Sports Trauma: Wrist and Hand

  • Margaret W. M. Fok
  • Christine L. Redmond
  • Gregory I. BainEmail author


Wrist and hand injuries are very common in sports trauma, particularly in many contact and ball sports. However, they are often missed or treated as simple sprains. A high index of suspicion is needed when symptoms and signs persist, particularly, if the athlete continues to compete with a painful wrist or swollen finger, which can lead to further injury of the secondary stabilizers and articular surfaces. Unfortunately, these late presentations are a much greater challenge to manage. It is too late to simply reduce the joint or the fracture, so a salvage procedure such as a fusion may be required. This chapter presents and discusses different scenarios of wrist and hand injury in sports practice, clinical and radiological evaluation, as well as therapeutic approaches.


Wrist injuries Finger injury Fracture dislocation Fracture, Bone Sports Metacarpophalangeal joint Sports medicine 



For assistance in preparation of this manuscript, Kimberley Ruxton, Research Manager, Department of Orthopaedic Surgery, Flinders University, and Flinders Medical Centre, Adelaide, Australia;; +61882044289.


  1. 1.
    Rettig AC. Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist. Am J Sports Med. 2003;31:1038–48.CrossRefGoogle Scholar
  2. 2.
    Rettig AC. Epidemiology of hand and wrist injuries in sports. Clin Sports Med. 1998;17:401–6.CrossRefGoogle Scholar
  3. 3.
    Gilula LA, Weeks PM. Post-traumatic ligamentous instabilities of the wrist. Radiology. 1978;129:641–51.CrossRefGoogle Scholar
  4. 4.
    Corre AL, Huynh KP, Dhaliwal RS, Bain GI. Development of a protocol for SPECT/CT in the assessment of wrist disorders. J Wrist Surg. 2016;5:297–305.CrossRefGoogle Scholar
  5. 5.
    Green DP, O’Brien ET. Classification and management of carpal dislocations. Clin Orthop Relat Res. 1980;(149):55–72.Google Scholar
  6. 6.
    Dunn JC, Koehler LR, Kusnezov NA, Polfer E, Orr JD, Pirela-Cruz MA, Mitchell JS. Perilunate dislocations and perilunate fracture dislocations in the U.S. military. J Wrist Surg. 2018;7:57–65.CrossRefGoogle Scholar
  7. 7.
    Woon CY-L, Baxamusa T. A stepwise approach to management of open radiocarpal fracture-dislocations: a case report. J Hand Surg Asian Pac Vol. 2017;22:366–70.CrossRefGoogle Scholar
  8. 8.
    Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9:358–65.CrossRefGoogle Scholar
  9. 9.
    Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg Am. 1984;66:504–9.CrossRefGoogle Scholar
  10. 10.
    Fufa DT, Goldfarb CA. Sports injuries of the wrist. Curr Rev Musculoskelet Med. 2012;6:35–40.CrossRefGoogle Scholar
  11. 11.
    Suh N, Grewal R. Controversies and best practices for acute scaphoid fracture management. J Hand Surg Eur Vol. 2018;43:4–12.CrossRefGoogle Scholar
  12. 12.
    Grewal R, Suh N, MacDermid JC. Is casting for non-displaced simple scaphoid waist fracture effective? A CT based assessment of union. Open Orthop J. 2016;10:431–8.CrossRefGoogle Scholar
  13. 13.
    Bond CD, Shin AY, McBride MT, Dao KD. Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures. J Bone Joint Surg Am. 2001;83:483–8.CrossRefGoogle Scholar
  14. 14.
    Ram AN, Chung KC. Evidence-based management of acute nondisplaced scaphoid waist fractures. J Hand Surg Am. 2009;34:735–8.CrossRefGoogle Scholar
  15. 15.
    Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical versus nonsurgical treatment of acute minimally displaced and undisplaced scaphoid waist fractures: pairwise and network meta-analyses of randomized controlled trials. J Hand Surg Am. 2011;36:1759–1768.e1.CrossRefGoogle Scholar
  16. 16.
    Düppe H, Johnell O, Lundborg G, Karlsson M, Redlund-Johnell I. Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg Am. 1994;76:249–52.CrossRefGoogle Scholar
  17. 17.
    Helm RH, Tonkin MA. The Chauffeur’s fracture: simple or complex? J Hand Surg Br. 2016;17:156–9.CrossRefGoogle Scholar
  18. 18.
    Chennagiri RJR, Lindau TR. Assessment of scapholunate instability and review of evidence for management in the absence of arthritis. J Hand Surg Eur Vol. 2013;38:727–38.CrossRefGoogle Scholar
  19. 19.
    Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am. 2012;37:2175–96.CrossRefGoogle Scholar
  20. 20.
    Fok MWM, Fernandez DL. Chronic scapholunate instability treated with temporary screw fixation. J Hand Surg Am. 2015;40:752–8.CrossRefGoogle Scholar
  21. 21.
    Fok MWM, Fang CX, Lau TW, Fung YKE, Fung BKK, Leung FKL. The status of triangular fibrocartilage complex after the union of distal radius fractures with internal plate fixation. Int Orthop. 2018;78:357–1922.Google Scholar
  22. 22.
    Kim JK, Yun Y-H, Kim DJ, Yun GU. Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures. Injury. 2011;42:371–5.CrossRefGoogle Scholar
  23. 23.
    Wijffels M, Ring D. The influence of non-union of the ulnar styloid on pain, wrist function and instability after distal radius fracture. J Hand Microsurg. 2011;3:11–4.CrossRefGoogle Scholar
  24. 24.
    Minami A. Triangular fibrocartilage complex tears. Hand Surg. 2015;20:1–9.CrossRefGoogle Scholar
  25. 25.
    Pang EQ, Yao J. Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU). Curr Rev Musculoskelet Med. 2017;10:53–61.CrossRefGoogle Scholar
  26. 26.
    Henry MH. Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg. 2008;16:320–9.CrossRefGoogle Scholar
  27. 27.
    Campbell D, Campbell R, O’Connor P, Hawkes R. Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. Br J Sports Med. 2013;47:1105–11.CrossRefGoogle Scholar
  28. 28.
    Fok MWM, Liu B, White J, Bain G. Hand and wrist tendinopathies. In:Muscle and tendon injuries. 5th ed. Berlin: Springer; 2017. p. 241–53.CrossRefGoogle Scholar
  29. 29.
    Inoue G, Tamura Y. Surgical treatment for recurrent dislocation of the extensor carpi ulnaris tendon. J Hand Surg Br. 2001;26:556–9.CrossRefGoogle Scholar
  30. 30.
    Burkhart SS, Wood MB, Linscheid RL. Posttraumatic recurrent subluxation of the extensor carpi ulnaris tendon. J Hand Surg Am. 1982;7:1–3.CrossRefGoogle Scholar
  31. 31.
    Whalen JL, Bishop AT, Linscheid RL. Nonoperative treatment of acute hamate hook fractures. J Hand Surg Am. 1992;17:507–11.CrossRefGoogle Scholar
  32. 32.
    Scheufler O, Kamusella P, Tadda L, Radmer S, Russo SG, Andresen R. High incidence of hamate hook fractures in underwater rugby players: diagnostic and therapeutic implications. Hand Surg. 2013;18:357–63.CrossRefGoogle Scholar
  33. 33.
    Stein AH. Stenosing tendovaginitis at the radial styloid process (de Quervain’s disease). Arch Surg. 1951;63:216–28.CrossRefGoogle Scholar
  34. 34.
    Adams JE, Habbu R. Tendinopathies of the hand and wrist. J Am Acad Orthop Surg. 2015;23:741–50.CrossRefGoogle Scholar
  35. 35.
    Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, Jianmongkol S, Chatuparisute P, Jung S. Treatment of de Quervain disease with triamcinolone injection with or without nimesulide. J Bone Joint Surg Am. 2004;86:2700–6.CrossRefGoogle Scholar
  36. 36.
    Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for de Quervain’s tenosynovitis. Cochrane Database Syst Rev. 2009;27A:322.Google Scholar
  37. 37.
    Richie CA, Briner WW. Corticosteroid injection for treatment of de Quervain’s tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16:102–6.CrossRefGoogle Scholar
  38. 38.
    Ruland RT, Hogan CJ. The ECU synergy test: an aid to diagnose ECU tendonitis. J Hand Surg Am. 2008;33:1777–82.CrossRefGoogle Scholar
  39. 39.
    Lee RKL, Ng AWH, Tong CSL, Griffith JF, Tse WL, Wong C, Ho PC. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography. Skelet Radiol. 2013;42:1277–85.CrossRefGoogle Scholar
  40. 40.
    Ruchelsman DE, Lee SK. Neurovascular injuries of the hand in athletes. Curr Orthop Prac. 2009;20:409–15.CrossRefGoogle Scholar
  41. 41.
    Kumar Y, Hooda K, Lo L, Karol I. Ulnar artery aneurysm and hypothenar hammer syndrome. BMJ Case Rep. 2015;2015:bcr2015211444.CrossRefGoogle Scholar
  42. 42.
    Müller LP, Rudig L, Kreitner KF, Degreif J. Hypothenar hammer syndrome in sports. Knee Surg Sports Traumatol Arthrosc. 1996;4:167–70.CrossRefGoogle Scholar
  43. 43.
    Blum AG, Zabel J-P, Kohlmann R, Batch T, Barbara K, Zhu X, Dautel G, Dap F. Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics. 2006;26:1021–44.CrossRefGoogle Scholar
  44. 44.
    Fok MWM, Ip WY, Fung BKK, Chan RK, Chow SP. Ten-year results using a dynamic treatment for proximal phalangeal fractures of the hands. Orthopedics. 2013;36:e348–52.CrossRefGoogle Scholar
  45. 45.
    Bain GI, Guy SD. Derotation taping for metacarpal and phalangeal fractures. Tech Hand Up Extrem Surg. 2003;7:130–2.CrossRefGoogle Scholar
  46. 46.
    Carpenter S, Rohde RS. Treatment of phalangeal fractures. Hand Clin. 2013;29:519–34.CrossRefGoogle Scholar
  47. 47.
    Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin. 2012;28:395–401, xCrossRefGoogle Scholar
  48. 48.
    Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y). 2014;9:16–23.CrossRefGoogle Scholar
  49. 49.
    Fufa DT, Goldfarb CA. Fractures of the thumb and finger metacarpals in athletes. Hand Clin. 2012;28:379–88, xCrossRefGoogle Scholar
  50. 50.
    Goldfarb CA. Commentary metacarpal fracture in the professional baseball player. Hand Clin. 2012;28:389.CrossRefGoogle Scholar
  51. 51.
    McCue FC, Andrews JR, Hakala M, Gieck JH. The coach’s finger. J Sports Med. 1974;2:270–5.CrossRefGoogle Scholar
  52. 52.
    Bain GI, Mehta JA, Heptinstall RJ, Bria M. Dynamic external fixation for injuries of the proximal interphalangeal joint. J Bone Joint Surg Br. 1998;80:1014–9.CrossRefGoogle Scholar
  53. 53.
    Chen F, Kalainov DM. Phalanx fractures and dislocations in athletes. Curr Rev Musculoskelet Med. 2017;10:10–6.CrossRefGoogle Scholar
  54. 54.
    Bain GI, Roth JH, Mehta JA. Injuries of the proximal interphalangeal joint. Br J Hand Ther. 2016;3:9–12.CrossRefGoogle Scholar
  55. 55.
    de Haseth KB, Neuhaus V, Mudgal CS. Dorsal fracture-dislocations of the proximal interphalangeal joint: evaluation of closed reduction and percutaneous Kirschner wire pinning. Hand (N Y). 2014;10:88–93.CrossRefGoogle Scholar
  56. 56.
    Bain GI, Mehta JA. The proximal interphalangeal joint: surgical and mobilisation options. Br J Hand Ther. 2016;3:13–8.CrossRefGoogle Scholar
  57. 57.
    Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 2004;32:262–73.CrossRefGoogle Scholar
  58. 58.
    Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am. 1977;2:66–9.CrossRefGoogle Scholar
  59. 59.
    Al-Qattan MM. Type 5 avulsion of the insertion of the flexor digitorum profundus tendon. J Hand Surg Br. 2001;26:427–31.CrossRefGoogle Scholar
  60. 60.
    Smith JH. Avulsion of a profundus tendon with simultaneous intraarticular fracture of the distal phalanx–case report. J Hand Surg Am. 1981;6:600–1.CrossRefGoogle Scholar
  61. 61.
    Garberman SF, Diao E, Peimer CA. Mallet finger: results of early versus delayed closed treatment. J Hand Surg Am. 1994;19:850–2.CrossRefGoogle Scholar
  62. 62.
    Lin JD, Strauch RJ. Closed soft tissue extensor mechanism injuries (mallet, boutonniere, and sagittal band). J Hand Surg Am. 2014;39:1005–11.CrossRefGoogle Scholar
  63. 63.
    Avery DM, Inkellis ER, Carlson MG. Thumb collateral ligament injuries in the athlete. Curr Rev Musculoskelet Med. 2017;10:28–37.CrossRefGoogle Scholar
  64. 64.
    Malik AK, Morris T, Chou D, Sorene E, Taylor E. Clinical testing of ulnar collateral ligament injuries of the thumb. J Hand Surg Eur Vol. 2009;34:363–6.CrossRefGoogle Scholar
  65. 65.
    Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. J Bone Joint Surg Br. 1962;44-B:869–79.CrossRefGoogle Scholar
  66. 66.
    Fedorczyk JM. Tendinopathies of the elbow, wrist, and hand: histopathology and clinical considerations. J Hand Ther. 2012;25:191–201.CrossRefGoogle Scholar
  67. 67.
    Cooper C. Fundamentals of hand therapy. Amsterdam: Elsevier Health Sciences; 2013.Google Scholar
  68. 68.
    Knygsand-Roenhoej K, Maribo T. A randomized clinical controlled study comparing the effect of modified manual edema mobilization treatment with traditional edema technique in patients with a fracture of the distal radius. J Hand Ther. 2011;24:184–94.CrossRefGoogle Scholar
  69. 69.
    Prosser R, Herbert R, LaStayo PC. Current practice in the diagnosis and treatment of carpal instability—results of a survey of Australian hand therapists. J Hand Ther. 2007;20:239–43.CrossRefGoogle Scholar
  70. 70.
    Bruder AM, Shields N, Dodd KJ, Taylor NF. Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. J Physiother. 2017;63:205–20.CrossRefGoogle Scholar
  71. 71.
    Muller MGS, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg. 2003;123:534–7.CrossRefGoogle Scholar
  72. 72.
    Clementson M, Thomsen N, Jørgsholm P, Besjakov J, Björkman A. Is early mobilisation better than immobilisation in the treatment of wrist sprains? J Plast Surg Hand Surg. 2016;50:156–60.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Margaret W. M. Fok
    • 1
  • Christine L. Redmond
    • 2
  • Gregory I. Bain
    • 3
    Email author
  1. 1.Department of Orthopaedics and TraumatologyQueen Mary Hospital, The University of Hong KongHong KongChina
  2. 2.Flinders Medical CentreAdelaideAustralia
  3. 3.Department of Orthopaedic SurgeryFlinders University, Flinders Medical CentreAdelaideAustralia

Personalised recommendations