Hand and Wrist Injuries in Golfers and Their Treatment

Estimates of Golf-Related Upper Extremity Injuries in the United States: A 10-Year Epidemiology Study (2011-2020)

BACKGROUND

Golf is one of the most popular sports in the United States (US) and is played by participants of all ages and skill level. Given the popularity and sport-specific demands on the upper torso, golf poses a considerable risk for upper extremity (UE) injuries. Therefore, the aim of the current study was to (1) determine the incidence rate of UE golf injuries presenting to emergency departments (EDs) in the US, (2) determine the most commonly injured body parts and mechanisms of injury, and (3) compare current injury epidemiology with previous trends in the literature.

HYPOTHESIS

Male sex, bimodal age extremes (young and elderly), and utilization of golf carts (vs walking) are associated with a higher incidence of golf-related UE injuries.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 3.

METHODS

The National Electronic Injury Surveillance System (NEISS) is a statistically validated injury surveillance system that collects data from ED visits as a representative probability sample of hospitals in the US. We queried the NEISS for the years 2011 to 2020 to examine the following variables for golf-related UE injuries: sociodemographic, diagnosis, body part, and mechanism of injury.

RESULTS

From 2011 to 2020, there were a total of 1862 golf-related UE injuries presenting to participating EDs, which correlates to an estimated 70,868 total injuries. Overall, male golf players were disproportionately affected (69.2%) versus female golf players (30.8%) and the most commonly injured age groups were those aged >60 and 10 to 19 years. The most common injuries included fractures (26.8%), strains/sprains (23.4%), and soft tissue injuries (15.9%). The joints injured most frequently were the shoulder (24.8%), wrist (15.6%), and joints in the hand (12.0%). The most common mechanisms of injury were cart accidents (44.63%), falling/tripping (29.22%), and golf club swinging/mechanics (10.37%).

CONCLUSION

Golf-related UE injuries can be acute or due to chronic overuse. Male athletes >60 years of age were the population most commonly presenting to the ED with a golf-related injury. Further, the shoulder, forearm, and wrist were most commonly injured. These findings are consistent with previous epidemiological trends in the literature. Interventions to reduce the incidence of injury should be sport-specific and focus primarily on equipment and golf cart safety and swing modification to optimize the biomechanical function of the UEs.

CLINICAL RELEVANCE

Our findings indicate that golf-related injury prevention programs should target UE injuries, particularly among young (<19) and older (>60 years) golfers with poor swing mechanics.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Hamatolunate impingement syndrome in golfers: results of arthroscopic burring of the apex of the hamate

Hamatolunate impingement syndrome is an uncommon cause of ulnar-sided wrist pain in the general population. Often misdiagnosed and untreated by non-specialized physicians, it is an important source of chronic ulnar wrist pain in golfers. The purpose of this retrospective study was to report results of arthroscopic burring of the apex of the hamate for hamatolunate impingement, whether isolated or not, in golf players, with a minimum of six months follow-up. Fifteen golf players (10 amateur, 2 semi-professional and 3 professional players), aged 40-61 years, with ulnar carpal pain implicating hamatolunate impingement with Viegas type-II carpal configuration, were included. Treatment consisted in arthroscopic burring of the apex of the hamate. At an average follow-up of 11 months (range, 6-24 months), all patients were satisfied with functional results, except 1 with persistent pain and stiffness; 93% returned to sport to their prior level. Mean range of motion was improved by 17 ° for wrist flexion (range, 15 ° to 30 °) and 15 ° for wrist extension (range, 10 ° to 25 °). All patients except 1 recovered grip strength, improving from 27 kg (range, 12-53) preoperatively to 35 kg (range, 17-61) at last-follow-up, and ulnar-sided pain was alleviated during golf practice. Return to prior sport level was possible by 5.5 months for professional players and by 9 months for amateurs. Arthroscopic burring of the apex of the hamate provided good clinical results for function and pain, with fairly rapid return to sport. Hamatolunate chondritis does not always mean pathology but represents the natural progression of Viegas type II wrists.

Trigger Finger From Ocean Rowing: An Observational Study

Background: Trigger finger has a prevalence of 2% to 3% in the general population. Although anecdotal evidence exists, there is a lack of conclusive data that prove a relationship between repetitive power grip and flexion with triggering. Ocean rowing is becoming a popular sport, with the race across the Atlantic alone attracting more than 100 participants annually. Anecdotal reports suggest ocean rowing may be a significant cause of trigger finger. We aimed to identify whether the sport causes an increased prevalence of triggering, whether there were any alleviating or compounding factors, and, finally, whether there was any effect on performance. Methods: A prospective observational study was carried out. A questionnaire was sent to all participants of the Talisker Whisky Atlantic Challenge 2018, which included a trigger finger self-scoring system and the Oslo Sports Trauma Center Overuse Injury Questionnaire. Results: Responses were received from 67 rowers (83% response rate). Age ranged from 21 to 62 years, with a mean of 40 years. In all, 49.3% had clinical triggering, with 79.3% reporting bilateral symptoms. The length of continuous rest time had a significant impact on the incidence of finger triggering and disease stage (P = .0275 and .0353, respectively; multivariate logistic regression). High-grade triggering had a more negative effect on rowing performance than low grade or no triggering (not significant). Conclusion: Ocean rowers suffered a 15-fold increase in trigger finger prevalence compared with the general population. This was increased in those who took shorter, more frequent rest periods. This study provides new conclusive evidence that the repetitive power grip and flexion involved in rowing increase the prevalence of trigger finger.

Role of magnetic resonance imaging on fingers in diagnosis of post-traumatic tendon and ligament injuries

Background

Magnetic resonance (MR) imaging is a powerful method for evaluating acute and chronic lesions of the stabilizing articular elements (volar plate and collateral ligaments) of the fingers and thumbs, the condition of tendons, the presence of a tear, the number of affected tendons, the extent of tendon retraction, and the presence of associated lesions. This study was done to clarify the value of magnetic resonance imaging (MRI) in assessment of trauma-related injuries of the tendons and ligaments of the fingers and subsequently positively affect the surgical decisions in such cases.

Results

This study included 42 patients (33 males and 9 females) with a mean age of 35 years. All of them had history of trauma. Male affection was 78.5%, while females constituted only 21.5%, striking right-sided-hand affection (92.9%). The most affected finger was the thumb. The most common affected sites were extending from the metacarpophalangeal (MCP) till the proximal interphalangeal (PIP). The tendons were affected in 42.9%; meanwhile, ligamentous affection represented 57.2%. The flexor tendon tear represented by 28.6%%, while extensor tendon tear occurred in 14.3%. The study also showed that partial thickness tear is represented by 66.7%, while complete thickness tear occurred in about 33.3%. Bone marrow edema and post-traumatic tenosynovitis occurred in about 14% of cases.

Conclusions

Magnetic resonance imaging is an essential technique to obtain a correct pre-surgical diagnosis. It is of utmost importance to possess an in-depth knowledge of finger radiological anatomy in detail, as well as the appearance of the different pathologic entities on MRI. It provides a great assessment of the tendons and ligaments tear by whether partial or complete, any associated marrow edema or bony fragment avulsion and the extent of retraction in cases of complete tear.

Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options

ABSTRACT

Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Non-steroidal anti-inflammatory drugs (NSAIDs) for trigger finger

BACKGROUND

Trigger finger is a common hand condition that occurs when movement of a finger flexor tendon through the first annular (A1) pulley is impaired by degeneration, inflammation, and swelling. This causes pain and restricted movement of the affected finger. Non-surgical treatment options include activity modification, oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and local injections with anti-inflammatory drugs.

OBJECTIVES

To review the benefits and harms of non-steroidal anti-inflammatory drugs (NSAIDs) versus placebo, glucocorticoids, or different NSAIDs administered by the same route for trigger finger.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, CNKI (China National Knowledge Infrastructure), ProQuest Dissertations and Theses, www.ClinicalTrials.gov, and the WHO trials portal until 30 September 2020. We applied no language or publication status restrictions.

SELECTION CRITERIA

We searched for randomised controlled trials (RCTs) and quasi-randomised trials of adult participants with trigger finger that compared NSAIDs administered topically, orally, or by injection versus placebo, glucocorticoid, or different NSAIDs administered by the same route.

DATA COLLECTION AND ANALYSIS

Two or more review authors independently screened the reports, extracted data, and assessed risk of bias and GRADE certainty of evidence. The seven major outcomes were resolution of trigger finger symptoms, persistent moderate or severe symptoms, recurrence of symptoms, total active range of finger motion, residual pain, patient satisfaction, and adverse events. Treatment effects were reported as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

MAIN RESULTS

Two RCTs conducted in an outpatient hospital setting were included (231 adult participants, mean age 58.6 years, 60% female, 95% to 100% moderate to severe disease). Both studies compared a single injection of a non-selective NSAID (12.5 mg diclofenac or 15.0 mg ketorolac) given at lower than normal doses with a single injection of a glucocorticoid (triamcinolone 20 mg or 5 mg), with maximum follow-up duration of 12 weeks or 24 weeks. In both studies, we detected risk of attrition and performance bias. One study also had risk of selection bias. The effects of treatment were sensitive to assumptions about missing outcomes. All seven outcomes were reported in one study, and five in the other. NSAID injection may offer little to no benefit over glucocorticoid injection, based on low- to very low-certainty evidence from two trials. Evidence was downgraded for bias and imprecision. There may be little to no difference between groups in resolution of symptoms at 12 to 24 weeks (34% with NSAIDs, 41% with glucocorticoids; absolute effect 7% lower, 95% confidence interval (CI) 16% lower to 5% higher; 2 studies, 231 participants; RR 0.83, 95% CI 0.62 to 1.11; low-certainty evidence). The rate of persistent moderate to severe symptoms may be higher at 12 to 24 weeks in the NSAIDs group (28%) compared to the glucocorticoid group (14%) (absolute effect 14% higher, 95% CI 2% to 33% higher; 2 studies, 231 participants; RR 2.03, 95% CI 1.19 to 3.46; low-certainty evidence). We are uncertain whether NSAIDs result in fewer recurrences at 12 to 24 weeks (1%) compared to glucocorticoid (21%) (absolute effect 20% lower, 95% CI 21% to 13% lower; 2 studies, 231 participants; RR 0.07, 95% CI 0.01 to 0.38; very low-certainty evidence). There may be little to no difference between groups in mean total active motion at 24 weeks (235 degrees with NSAIDs, 240 degrees with glucocorticoid) (absolute effect 5% lower, 95% CI 34.54% lower to 24.54% higher; 1 study, 99 participants; MD -5.00, 95% CI -34.54 to 24.54; low-certainty evidence). There may be little to no difference between groups in residual pain at 12 to 24 weeks (20% with NSAIDs, 24% with glucocorticoid) (absolute effect 4% lower, 95% CI 11% lower to 7% higher; 2 studies, 231 participants; RR 0.84, 95% CI 0.54 to 1.31; low-certainty evidence). There may be little to no difference between groups in participant-reported treatment success at 24 weeks (64% with NSAIDs, 68% with glucocorticoid) (absolute effect 4% lower, 95% CI 18% lower to 15% higher; 1 study, 121 participants; RR 0.95, 95% CI 0.74 to 1.23; low-certainty evidence). We are uncertain whether NSAID injection has an effect on adverse events at 12 to 24 weeks (1% with NSAIDs, 1% with glucocorticoid) (absolute effect 0% difference, 95% CI 2% lower to 3% higher; 2 studies, 231 participants; RR 2.00, 95% CI 0.19 to 21.42; very low-certainty evidence).

AUTHORS' CONCLUSIONS

For adults with trigger finger, by 24 weeks' follow-up, results from two trials show that compared to glucocorticoid injection, NSAID injection offered little to no benefit in the treatment of trigger finger. Specifically, there was no difference in resolution, symptoms, recurrence, total active motion, residual pain, participant-reported treatment success, or adverse events.

An Evidence-Based Review of Overuse Wrist Injuries in Athletes

Overuse wrist injuries are a common problem in athletes and can be related to tendinopathies or osteoarticular pathology. Fortunately, athletes rarely miss time from their sport due to these conditions because many can be treated nonoperatively. For refractory cases, there often is a curative surgical procedure that can be done during the off-season.

Lessons Learned in the Authors' First Years of Wide-Awake Hand Surgery at the W Hospital in Korea

Wide-awake local anesthesia no tourniquet (WALANT) is a promising development for surgeons and patients through improved operation outcomes in hand and wrist surgery. The authors have mostly used WALANT for flexor and extensor tendon repair, tenolysis, and tendon transfer. Its application at W Hospital in korea has bolstered surgeon confidence in tendon repair integrity, gliding ability, and transfer tension via direct observation and patient feedback. The authors do not use WALANT in complicated tenolysis or in secondary surgeries in previous severe injury situations. The procedure has proven similarly unsuitable in incomplete or complete digit replantation.

Diagnosis of a hamate hook fracture with 3D reconstruction of computed tomography images: A case report and review of literature

We report the case of a 19-year old man who presented to our institution with a history of pain of one week in the ulnar side of the left wrist and continuous pressing sensation in the palm. According to patient, there was no history of acute hand trauma. The conventional roentgenograms did not show the fracture and computerized tomographic (CT) scanning demonstrated a complete fracture of the hook of the hamate. The patient was given a surgical intervention and the hamate bone was reduced through a palmar skin incision. After surgery, the operated hand was immobilized in a wrist brace and the patient was put on a rehabilitation protocol. At the last follow-up, the patient was able to return to normal living activities without any symptoms. We reviewed the latest articles of the past 18 years and compared the research studies related to the diagnosis and treatment of the hamate hook fracture. Our conclusion is that CT scan is the most effective diagnostic tool for detecting the hamate hook fracture. Three-dimensionally (3D) reconstructed images based of CT could provide more accurate and insight illustration for better evaluation in surgical planning.

Hand and Wrist Injuries: Common Problems and Solutions

Injuries to the hands and wrist are common in athletes. Injuries include acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains. Complications in the treatment of sports injuries of the hand and wrist may be divided into 2 categories: incorrect or delayed diagnosis and iatrogenic injury related to treatment. This article highlights common sports injuries of the hand and wrist and their complications, and includes tips for successful management.