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Protecting hands as summer sports seasons open

By Dr. Stuart Elkowitz

Hand Surgeon Dr. Stuart Elkowitz Provides Tips on Injury Prevention

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Carmel, NY - One in four of all fractures involves the hand or wrist. Almost as common are soft tissue injuries - strains, sprains and contusions. "With so many bones, ligaments, tendons, and joints keeping hands and wrists working, it's not surprising that injuries to the hand and wrists are so common in athletes of all ages," says hand surgeon Dr. Stuart Elkowitz of Somers Orthopaedic Surgery and Sports Medicine Group. "While preventing a sports-related hand injury may not always be possible, there are things you can do to minimize the impact if one does occur. At this time of year, as athletes in many sports are getting ready for a new season, we advise three simple measures to reduce the risk of damage to the hands: strengthen, stretch and protect."

Strengthening exercises that protect the hands and wrists are simple to perform and do not require special equipment. Athletes can build strength by squeezing a ball in the hand, doing wrist curls while holding a soup can or a light weight, or extending the fingers against the resistance of rubber bands placed around them. Stretching should be part of every warmup and can include simple stretches like extending the arm with elbows straight, and curling the hand to move the wrists up and down. Protection comes in the form of wrist guards, which can help prevent fractures, and gloves, which protect the palm from a direct blow and the skin from wounds and cuts.

Traumatic and Overuse Hand Injuries
Injuries to an athlete's hands or wrists are generally classified into two main categories: traumatic and overuse. Traumatic injuries usually involve acute pain resulting from impact or a specific event and are more likely to occur in athletes who participate in sports that require higher levels of contact (e.g., football, hockey, wrestling). Traumatic hand injuries can result from a fall that forces the hand or fingers backward, a forceful impact to the hands, or a direct blow. Overuse injuries involve chronic pain that develops slowly and are sustained by athletes who participate in sports that require repetitive movements (e.g., baseball, tennis, golf). Some common traumatic injuries in athletes include joint dislocations, sprains, muscle strains, broken bones, tendon inflammation, and ligament tears.

According to Dr. Elkowitz, "even seemingly minor injuries should receive prompt medical attention. Patients often can't tell, for example, if a finger is broken. They may believe that if they can move it, it isn't broken and they don't see a doctor. But the only way to know for sure if the finger is fractured is with an x-ray. And a fracture left untreated can result in arthritis and considerable pain."

The use of the hand and wrist in different sports affects the way they may be injured. For example, wrist fractures and sprains are among the most common sports injuries to the hands since they are often caused by falls, which are common in all athletic activities. When falling forward, most people react by putting their hands in front of them to cushion the fall. This natural response causes landing on the palm, bending the wrist backwards and possibly stretching or tearing the ligaments connecting the bones in the wrist. The result is a sprain. Without an x-ray, a sprain often cannot be distinguished from a fracture, which usually results from falling on an outstretched wrist.

Baseball finger, also known as mallet finger, occurs when a ball or other object forcefully hits the tip of the finger, bending it downward and damaging the extensor tendon, which straightens the finger. The finger Is painful, swollen and bruised and often the fingertip droops noticeably. If an x-ray confirms that there is no fracture or misalignment of the joint, baseball finger can generally be treated non-surgically. Many finger injuries occur during baseball when athletes slide head first into a base and jam their fingers into a base. This can be avoided by sliding feet first.

Tennis elbow is a common injury in which a tendon on the outside of the forearm fails and begins to tear away from the bone, with pain sometimes extending down the forearm. It is most often seen in those who play racket sports but also affects individuals who participate in any activity that demands repetitive use of the forearm muscles (hand gripping and wrist turning activities). Often tennis elbow can be exacerbated by having the wrong grip size. Players should have their local tennis pro evaluate their racket to have the correct size. Golfer's elbow, while similar to tennis elbow, affects the tendon on the inner side of the elbow.

Extensor carpi ulnaris (ECU) tendonitis, also a common sports-related tendon injury, is an inflammation of the tendon that runs along the back of the wrist on the pinky side and is caused by repetitive twisting and backward flexing of the wrist. It is most commonly seen in basketball players and those playing racket sports.

"These are some of the common injuries that affect the hand, wrist and arm," says Dr. Elkowitz. "There are many more, with varying degrees of severity. The important things for athletes to keep in mind are that 'playing through the pain' can result in serious, permanent damage and that simple preventive measures - strengthen, stretch, protect - can help athletes have a healthy season."

Stuart J. Elkowitz, M.D., F.A.A.O.S., C.A.Q.H.S. is board certified in orthopaedic surgery and received a Certificate of Added Qualification in Hand Surgery (C.A.Q.H.S.), which is the equivalent of board certification in hand surgery. He is a member of the American Society for Surgery of the Hand, the American Academy of Orthopaedic Surgeons and the New York State Orthopaedic and Westchester County Medical Societies. Dr. Elkowitz obtained his medical degree from New York University School of Medicine and graduated cum laude with a B.S. degree in economics from the Wharton School in Pennsylvania. He completed his orthopaedic surgery residency at the Hospital for Joint Diseases and did a clinical rotation at the Shock Trauma Center in Baltimore MD. Specializing in hand surgery, Dr. Elkowitz completed a fellowship at the Raymond Curtis National Hand Center at Union Memorial Hospital in Baltimore. He is the co-author of several publications involving orthopaedic problems of the hand, wrist and fingers and has had research presented at a number of prestigious meetings. www.somersortho.com

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