Common Soft Tissue Injuries of the Hand

  • Scott M. Tintle
  • David R. Steinberg
  • David J. Bozentka
  • L. Scott Levin
Living reference work entry
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Abstract

The hand is critical for successful athletic participation in all but the rarest of circumstances. Despite the importance of the hands to the success of an athlete, they are often underemphasized in training and education due to the more severe orthopedic injuries that affect the larger upper or lower extremity joints and are immediately debilitating. Despite minimal attention to these injuries, they do amount to a substantial loss of time from sports. The following chapter highlights the common soft tissue injuries and dislocations of the hand that commonly affect athletes of all skill levels. Proposed treatments, technical pearls, and common errors, rehabilitation, and outcomes are discussed.

Keywords

Proximal Phalanx Distal Phalanx Ulnar Collateral Ligament Lateral Band Flexor Digitorum Profundus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. Ahn JM, Sartoris DJ, Kang HS et al (1998) Gamekeeper thumb: comparison of MR arthrography with conventional arthrography and MR imaging in cadavers. Radiology 206:737–744PubMedCrossRefGoogle Scholar
  2. Arnold DM, Cooney WP, Wood MB (1992) Surgical management of chronic ulnar collateral ligament insufficiency of the thumb metacarpophalangeal joint. Orthop Rev 5:583–588Google Scholar
  3. Badia A, Riano F, Ravikoff J et al (2005) Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations. J Hand Surg 30:154–160CrossRefGoogle Scholar
  4. Bain GI, Mehta JA, Heptinstall RJ (1998) Dynamic external fixation for injuries of the proximal interphalangeal joint. J Bone Joint Surg Br 80:1014–1019PubMedCrossRefGoogle Scholar
  5. Bettinger PC, Berger RA (2001) Functional ligamentous anatomy of the trapezium and trapeziometacarpal joint (gross and arthroscopic). Hand Clin 17:151–168, viiPubMedGoogle Scholar
  6. Bindra RR, Foster BJ (2009) Management of proximal interphalangeal joint dislocations in athletes. Hand Clin 25:423–435PubMedCrossRefGoogle Scholar
  7. Blazar PE, Steinberg DR (2000) Fractures of the proximal interphalangeal joint. J Am Acad Orthop Surg 8:383–390PubMedGoogle Scholar
  8. Boden RA, Srinivasan MS (2008) Rotational dislocation of the proximal interphalangeal joint of the finger. J Bone Joint Surg Br 90:385–386PubMedCrossRefGoogle Scholar
  9. Bruske J, Bednarski M, Niedźwiedź Z et al (2001) The results of operative treatment of fractures of the thumb metacarpal base. Acta Orthop Belg 67:368–373PubMedGoogle Scholar
  10. Bynum DK Jr, Gilbert JA (1988) Avulsion of the flexor digitorum profundus: anatomic and biomechanical considerations. J Hand Surg 13:222–227CrossRefGoogle Scholar
  11. Calfee RP, Sommerkamp TG (2009) Fracture–dislocation about the finger joints. J Hand Surg 34:1140–1147CrossRefGoogle Scholar
  12. Carlsen BT, Moran SL (2009) Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg 34:945–952CrossRefGoogle Scholar
  13. Cooper JG, Johnstone AJ, Hider P (2005) Local anaesthetic infiltration increases the accuracy of assessment of ulnar collateral ligament injuries. Emerg Med Australas 17:132–136PubMedCrossRefGoogle Scholar
  14. De Smet L, Boone P (2002) Treatment of fracture–dislocation of the proximal interphalangeal joint using the suzuki external fixator. J Orthop Trauma 16:668PubMedCrossRefGoogle Scholar
  15. Deitch MA, Kiefhaber TR, Comisar BR (1999) Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg 5:914–923Google Scholar
  16. Derkash RS, Matyas JR, Weaver JK et al (1987) Acute surgical repair of the skier’s thumb. Clin Orthop Relat Res 216:29PubMedGoogle Scholar
  17. Edmunds JO (2006) Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb. Hand Clin 22:365–392PubMedCrossRefGoogle Scholar
  18. Elson RA (1986) Rupture of the central slip of the extensor hood of the finger. A test for early diagnosis. J Bone Joint Surg Br 68:229–231PubMedGoogle Scholar
  19. Ford DJ, Ali MS, Steel WM (1989) Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? J Hand Surg Br 14:165–167PubMedCrossRefGoogle Scholar
  20. Frykman G, Johansson O (1956) Surgical repair of rupture of the ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. Acta Chir Scand 112:58–64PubMedGoogle Scholar
  21. Gama C (1979) Results of the Matev operation for correction of Boutonniere deformity. Plast Reconstr Surg 64:319PubMedCrossRefGoogle Scholar
  22. Geissler WB (2009) Operative fixation of metacarpal and phalangeal fractures in athletes. Hand Clin 25:409–421PubMedCrossRefGoogle Scholar
  23. Gerber C, Senn E, Matter P (1981) Skier’s thumb surgical treatment of recent injuries to the ulnar collateral ligament of the thumb’s metacarpophalangeal joint. Am J Sports Med 3:171–177CrossRefGoogle Scholar
  24. Haddock NT, Beasley RW (2009) Thumb metacarpophalangeal joint ulnar collateral ligament repair with condylar shaving. Tech Hand Up Extrem Surg 13:199–201PubMedCrossRefGoogle Scholar
  25. Hamer DW, Quinton DN (1992) Dorsal fracture subluxation of the proximal interphalangeal joints treated by extension block splintage. J Hand Surg Br 17:586–590PubMedCrossRefGoogle Scholar
  26. Hamilton SC, Stern PJ, Fassler PR, Kiefhaber TR (2006) Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg AM 31:1349–1354PubMedCrossRefGoogle Scholar
  27. Handoll HH, Vaghela MV (1996) Interventions for treating mallet finger injuries. Cochrane Database Syst RevGoogle Scholar
  28. Harper MT, Chandnani VP, Spaeth J et al (1996) Gamekeeper thumb: diagnosis of ulnar collateral ligament injury using magnetic resonance imaging, magnetic resonance arthrography and stress radiography. J Magn Reson Imaging 6:322–328PubMedCrossRefGoogle Scholar
  29. Hergan K, Mittler C, Oser W (1995) Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US and MR imaging. Radiology 194:65–71PubMedCrossRefGoogle Scholar
  30. Heyman P (1997) Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg 5:224–229PubMedGoogle Scholar
  31. Hollister A, Giurintano DJ, Buford WL et al (1995) The axes of rotation of the thumb interphalangeal and metacarpophalangeal joints. Clin Orthop Relat Res 320:188PubMedGoogle Scholar
  32. Husain SN, Dietz JF, Kalainov DM, Lautenschlager EP (2008) A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand Surg Am 33:26–30PubMedCrossRefGoogle Scholar
  33. Johnson JW, Culp RW (2009) Acute ulnar collateral ligament injury in the athlete. Hand Clin 25:437–442PubMedCrossRefGoogle Scholar
  34. Kalainov DM, Hoepfner PE, Hartigan BJ et al (2005) Nonsurgical treatment of closed mallet finger fractures. J Hand Surg Am 30:580–586PubMedCrossRefGoogle Scholar
  35. Kaplan EB (1957) Dorsal dislocation of the metacarpophalangeal joint of the index finger. J Bone Joint Surg Am 39:1081–1086PubMedGoogle Scholar
  36. Katolik LI, Friedrich J, Trumble TE (2008) Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques. Plast Reconstr Surg 122:1451–1456PubMedCrossRefGoogle Scholar
  37. Khan W, Fahmy N (2006) The S-Quattro in the management of acute intraarticular phalangeal fractures of the hand. J Hand Surg Br 31:79–92PubMedCrossRefGoogle Scholar
  38. Kjaer-Petersen K, Langhoff O, Andersen K (1990) Bennett’s fracture. J Hand Surg Br 15:58–61PubMedCrossRefGoogle Scholar
  39. Kovacic J, Bergfeld J (2005) Return to play issues in upper extremity injuries. Clin J Sport Med 15:448–452PubMedCrossRefGoogle Scholar
  40. Kozin SH (1995) Treatment of thumb ulnar collateral ligament ruptures with the Mitek bone anchor. Ann Plast Surg 35:1–5PubMedCrossRefGoogle Scholar
  41. Krakauer JD, Stern PJ (1996) Hinged device for fractures involving the proximal interphalangeal joint. Clin Orthop Relat Res 327:29–37PubMedCrossRefGoogle Scholar
  42. Leddy JP, Packer JW (1977) Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am 2:66–69PubMedCrossRefGoogle Scholar
  43. Lee L-S, Lee H-M, Hou Y-T et al (2008) Surgical outcome of volar plate arthroplasty of the proximal interphalangeal joint using the Mitek Micro GII suture anchor. J Trauma 65:116–122PubMedCrossRefGoogle Scholar
  44. Lee SK, Fajardo M, Kardashian G et al (2011) Repair of flexor digitorum profundus to distal phalanx: a biomechanical evaluation of four techniques. J Hand Surg 36:1604–1609CrossRefGoogle Scholar
  45. MA W, LH S (1984) Mallet fractures. J Bone Joint Surg Am 66:658–669Google Scholar
  46. Mall NA, Carlisle JC, Matava MJ et al (2008) Upper extremity injuries in the national football league: Part I: hand and digital injuries. Am J Sports Med 36:1938–1944PubMedCrossRefGoogle Scholar
  47. Mansha M, Miranda S (2013) Early results of a simple distraction dynamic external fixator in management of comminuted intra-articular fractures of base of middle phalanx. J Hand Microsurg 5:63–67PubMedCrossRefGoogle Scholar
  48. McCue FC, Abbott JL (1967) The treatment of mallet finger and boutonniere deformities. Va Med Mon 94:623–628PubMedGoogle Scholar
  49. McCue FC, Hakala MW, Andrews JR (1974) Ulnar collateral ligament injuries of the thumb in athletes. Am J Sports Med 2:70–80CrossRefGoogle Scholar
  50. McDermott TP, Levin LS (1998) Suture anchor repair of chronic radial ligament injuries of the metacarpophalangeal joint of the thumb. J Hand Surg Br 23:271–274PubMedCrossRefGoogle Scholar
  51. Mcelfresh EC, Dobyns JH, O’Brien ET (1972) Management of fracture-dislocation of the proximal interphalangeal joints by extension-block splinting. J Bone Joint Surg Am 54:1705–1711PubMedGoogle Scholar
  52. McKeon KE, Gelberman RH, Calfee RP (2013) Ulnar collateral ligament injuries of the thumb. J Bone Joint Surg Am 95:881–7 http://dx.doi.org/10.2106/JBJS.L.00204
  53. MD PCB, MD RLL, Richard A, Berger MD P (1999) An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg 24:786–798CrossRefGoogle Scholar
  54. Moran SL, Berger RA (2003) Biomechanics and hand trauma: what you need. Hand Clin 19:17–31PubMedCrossRefGoogle Scholar
  55. Neuhaus V, Thomas MA, Mudgal CS (2013) Type IIb bony mallet finger: is anatomical reduction of the fracture necessary? Am J Orthop 42:223–226PubMedGoogle Scholar
  56. Newington D (2001) The treatment of dorsal fracture-dislocation of the proximal interphalangeal joint by closed reduction and kirschner wire fixation: a 16-year follow up. J Hand Surg Br 26:537–540PubMedCrossRefGoogle Scholar
  57. Newland CC (1992) Gamekeeper’s thumb. Orthop Clin North Am 23:41–48PubMedGoogle Scholar
  58. Niechajev IA (1985) Conservative and operative treatment of Mallet finger. Plast Reconstr Surg 76:580PubMedCrossRefGoogle Scholar
  59. Oosterbos CJM, de Boer HH (1995) Nonoperative treatment of Bennett’s fracture: a 13-year follow-up. J Orthop Trauma 9:23PubMedCrossRefGoogle Scholar
  60. Palmer AK, Louis DS (1978) Assessing ulnar instability of the metacarpophalangeal joint of the thumb. J Hand Surg Am 3:542–546PubMedCrossRefGoogle Scholar
  61. Pardini AG, Costa RD, Morais MS (1979) Surgical repair of the boutonniere deformity of the fingers. Hand 11:87–92PubMedCrossRefGoogle Scholar
  62. Phadnis J, Yousaf S, Little N (2010) Open reduction internal fixation of the unstable mallet fracture. Tech Hand Up Extrem Surg 14:155–159PubMedCrossRefGoogle Scholar
  63. Posner MA (1977) Injuries to the hand and wrist in athletes. Orthop Clin North Am 8:593–618PubMedGoogle Scholar
  64. Rhee PC, Jones DB, Kakar S (2012) Management of thumb metacarpophalangeal ulnar collateral ligament injuries. J Bone Joint Surg Am 94:2005–2012PubMedCrossRefGoogle Scholar
  65. Rubin J, Bozentka DJ, Bora FW (1996) Diagnosis of closed central slip injuries: a cadaveric analysis of non-invasive tests. J Hand Surg Br 21:614–616PubMedCrossRefGoogle Scholar
  66. Ruland RT, Hogan CJ, Cannon DL, Slade JF (2008) Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint. J Hand Surg 33:19–25CrossRefGoogle Scholar
  67. Sanghrajka A, Goldie B (2012) Static monolateral external fixation for the treatment of intra-articular fractures of the base of the first metacarpal. J Bone Joint Surg Br 94:112–115CrossRefGoogle Scholar
  68. Stamos BD, Leddy JP (2000) Closed flexor tendon disruption in athletes. Hand Clin 16:359–365PubMedGoogle Scholar
  69. Stark HH, Boyes JH, Wilson JN (1962) Mallet finger. J Bone Joint Surg Am 44:1061–1068PubMedGoogle Scholar
  70. Stern PJ, Kastrup JJ (1988) Complications and prognosis of treatment of mallet finger. J Hand Surg 13:329–334CrossRefGoogle Scholar
  71. Terrill RQ, John Groves R (1992) Correction of the severe nonrheumatoid chronic boutonnière deformity with a modified Matev procedure. J Hand Surg 17:874–880CrossRefGoogle Scholar
  72. Theivendran K, Mahon A, Rajaratnam V (2007) A novel hook plate fixation technique for the treatment of mallet fractures. Ann Plast Surg 58:112–115PubMedCrossRefGoogle Scholar
  73. Thurston AJ, Dempsey SM (1993) Bennett’s fracture: a medium to long-term review. ANZ J Surg 63:120–123CrossRefGoogle Scholar
  74. Timmenga E, Blokhuis TJ, Maas M (1994) Long-term evaluation of bennett’s fracture. A comparison between open and closed reduction. J Hand Surg Br 19:373–377PubMedCrossRefGoogle Scholar
  75. Urbaniak JR, Hayes MG (1981) Chronic boutonniere deformity – an anatomic reconstruction. J Hand Surg 6:379–383CrossRefGoogle Scholar
  76. Van Heest AE, Kallemeier P (2008) Thumb carpal metacarpal arthritis. J Am Acad Orthop Surg 16:140–151PubMedGoogle Scholar
  77. Weiland AJ, Berner SH, Hotchkiss RN (1997) Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with an intraosseous suture anchor. J Hand Surg 22:585–591CrossRefGoogle Scholar
  78. Williams R, Kiefhaber TR, Sommerkamp TG (2003) Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a Hemi-Hamate Autograft. J Hand Surg 28A:1–10Google Scholar
  79. Wilppula E, Nummi J (1970) Surgical treatment of ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. Injury 2:69–72PubMedCrossRefGoogle Scholar
  80. Yeh PC, Shin SS (2012) Tendon ruptures. Hand Clin 28:425–430PubMedCrossRefGoogle Scholar
  81. Zhang X, Meng H, Shao X et al (2010) Pull-out wire fixation for acute mallet finger fractures with K-wire stabilization of the distal interphalangeal joint. J Hand Surg 35:1864–1869CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Scott M. Tintle
    • 1
  • David R. Steinberg
    • 2
  • David J. Bozentka
    • 2
  • L. Scott Levin
    • 2
  1. 1.Walter Reed National Military Medical CenterBethesdaUSA
  2. 2.University of PennsylvaniaPhiladelphiaUSA

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