This is a review of a few uncommon, but easily missed, injuries that need special attention when x-rays look normal.
Wrist bone dislocation (Scapholunate dissociation)
Mechanism: Fall back on hand
Pain: Back of hand pain and swelling, tenderness on the bump before the wrist (lister’s tubercle) in a straight line from between index and middle finger toward the wrist.
Treatment: Thumb splint, early referral to a specialist if moderate to severe (grade 2-3), Expect: 4-6 months recovery
Improper Treatment: Scapholunate Advance Collapse (SLAC) - this is the most common degenerative arthritis of the wrist from poor wrist bone alignment
Wrist fracture (Triquetral Flake Fracture):
Mechanism: Fall on outstretched hand (or FOOSH) with wrist flexed towards forearm - ligament,
Pain: tender on the back of the hand in the wrist divot which is inline with ring finger.
Treatment: Volar splint, then short arm cast, immobilization for 3-4 weeks
Improper Treatment: Significant ligament (lunotriquetral ligament tear) injury and could also tear the TFCC (triangular fibrocartilage complex) tear leading to chronic wrist pain and possible loss of grip strength
Hand/Wrist fracture (Hook of the hamate fracture):
Mechanism: FOOSH or repetitive, direct blow or repetitive strain.
Pain: pain in the palm of the hand 2 cm above wrist in line with the middle of the ring and pinky fingers. Pain with gripping
Treatment: Hand surgeon immediately, short arm cast until pain free and range of motion is full. 4-6 weeksImproper
Improper Treatment: Nerve damage causing carpal tunnel complications and numbness. Possible fracture of the hook of the bone protecting nerve that can does not heal is relatively high.
Elbow fracture or dislocation (Cornoid process fracture, or radial head fracture)
Mechanism: FOOSH or direct impact to elbow
Pain: At back of elbow. Feels weak and unstable
Improper Treatment:: Possibility of 2 fractures, ligament damage (ulnar collateral ligament), nerve and blood vessel injury, loss of full elbow straightening, chronic arthritis possible
Treatment: If displaced 2 mm, and large bone fragment seen on X-ray need immediate orthopedic surgeon to look at it.
Mid-foot injury (Lisfranc Injury-sprain or fracture: 1st big toe and 2nd toe)
Mechanism: Plant foot on toes with a twist and downward force.
Pain: Swelling bruising and pain on the inside of the top mid-foot. Painful to so player does not want to go onto toes at all.
Improper Treatment: Significant muscle and ligament injury, arch collapse, chronic pain and disability, arthritis. Sometimes player may never regain to pre-injury function.
Treatment: Dislocated immediate orthopedic referral for stabilization/fixation. If not displaced and stable injuries, then cast. Long recovery, 4-12 months.
High Ankle Sprain (Syndesmosis injury): Front and back outside and transverse ligament damage of the ankle.
Mechanism: Outward rotation with flexing of the ankle and foot pointing outwards.
Pain: Outside ankle, in front of the ankle
Improper Treatment: Unstable fracture in young teenager (Tillaux or Maisonneuve fracture) ligament tears off bone, needs screw to stabilize in moderate to severe injury (grade 2-3) ligament tears.
Treatment: Stable injury (grade 1) - Post Slab cast, no weight bearing.
Unstable (grade 2-3) see orthopedic surgeon for stabilization/fixation.
Remember these things
* Information courtesy of lecture by Dr. Jody Murray, sports medicine fellow *