Tuesday, September 20, 2016
Injuries happen in football. Whether a player can return to play quickly or perhaps needs weeks of rehab depends on the injured body part and the player’s position. Demarcus Ware, a Denver Bronco lineman might play within 4-5 weeks after a forearm fracture but the Bears’ quarterback Jay Cutler may have a season ending injury because of an injured thumb on his throwing hand. The hand is a complicated machine with tendons and pulleys manipulating multiple joints to allow precise, minute movements…or the ability roughly grasp a football and be able to throw a spiral.
The language of medicine has allowed many hand injuries to be described with colorful terms or eponyms that can be confusing when the general public tries to understand what might actually be wrong.
Gamekeeper’s or skier’s thumb described a torn ulnar collateral ligament. This is the ligament that attached the thumb to the rest of the hand and if it is damaged, the ability to grasp with power is lost. The damage occurs during a fall on an outstretched hand where the thumb splays away from the rest of the hand. The ligament needs to heal and this may be allowed to occur naturally by keeping the thumb and hand casted for weeks. Otherwise, surgery is an option to reattach the torn ends. Occasionally, a piece of bone gets torn off where the ligament attaches and potentially makes surgery more of an option.
The metacarpals are the long bones of the hand that attach the carpal bones to the digits (thumb and fingers). The first metacarpal is the long bone just proximal to the thumb. Should the thumb be flexed just as a fall occurs, the base of the first metacarpal can break (fracture, crack mean the same thing) and potentially become unstable. As well, if the bone does not heal well, the joint between it and the carpal bone can become arthritis and cause chronic pain and weakness with grasp. Surgery is often required to wire the bones into good alignment and hopefully produce a normally functioning hand.
If the tip of a finger is hit by a ball and is forcibly flexed, it can tear the extensor tendon off the distal phalanx (the tip of the finger where the nail is located). The last joint in the finger, the distal interphalangeal joint (DIP), cannot extend and the fingertip droops. While not a terrible injury, a droopy finger gets in the way when the hand tries to grasp or if one tries to put their hand in a pocket. The finger can be splinted for a few weeks and the tendon often reattaches. Surgery is an alternative to reattach the tendon or if a significant chunk of bone gets pulled of the distal phalanx when the injury occurred.
The proximal interphalangeal joint (PIP) is a construction wonder, since tendons have to attach to move it while at the same time allow other tendons to span the joint and get to the DIP joint. It’s a complicated engineering feat and includes tendons that slide on each side of the joint with a central hood that then protects the PIP. If the finger is forcibly flexed or dislocated, this central slip can be torn, the tendons displaced and the joint gets pushed through the central slip. The joint gets stuck and leads to the deformity. Hand function may or may not be affected but the finger but looks weird. Chronic pain and arthritis may develop, like in any other joint injury. Splinting or surgery may or may not work to fix the problem.
This seems simple enough. If one were to hit a wall, or some other immoveable object, bones in the hand can break. A Boxer’s fracture describes a broken fifth metacarpal head, the bone just proximal to the little finger and the metacarpophalageal joint. If the fracture does not involve the joint, then the body can tolerate significant amount of angulation and still have a normally functioning hand. Attempts to manipulate and cast this injury usually fail and the bone tends to heal but the bone remains misshapen but does not affect how the hand moves, grasps or looks.
Just a Bruise
And sometimes, the hand just doesn’t break but can look bad. Viking quarterback, Sam Bradford, had the back of his hand smack up against a defensive player and had immediate swelling. The dorsum of the hand (the side opposite of the palm) has little padding and if one of the prominent veins breaks, there can be significant bleeding. The skin is loose and there is nothing to tamponade or place pressure on the broken vein to make the blood clot quickly. It is sometimes hard to tell whether the bleeding is due to just that or a broken bone underneath. Bradford’s x-rays were negative and al that ugly swelling was no more than a bad bruise. There is no eponym for that yet.
This entry was tagged Bennett, boutonniere deformity, boxer's fracture, Demarcus Ware, finger, fracture, gamekeeper's thumb, Jay Cutler, mallet finger, Sam Bradford, skier's thumb