Hand and finger injuries account for up to 9% of sports injuries, and the hand is the most frequently injured part of the athlete's upper extremity.1 These injuries are particularly common in ball sports, perhaps because athletes tend to avoid use of protective equipment that may limit dexterity.
Up to 30% of hand injuries are misdiagnosed or mismanaged.2 This problem may have long-term ramifications, because if they are not managed properly and efficiently, these injuries—especially those to the dominant hand—can be disabling.
Primary care physicians are capable of managing many sports-related hand and finger injuries effectively, as long as they obtain a detailed history, conduct a focused examination, and know the indications for referral. In this article, we discuss diagnosis and management of the traumatic injuries that are common in ball sports. We also describe the criteria for referral to ensure that patients receive the best possible care and achieve a safe return to sports activity.
HISTORY
Taking a thorough history of the injury is key to making an accurate assessment, ordering the proper ancillary tests, and formulating an appropriate treatment plan. First, identify the sport or activity that the patient was involved in at the time of injury; also ascertain his or her hand dominance, which may affect the injury mechanism and recovery or disability. Determining the mechanism of injury also helps the diagnosis. For example, did the injury involve a fall? Was the athlete holding a piece of equipment? Was he or she grabbing a jersey or trying to catch a ball?
The chief complaint with most hand injuries is pain.The location, quality, and onset of pain, as well as the precipitating and alleviating movements or positions all are important aspects of a thorough history. Is there swelling and ecchymosis? Was there an immediate or delayed onset? The presence of pallor or paresthesia could mean there is neurovascular involvement that requires immediate intervention. The patient's age is important, because injuries often occur at locations of greatest weakness (open growth plates are more likely to be involved in younger patients vs ligaments and tendons in adults). Learning what the athlete cannot do with the injured hand helps focus the clinician in formulating his diagnosis and treatment plan. Also helpful is an understanding of the complex anatomy of the hand (Figure).
EXAMINATION OF SPECIFIC INJURIES
Mallet finger
This injury, also known as baseball finger, results from ligamentous disruption of the extensor tendon at the distal interphalangeal (DIP) joint. A mallet finger may be a tear of the ligament itself or a small avulsion of its bony attachment on the distal phalanx. There is a loss of full extension (5° to 20°), also known as an extensor lag, at the DIP joint.3 A mallet finger often occurs when a finger is "jammed" during baseball, basketball, or football participation. While the athlete is attempting to catch a ball, his DIP joint is actively extended.The ball hits the finger, causing forced flexion and injuring the extensor tendon.
