Skip to main content

Hand and Wrist Injuries

  • Chapter
  • First Online:
Essential Radiology for Sports Medicine

Abstract

In comparison to lower limb injury, wrist and hand injury in sport is relatively uncommon accounting for only 3–9% of all sports injury.

It however has much greater relevance in some sports particularly where the incidence of injury is increased (golf, tennis, snowboarding and contact sports) or the impact of wrist and hand dysfunction on performance is high. Preservation of hand and wrist function is also vital to activities of daily life and early accurate diagnosis and treatment of sports-related wrist and hand injury will have clear patient benefits beyond sport.

The clinical presentation and clinical findings in these conditions often substantially overlap and as in all areas of modern medicine imaging is becoming an increasingly important part of the clinical assessment. To understand wrist and hand injury a clear understanding of some complex anatomy, biomechanics and injury mechanisms is required. This chapter will deal with the wrist and hand detailing the anatomy, biomechanics, injury patterns and imaging approaches and findings in sports injury of the hand and wrist.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Geissler WB (2001) Carpal fractures in athletes. Clin Sports Med 20:167–188

    Article  PubMed  CAS  Google Scholar 

  2. Jacobson JA, Miller BS, Morag Y (2005) Golf and racquet sports injuries. Semin Musculoskelet Radiol 9:346–359

    Article  PubMed  Google Scholar 

  3. Masmejean EH, Chavane H, Chantegret A, Issermann JJ, Alnot JY (1999) The wrist of the formula 1 driver. Br J Sports Med 33:270–273

    Article  PubMed  CAS  Google Scholar 

  4. McCarroll JR (2001) Overuse injuries of the upper extremity in golf. Clin Sports Med 20:469–479

    Article  PubMed  CAS  Google Scholar 

  5. Rettig AC (2004) Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 32:262–273

    Article  PubMed  Google Scholar 

  6. Rooks MD (1997) Rock climbing injuries. Sports Med 23:261–270

    Article  PubMed  CAS  Google Scholar 

  7. Theriault G, Lachance P (1998) Golf injuries. An overview. Sports Med 26:43–57

    Article  PubMed  CAS  Google Scholar 

  8. Webb BG, Rettig LA (2008) Gymnastic wrist injuries. Curr Sports Med Rep 7:289–295

    PubMed  Google Scholar 

  9. Kristensen SS, Thomassen E, Christensen F (1986) Ulnar variance in Kienbock’s disease. J Hand Surg Br 11:258–260

    Article  PubMed  CAS  Google Scholar 

  10. Conway WF, Destouet JM, Gilula LA, Bellinghausen HW, Weeks PM (1985) The carpal boss: an overview of radiographic evaluation. Radiology 156:29–31

    PubMed  CAS  Google Scholar 

  11. Maquirriain J, Ghisi JP (2006) Acute os styloideum injury in an elite athlete. Skeletal Radiol 35:394–396

    Article  PubMed  Google Scholar 

  12. Sokolow C, Saffar P (2001) Anatomy and histology of the scapholunate ligament. Hand Clin 17:77–81

    PubMed  CAS  Google Scholar 

  13. Doyle JR (1988) Anatomy of the finger flexor tendon sheath and pulley system. J Hand Surg Am 13:473–484

    Article  PubMed  CAS  Google Scholar 

  14. Hauger O, Chung CB, Lektrakul N et al (2000) Pulley system in the fingers: normal anatomy and simulated lesions in cadavers at MR imaging, CT, and US with and without contrast material distention of the tendon sheath. Radiology 217:201–212

    PubMed  CAS  Google Scholar 

  15. Lee JC, Healy JC (2005) Normal sonographic anatomy of the wrist and hand. Radiographics 25:1577–1590

    Article  PubMed  Google Scholar 

  16. Hanks GA, Kalenak A, Bowman LS, Sebastianelli WJ (1989) Stress fractures of the carpal scaphoid. A report of four cases. J Bone Joint Surg Am 71:938–941

    PubMed  CAS  Google Scholar 

  17. Heckmann A, Lahoda LU, Alkandari Q, Vogt PM, Knobloch K (2008) C-type scaphoid fracture in a elite power lifting. Sportverletz Sportschaden 22:106–108

    Article  PubMed  CAS  Google Scholar 

  18. Hosey RG, Hauk JM, Boland MR (2006) Scaphoid stress fracture: an unusual cause of wrist pain in a competitive diver. Orthopedics 29:503–505

    PubMed  Google Scholar 

  19. Blum AG, Zabel JP, Kohlmann R et al (2006) Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics 26:1021–1044

    Article  PubMed  Google Scholar 

  20. David TS, Zemel NP, Mathews PV (2003) Symptomatic, partial union of the hook of the hamate fracture in athletes. Am J Sports Med 31:106–111

    PubMed  Google Scholar 

  21. Evans MW Jr (2004) Hamate hook fracture in a 17-year-old golfer: importance of matching symptoms to clinical evidence. J Manipulative Physiol Ther 27:516–518

    Article  PubMed  Google Scholar 

  22. Evans MW Jr, Gilbert ML, Norton S (2006) Case report of right hamate hook fracture in a patient with previous fracture history of left hamate hook: is it hamate bipartite? Chiropr Osteopat 14:22

    Article  PubMed  Google Scholar 

  23. Batt ME (1993) Golfing injuries. An overview. Sports Med 16:64–71

    Article  PubMed  CAS  Google Scholar 

  24. Murray PM, Cooney WP (1996) Golf-induced injuries of the wrist. Clin Sports Med 15:85–109

    PubMed  CAS  Google Scholar 

  25. Mann FA, Wilson AJ, Gilula LA (1992) Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology 184:15–24

    PubMed  CAS  Google Scholar 

  26. Short WH, Werner FW, Green JK, Masaoka S (2002) Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 27:991–1002

    Article  PubMed  Google Scholar 

  27. Magee T (2009) Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 192:80–85

    Article  PubMed  Google Scholar 

  28. Griffith JF, Chan DP, Ho PC, Zhao L, Hung LK, Metreweli C (2001) Sonography of the normal scapholunate ligament and scapholunate joint space. J Clin Ultrasound 29:223–229

    Article  PubMed  CAS  Google Scholar 

  29. Jacobson JA, Oh E, Propeck T, Jebson PJ, Jamadar DA, Hayes CW (2002) Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy. AJR Am J Roentgenol 179:523–527

    PubMed  Google Scholar 

  30. Cassidy C, Ruby LK (2003) Carpal instability. Instr Course Lect 52:209–220

    PubMed  Google Scholar 

  31. Larsen CF, Mathiesen FK, Lindequist S (1991) Measurements of carpal bone angles on lateral wrist radiographs. J Hand Surg Am 16:888–893

    Article  PubMed  CAS  Google Scholar 

  32. Friedman SL, Palmer AK (1991) The ulnar impaction syndrome. Hand Clin 7:295–310

    PubMed  CAS  Google Scholar 

  33. Fortems Y, De Smet L, Dauwe D, Stoffelen D, Deneffe G, Fabry G (1994) Incidence of cartilaginous and ligamentous lesions of the radio-carpal and distal radio-ulnar joint in an elderly population. J Hand Surg Br 19:572–575

    Article  PubMed  CAS  Google Scholar 

  34. Kirschenbaum D, Sieler S, Solonick D, Loeb DM, Cody RP (1995) Arthrography of the wrist. Assessment of the integrity of the ligaments in young asymptomatic adults. J Bone Joint Surg Am 77:1207–1209

    PubMed  CAS  Google Scholar 

  35. Romaniuk CS, Butt WP, Coral A (1995) Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management. Skeletal Radiol 24:95–99

    Article  PubMed  CAS  Google Scholar 

  36. Brown JA, Janzen DL, Adler BD et al (1994) Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain. Can Assoc Radiol J 45:292–296

    PubMed  CAS  Google Scholar 

  37. Cantor RM, Stern PJ, Wyrick JD, Michaels SE (1994) The relevance of ligament tears or perforations in the diagnosis of wrist pain: an arthrographic study. J Hand Surg Am 19:945–953

    Article  PubMed  CAS  Google Scholar 

  38. Oneson SR, Scales LM, Timins ME, Erickson SJ, Chamoy L (1996) MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions. Radiographics 16:97–106

    PubMed  CAS  Google Scholar 

  39. Mikic Z, Somer L, Somer T (1992) Histologic structure of the articular disk of the human distal radioulnar joint. Clin Orthop Relat Res 29–36

    Google Scholar 

  40. Mikic ZD (1978) Age changes in the triangular fibrocartilage of the wrist joint. J Anat 126:367–384

    PubMed  CAS  Google Scholar 

  41. Hobby JL, Tom BD, Bearcroft PW, Dixon AK (2001) Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol 56:50–57

    Article  PubMed  CAS  Google Scholar 

  42. Meier R, Schmitt R, Christopoulos G, Krimmer H (2003) [TFCC-lesion. MR arthrography vs. arthroscopy of the wrist]. Unfallchirurg 106:190–194

    Article  PubMed  CAS  Google Scholar 

  43. Joshy S, Ghosh S, Lee K, Deshmukh SC (2008) Accuracy of direct magnetic resonance arthrography in the diagnosis of triangular fibrocartilage complex tears of the wrist. Int Orthop 32:251–253

    Article  PubMed  Google Scholar 

  44. Hobby JL, Dixon AK, Bearcroft PW et al (2001) MR imaging of the wrist: effect on clinical diagnosis and patient care. Radiology 220:589–593

    Article  PubMed  CAS  Google Scholar 

  45. Maizlin ZV, Brown JA, Clement JJ et al (2009) MR arthrography of the wrist: controversies and concepts. Hand (N Y) 4:66–73

    Article  Google Scholar 

  46. Imaeda T, Nakamura R, Shionoya K, Makino N (1996) Ulnar impaction syndrome: MR imaging findings. Radiology 201:495–500

    PubMed  CAS  Google Scholar 

  47. Cerezal L, del Pinal F, Abascal F, Garcia-Valtuille R, Pereda T, Canga A (2002) Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 22:105–121

    PubMed  Google Scholar 

  48. Bell MJ, Hill RJ, McMurtry RY (1985) Ulnar impingement syndrome. J Bone Joint Surg Br 67:126–129

    PubMed  CAS  Google Scholar 

  49. Staron RB, Feldman F, Haramati N, Singson RD, Rosenwasser M, Esser PD (1994) Abnormal geometry of the distal radioulnar joint: MR findings. Skeletal Radiol 23:369–372

    Article  PubMed  CAS  Google Scholar 

  50. Emery KH (2006) Imaging of sports injuries of the upper extremity in children. Clin Sports Med 25:543–568, viii

    Article  PubMed  Google Scholar 

  51. Hagel B (2005) Skiing and snowboarding injuries. Med Sport Sci 48:74–119

    Article  PubMed  Google Scholar 

  52. Kraus R, Szalay G, Meyer C, Kilian O, Schnettler R (2007) Distal radius fracture – a goalkeepers’ injury in children and adolescents. Sportverletz Sportschaden 21:177–179

    Article  PubMed  CAS  Google Scholar 

  53. Macgregor DM (2003) Don’t save the ball! Br J Sports Med 37:351–353

    Article  PubMed  CAS  Google Scholar 

  54. Zimmermann R, Rudisch A, Fritz D, Gschwentner M, Arora R (2007) MR imaging for the evaluation of accompanying injuries in cases of distal forearm fractures in children and adolescents. Handchir Mikrochir Plast Chir 39:60–67

    Article  PubMed  CAS  Google Scholar 

  55. Caine DJ, Nassar L (2005) Gymnastics injuries. Med Sport Sci 48:18–58

    Article  PubMed  Google Scholar 

  56. DiFiori JP (2006) Overuse injury and the young athlete: the case of chronic wrist pain in gymnasts. Curr Sports Med Rep 5:165–167

    PubMed  Google Scholar 

  57. DiFiori JP, Mandelbaum BR (1996) Wrist pain in a young gymnast: unusual radiographic findings and MRI evidence of growth plate injury. Med Sci Sports Exerc 28:1453–1458

    Article  PubMed  CAS  Google Scholar 

  58. Dobyns JH, Gabel GT (1990) Gymnast’s wrist. Hand Clin 6:493–505

    PubMed  CAS  Google Scholar 

  59. Bilic R, Kolundzic R, Jelic M (2001) Overuse injury syndromes of the hand, forearm and elbow. Arh Hig Rada Toksikol 52:403–414

    PubMed  CAS  Google Scholar 

  60. du Toit P, Sole G, Bowerbank P, Noakes TD (1999) Incidence and causes of tenosynovitis of the wrist extensors in long distance paddle canoeists. Br J Sports Med 33:105–109

    Article  PubMed  Google Scholar 

  61. Guerini H, Drape JL, Le Viet D et al (2007) Imaging of wrist injuries in athletes. J Radiol 88:111–128

    Article  PubMed  CAS  Google Scholar 

  62. Ilyas AM, Ast M, Schaffer AA, Thoder J (2007) De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg 15:757–764

    PubMed  Google Scholar 

  63. Rettig AC (1994) Wrist problems in the tennis player. Med Sci Sports Exerc 26:1207–1212

    PubMed  CAS  Google Scholar 

  64. Rossi C, Cellocco P, Margaritondo E, Bizzarri F, Costanzo G (2005) De Quervain disease in volleyball players. Am J Sports Med 33:424–427

    Article  PubMed  Google Scholar 

  65. Glajchen N, Schweitzer M (1996) MRI features in de Quervain’s tenosynovitis of the wrist. Skeletal Radiol 25:63–65

    Article  PubMed  CAS  Google Scholar 

  66. Klug JD (1995) MR diagnosis of tenosynovitis about the wrist. Magn Reson Imaging Clin N Am 3:305–312

    PubMed  CAS  Google Scholar 

  67. Richie CA 3rd, Briner WW Jr (2003) Corticosteroid injection for treatment of de Quervain’s tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract 16:102–106

    Article  PubMed  Google Scholar 

  68. Montalvan B, Parier J, Brasseur JL, Le Viet D, Drape JL (2006) Extensor carpi ulnaris injuries in tennis players: a study of 28 cases. Br J Sports Med 40:424–429, discussion 429

    Article  PubMed  CAS  Google Scholar 

  69. Wiesler ER, Lumsden B (2005) Golf injuries of the upper extremity. J Surg Orthop Adv 14:1–7

    PubMed  Google Scholar 

  70. Pfirrmann CW, Theumann NH, Chung CB, Botte MJ, Trudell DJ, Resnick D (2001) What happens to the triangular fibrocartilage complex during pronation and supination of the forearm? Analysis of its morphology and diagnostic assessment with MR arthrography. Skeletal Radiol 30:677–685

    Article  PubMed  CAS  Google Scholar 

  71. Henry M (2008) Arthroscopic management of dorsal wrist impingement. J Hand Surg Am 33:1201–1204

    Article  PubMed  Google Scholar 

  72. VanHeest AE, Luger NM, House JH, Vener M (2007) Extensor retinaculum impingement in the athlete: a new diagnosis. Am J Sports Med 35:2126–2130

    Article  PubMed  Google Scholar 

  73. Jagenburg A, Goyen M, Hirschelmann R, Carstens IM, Kroger K (2000) Hypothenar hammer syndrome: causes, sequelae and diagnostic aspects. Rofo 172:295–300

    Article  PubMed  CAS  Google Scholar 

  74. Winterer JT, Ghanem N, Roth M et al (2002) Diagnosis of the hypothenar hammer syndrome by high-resolution contrast-enhanced MR angiography. Eur Radiol 12:2457–2462

    PubMed  CAS  Google Scholar 

  75. Akuthota V, Plastaras C, Lindberg K, Tobey J, Press J, Garvan C (2005) The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med 33:1224–1230

    Article  PubMed  Google Scholar 

  76. Hsu WC, Chen WH, Oware A, Chiu HC (2002) Unusual entrapment neuropathy in a golf player. Neurology 59:646–647

    Article  PubMed  Google Scholar 

  77. Dias JJ, Dhukaram V, Kumar P (2007) The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol 32:502–508

    Article  PubMed  CAS  Google Scholar 

  78. Magee TH, Rowedder AM, Degnan GG (1995) Intraosseus ganglia of the wrist. Radiology 195:517–520

    PubMed  CAS  Google Scholar 

  79. Wright WC, Griffiths HJ (2002) Radiologic case study. Wrist instability, volar intercalary segmental instability, and ganglion cysts. Orthopedics 25(906):995–996

    Google Scholar 

  80. Wang H, Terrill RQ, Tanaka S, Amrami KK, Spinner RJ (2009) Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory. Neurosurg Focus 26:E10

    Article  PubMed  Google Scholar 

  81. Teefey SA, Dahiya N, Middleton WD, Gelberman RH, Boyer MI (2008) Ganglia of the hand and wrist: a sonographic analysis. AJR Am J Roentgenol 191:716–720

    Article  PubMed  Google Scholar 

  82. Wang G, Jacobson JA, Feng FY, Girish G, Caoili EM, Brandon C (2007) Sonography of wrist ganglion cysts: variable and noncystic appearances. J Ultrasound Med 26:1323–1328, quiz 1330–1321

    PubMed  Google Scholar 

  83. Goldsmith S, Yang SS (2008) Magnetic resonance imaging in the diagnosis of occult dorsal wrist ganglions. J Hand Surg Eur Vol 33:595–599

    Article  PubMed  CAS  Google Scholar 

  84. Bollen SR (1990) Injury to the A2 pulley in rock climbers. J Hand Surg Br 15:268–270

    PubMed  CAS  Google Scholar 

  85. Rooks MD, Johnston RB 3rd, Ensor CD, McIntosh B, James S (1995) Injury patterns in recreational rock climbers. Am J Sports Med 23:683–685

    Article  PubMed  CAS  Google Scholar 

  86. Clavero JA, Alomar X, Monill JM et al (2002) MR imaging of ligament and tendon injuries of the fingers. Radiographics 22:237–256

    PubMed  Google Scholar 

  87. Gabl M, Lener M, Pechlaner S, Lutz M, Rudisch A (1996) Rupture or stress injury of the flexor tendon pulleys? Early diagnosis with MRI. Handchir Mikrochir Plast Chir 28:317–321

    PubMed  CAS  Google Scholar 

  88. Parellada JA, Balkissoon AR, Hayes CW, Conway WF (1996) Bowstring injury of the flexor tendon pulley system: MR imaging. AJR Am J Roentgenol 167:347–349

    PubMed  CAS  Google Scholar 

  89. Cresswell TR, Allott C, Auchincloss JM (1998) Colour Doppler ultrasound in the diagnosis, management and follow-up of a digital flexor pulley injury. J Hand Surg Br 23:655–657

    Article  PubMed  CAS  Google Scholar 

  90. Smith RD, O’Leary ST, McCullough CJ (1998) Trigger wrist and flexor tenosynovitis. J Hand Surg Br 23:813–814

    Article  PubMed  CAS  Google Scholar 

  91. Guerini H, Pessis E, Theumann N et al (2008) Sonographic appearance of trigger fingers. J Ultrasound Med 27:1407–1413

    PubMed  Google Scholar 

  92. Paulius KL, Maguina P (2009) Ultrasound-assisted percutaneous trigger finger release: is it safe? Hand (N Y) 4:35–37

    Article  Google Scholar 

  93. Lopez-Ben R, Lee DH, Nicolodi DJ (2003) Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis with dynamic US – report of three cases. Radiology 228:642–646

    Article  PubMed  Google Scholar 

  94. Masson JA, Golimbu CN, Grossman JA (1995) MR imaging of the metacarpophalangeal joints. Magn Reson Imaging Clin N Am 3:313–325

    PubMed  CAS  Google Scholar 

  95. Stener B (1963) Skeletal injuries associated with rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. A clinical and anatomical study. Acta Chir Scand 125:583–586

    PubMed  CAS  Google Scholar 

  96. Breeze SW, Ouellette T, Mays MM (2009) Isolated avulsion fracture of the extensor carpi radialis brevis insertion due to a boxer’s injury. Orthopedics 32:210

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Philip J. O’Connor .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

O’Connor, P.J. (2010). Hand and Wrist Injuries. In: Robinson, P. (eds) Essential Radiology for Sports Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5973-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-5973-7_7

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-5972-0

  • Online ISBN: 978-1-4419-5973-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics