASH score immediately to prior discharge was 5.66 (range: 0-56.82). Twelve complications were reported on nine patients. No infections were reported. Rapid diagnosis and rapid surgical treatment led to restoration of full range motion.

Quantitative Assessment of First Annular Pulley and Adjacent Tissues Using High-Frequency Ultrasound

Due to a lack of appropriate image resolution, most ultrasound scanners are unable to sensitively discern the pulley tissues. To extensively investigate the properties of the A1 pulley system and the surrounding tissues for assessing trigger finger, a 30 MHz ultrasound system was implemented to perform in vitro experiments using the hypodermis, A1 pulley, and superficial digital flexor tendon (SDFT) dissected from cadavers. Ultrasound signals were acquired from both the transverse and sagittal planes of each tissue sample. The quantitative ultrasonic parameters, including sound speed, attenuation coefficient, integrated backscatter (IB) and Nakagami parameter (m), were subsequently estimated to characterize the tissue properties. The results demonstrated that the acquired ultrasound images have high resolution and are able to sufficiently differentiate the variations of tissue textures. Moreover, the attenuation slope of the hypodermis is larger than those of the A1 pulley and SDFT. The IB of A1 pulley is about the same as that of the hypodermis, and is very different from SDFT. The m parameter of the A1 pulley is also very different from those of hypodermis and SDFT. This study demonstrated that high-frequency ultrasound images in conjunction with ultrasonic parameters are capable of characterizing the A1 pulley system and surrounding tissues.

Sports-related wrist and hand injuries: a review

Background

Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population.

Main body

The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided.

Conclusion

Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.

Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience

Context:

Jam injuries of the finger are frequently encountered in general orthopaedic and sports medicine practice. The finger joints in particular are very susceptible to traumatic injury, but in the absence of severe deformity, digital trauma is often downplayed in the hopes of a more rapid return to game play.

Evidence Acquisition:

Articles published from 1966 to 2015 were reviewed to capture historical and current views on the presentation, diagnosis, and treatment of jam injuries in athletes.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Although jam injuries are frequently grouped together, they represent a host of injuries that can be challenging to differentiate. A thorough knowledge of finger joint anatomy and injury mechanism is critical to perform an appropriate examination, establish an accurate diagnosis, and identify a treatment plan for each patient.

Conclusion:

Every member of the athletic care team must be aware of the spectrum of digital injuries, including the basic signs present on examination, which may indicate the need for more formal workup. Additionally, preventing injury through athlete education is paramount to athletic care.

Extensor tendons injuries

Extensor mechanism injuries are frequently encountered in athletes and can lead to permanent disability or deformity if not promptly and properly treated. This article reviews basic anatomy, and then discusses mallet finger injuries, boutonniere deformity, and sagittal band rupture. Once treatment has begun, return to sport is highly variable because of the varied needs of each athlete and where they fall on the spectrum of disease. As such, each athlete must be carefully evaluated and closely followed to ensure a safe, prompt, and judicious return to athletic pursuits.

In-game Management of Common Joint Dislocations

Context:

Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints.

Evidence Acquisition:

A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries.

Conclusion:

When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game.

Pediatric upper-extremity fractures

Upper-extremity fractures account for more than half of childhood bony injuries. The frequency of injury increases with increasing mobility. The most common mechanism is a fall on an outstretched hand while playing. Optimal management requires knowledge of the normal anatomy and variants unique to pediatric bones. The physician needs to maintain a high level of suspicion for growth plate injuries because if unrecognized, these may result in growth arrest. Although the vast majority of pediatric upper-extremity fractures will heal rapidly with minimal intervention, physicians should be aware of the complications that can arise from these injuries.

Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial

STUDY DESIGN

Randomized clinical trial.

INTRODUCTION

Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries, it is unclear whether orthosis self-removal has an impact on the final outcome.

PURPOSE

To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast(®) (QC) compared to a removable, lever-type thermoplastic orthosis (LTTP).

METHODS

57 subjects were randomized in 2 groups. DIPj extensor lag and the Gaberman success scale were used as primary outcomes.

RESULTS

LTTP subjects resulted in greater extensor lag than QC subjects (x = 5°; p = 0.05) at 12 weeks from baseline, and high edema and older age negatively affected DIPj extensor lag. No other differences were found between groups.

CONCLUSION

Cast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema.

LEVEL OF EVIDENCE

1B.

Tendon injuries of the hand

Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons, but less frequent injuries, e.g., damage to the functional system tendon sheath and pulley or dull avulsions, also need to be considered. After clinical examination, ultrasound and magnetic resonance imaging have proved to be important diagnostic tools. Tendon injuries mostly require surgical repair, dull avulsions of the distal phalanges extensor tendon can receive conservative therapy. Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger an “intrinsic” tendon healing to guarantee a good outcome. Many substances were evaluated to see if they improved tendon healing; however, little evidence was found. Nevertheless, hyaluronic acid may improve intrinsic tendon healing.

Repair of flexor digitorum profundus to distal phalanx: a biomechanical evaluation of four techniques

PURPOSE

Many techniques for repair of the flexor digitorum profundus to the distal phalanx show excessive gapping with variable clinical results. The purpose of this study was to test the biomechanical characteristics of an anchor-button (AB) technique, as compared to 3 other techniques.

METHODS

Twenty-four fresh-frozen human cadaveric fingers were randomized to 4 groups, 6 in each: group 1, 2-strand Bunnell suture button pullout technique; group 2, modified Kessler suture and 2 retrograde anchors; group 3: locking Krakow suture with 2 retrograde anchors; group 4, AB technique incorporating a 2-part repair, consisting of a locking dorsal Krakow suture with 2 retrograde anchors and a locking palmar Krakow suture fixed with a button. Tendon-to-bone gapping was measured after cyclical loading. Ultimate load to failure was measured at the end of 500 cycles.

RESULTS

The AB technique resulted in significantly less gapping when compared to the other techniques. It also resulted in a significantly stronger repair compared to all the other groups with an average load to failure comparable to the native tendon-to-bone interface.

CONCLUSIONS

The AB repair might allow for early active postoperative motion after repair of flexor digitorum profundus avulsion injuries and tendon reconstruction procedures; however, the soft tissue effects of this multistrand technique are unknown in clinical repairs.

[Who is who in the fractures of the upper and lower limb]

The precision is a major factor in the communication of medical facts and data. Predominantly, it is reached by the use of classification systems. However, many of our classifications do not provide an unlimited use in the day-to-day practice. Thus, particularly in the field of traumatology, colloquialisms play a major role. They provide a high degree of information transmission. However, it is a must for all members of a trauma team to fully understand the definitions of such terms and use them in the same manner.

Repair of arthroscopic triangular fibrocartilage complex tears in athletes

Triangular fibrocartilage complex (TFCC) injuries are a common source of wrist pain in athletes. These injuries constitute a unique orthopedic challenge because of the particular physical demands on these patients. A specialized management approach is often necessary, due to the short recovery time available and the need for high demand performances afterward. Arthroscopic repair of TFCC is becoming the treatment of choice in this group of patients.

Zone I rupture of the flexor digitorum profundus tendon caused by blunt trauma: a case report

Traumatic ruptures of flexor tendons as a result of blunt trauma without an associated pathologic condition are rare. This is a case of a midsubstance flexor tendon rupture as a result of closed direct trauma. The patient sustained a flexor digitorum profundus (FDP) rupture 1 cm proximal to its insertion on his right ring finger without any accompanying laceration. Additionally, this case highlights the utility of ultrasound in diagnosing ruptured flexor tendon, which has been demonstrated in prior studies.