Acute hand and wrist injuries in experienced rock climbers

Background: The sport of rock climbing has its own spectrum of injuries, almost half of which involve the wrist and hand.

Objective: To examine the incidence of acute wrist and hand injuries in 545 members of The Climbers' Club of Great Britain.

Method: A total of 1100 questionnaires were sent to current members of The Climbers' Club of Great Britain for them to detail any hand and wrist injuries sustained to date. In decade years, the climbing grades and time spent climbing at each grade were determined. From these results a total and historic climbing intensity score for each climber could be calculated.

Results: Half of the questionnaires were returned complete. The respondents were almost entirely male. There were 235 wrist and hand injuries in 155 climbers (28%). The climbing intensity scores were significantly higher in the injury group than in those who had not suffered a wrist or hand injury (p<0.05). Finger tendon injuries were the most common injury, followed by abrasions/lacerations and fractures.

Discussion: The most common injuries found in rock climbing involve the wrist and hand. The predominant injury to the hand involves the finger tendons or pulleys. The greater the climbing intensity calculated over a climber's career, the greater the likelihood of sustaining these injuries.

     

Imaging of athletic wrist and hand injuries

Sports-related injuries of the wrist and hand are commonly encountered in clinical practice. Athletic injuries create special challenges for the orthopedic surgeon and radiologist, as these patients expect to recover quickly and return to the same athletic endeavors that caused their original injuries. A thorough understanding of the mechanism of injury and imaging findings are necessary for accurate diagnosis and effective therapy. This knowledge allows the clinician to effectively educate the athlete concerning the risks, complications, and prognosis of the injury and its treatment. This article will review mechanisms of injury, imaging findings, and some therapeutic options of common sports-related injuries to the wrist and hand.     

Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist

Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses briefly the causes of hand and wrist injuries in sports and discusses pertinent biomechanical findings regarding the range of motion required in different sports activities. The bulk of the review discusses specific traumatic and overuse injuries to the hand and wrist commonly seen in the athlete. Emphasis is placed on problematic traumatic injuries such as carpal scaphoid fractures and hook of the hamate fractures, as well as ligament injuries to the wrist with regard to diagnosis, treatment, and return to athletic competition.     

Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand

Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses common overuse injuries of the wrist including tendon injuries such as de Quervain's syndrome, subluxation of the extensor carpi ulnaris, and the common dorsal carpal impingement syndrome. The main focus of this section is the discussion of traumatic injuries to the hand in the athlete. Included is a discussion and review of fractures of the phalanges and metacarpals, common proximal interphalangeal joint injuries, and thumb carpal metacarpal and metacarpophalangeal joint injuries. Emphasis is placed on more common injuries seen regarding diagnosis, indications for non-operative versus operative treatment, and time to return to athletic competition.     

Closed tendon injuries of the hand and wrist in the athlete.

Evaluation and treatment of closed tendon injuries in the athlete is usually fairly straightforward if seen in the acute stages. These usually respond well in most cases to nonoperative treatment; a small percentage require initial operative treatment, however. In most cases, continued participation in sports is possible during treatment as long as protective splinting is allowed.     

Radiology of wrist and hand injuries in athletes

Traumatic injuries are a major cause of hand and wrist pain in athletes. Wrist injuries include fractures, dislocations, and instability patterns. Hand injuries include tendon injuries, ligamentous injuries, and fractures. In this article we have presented the radiographic appearance of the more common of these injuries.     

Rehabilitation of common athletic injuries of the hand and wrist

Rehabilitation of athletic injuries of the hand and wrist should begin at the time of injury. Early recognition and prompt medical attention can serve to minimize the initial effects of injury. A systematic evaluation should include assessment of deformity, joint instability, active and passive motion, edema, and nerve and tendon function. In spite of initial negative findings, painful joints should be protected. Joints of the hand and wrist are particularly vulnerable to the effects of aggressive rehabilitation. Signs of reaction to exercises should be closely observed. Upgrading of activity should only occur as soft-tissue healing will allow.     

Soft-tissue injuries of the hand and wrist in racquet sports

Participants in racquet sports are prone to a host of soft-tissue injuries to their hands and wrists owing to the direct impact of the handle as well as the repetitive stretching that occurs as the wrist is forcefully whipped into extremes of position. Tendinitis can occur in all tendons but is most common in the first dorsal compartment, flexor carpi ulnaris, flexor carpi radialis, and extensor carpi ulnaris. Ligamentous tears can produce instability patterns that, if unrecognized, can become chronic disabilities. Vessels and nerves can be compromised by repetitive blunt trauma to the structures themselves or by entrapment by surrounding structures. Prompt diagnosis will allow for the appropriate treatment and eliminate the need for vague terms such as "wrist sprain." The goal of early recognition and treatment is to allow the player to get back to the court and prevent the development of chronic discomfort or permanent impairment.     

Pulpous hamartoma of the spleen. Imaging by CT and MRT]

A rare case of a symptomatic splenic hamartoma is presented. Its appearance on both unenhanced and enhanced computed tomography and fast-scan magnetic resonance imaging is demonstrated.     

Nerve injuries of the elbow, wrist, and hand in athletes

Upper extremity compression neuropathies are fairly rare in athletes. Initially, most can be managed conservatively. These conditions can follow direct contusion of the tissues that overlay these peripheral nerves or can result from vigorous, repetitive, athletic activity leading to tissue swelling and ischemia with nerve compression symptoms. A complete history and physical examination, including a neurologic examination, should be paramount when treating athletes with upper extremity injuries. Early diagnosis and treatment with conservative measures such as splinting, rest, activity modification, and medications can afford the athlete an earlier return to sports. Surgery can be employed when conservative treatment fails and a specific diagnosis has been ascertained.     

Current concepts in the diagnosis and treatment of hand and wrist injuries in sports

The hand is the most commonly injured part in sport. Fortunately, most injuries are minor and do not interfere with the sport participation, but even these leave residual functional deficits that may increase with time. More severe injuries of the hand are appreciated instantly by the player and health care personnel and generally receive better care. The goal is to maintain the best functioning hands now for the sport and in the future for the life's work of the hand. A program is herein described outlining the care of minor and major sports injuries to the hand that tries to return the injured player quickly to the sport participation while not jeopardizing the future. Because injuries to this most important tool are so frequent, it is recommended that a lecture be given to each sport group prior to the season to describe and raise the awareness of the players regarding hand and finger injury.     

Imaging of stress injuries of the pelvis

Stress fractures are common, representing the final stage in a continuum of bone response to continued mechanical damage. Encompassing fatigue- and insufficiency-type fractures, stress fractures of the pelvis are likely underreported. Radiographs are insensitive to stress injuries, particularly those in the pelvis, whereas scintigraphy and magnetic resonance imaging are exquisitely sensitive. In this article we discuss the pathophysiology and imaging appearances of stress injuries of the pelvis and sacrum. Relevant literature regarding risk factors, problem-solving issues, and an imaging algorithm are discussed, with the goal of improving accuracy in the diagnosis of these common injuries.     

手足肌腱损伤的影像学研究进展

目前,肌腱韧带损伤的检查常为超声和磁共振,而CT在诊断肌腱韧带损伤中受到很大限制。近年来问世的宝石能谱CT以其独特的优势,对手足肌腱进行能谱扫描,利用其强大的图像后处理功能,可多方位、清晰、立体、直观地显示肌腱的解剖结构或损伤情况。因此,作为一种新方法.其在临床上的广泛应用具有很好的前景。本文主要就手足肌腱损伤的影像研究进展及展望进行综述。     

Fractures of the hand and wrist in the athlete.

The challenge of treating fractures of the hand and wrist in the athlete is finding innovative ways of internal and external fixation that will allow the athlete to continue participation while the fracture is healing. The challenge is to provide enough immobilization or restriction to allow optimal fracture healing while providing enough freedom to allow the athlete to participate in his sport.     

Sonography of the wrist and the hand

Sonographic examination of the hand requires high-frequency linear transducers. As the relevant structures are located very close to the surface, water stand-off pads are mandatory. Owing to the high sensitivity of sonography in the detection of fluid, exudative synovitis, tenosynovitis and ganglia can be easily diagnosed. Sonographic information on muscle atrophy and alterations of the shape and echogenicity of the median nerve in patients with carpal tunnel syndrome may be useful in evaluating the extent of disease. Further indications for the sonographic examination of the hand include suspected tumors, foreign bodies and synovial proliferation. Osseous destruction can be visualized in patients with rheumatoid disease, but the precise extent is hard to determine.     

Complications of hand and wrist surgery in the athlete.

The hand injuries reviewed in this article are those about which the treating physician should be suspicious, whether an athlete presents with them on the field or shortly thereafter in the emergency department or clinic. Education on the part of the physician and the patient are the primary safeguards to limiting complications.