Sports Medicine – Hand

Baseball Finger, also known as Mallet Finger, is a condition that occurs when one of the tendons that assist in straightening out the finger is damaged. This damage can occur from the jamming or forceful bending down of the fingertip. Symptoms include swelling and tenderness around the fingertip.

Those at Risk
Though it is called Baseball Finger, the injury can also occur while playing football and basketball as well.

Diagnosis
A Baseball Finger is diagnosed once the manner in which the injury was incurred is discussed and the last knuckle and extension of the finger are physically examined. An X-ray may also be indicated in order to determine if the finger bone was damaged during the force.

Treatment
Baseball Finger is not a serious injury and generally only requires a splint that holds the finger out straight. Occasionally surgery is required if the bone sustained serious damage.

Common in sports, finger sprains occur when the ligaments of the fingers or thumb are stretched and unusually bent – generally during a fall onto the hand. And a finger dislocation occurs when the ligaments and joint capsule surrounding the joint are actually torn and forced out of alignment.

Sprain
The bones of the finger joints are connected by joint capsules, in which the ligaments are located. When the ligament is stretched beyond its capacity, it tears or sprains. In sports, this is often referred to as a jammed finger. The classification of ligament sprains includes: Grade I, which is a 25 percent tearing of the ligament; Grade II, which is a 25 to 75 percent tearing of the ligament; and a Grade III, which is a complete tearing of the ligament.

Dislocation
When the strong force placed on the ligament does not tear the ligament, but rather pulls a small piece of bone off the finger at the end of the ligament, it is called an avulsion fracture, or a third-degree sprain – representing a complete ligamentous disruption. A dislocation is the most severe form of a third-degree sprain, because the ligament must be torn completely to dislocate the joint.

All types of sprains will prompt joint swelling, stiffness, and loss of joint motion. Bruising may also be present.

Diagnosis
Following patient history and physical examination, an X-ray will help diagnose the severity of the injury and determine the type of treatment required.

Treatment
When a finger or thumb injury occurs, there should be an immediate refrain from activity involving the injured hand while cold compression and elevation help reduce swelling. It is important to reduce swelling, as it can cause stiffness and make recovery and resumption of normal range of motion more difficult.

For minor sprains, treatment includes a brief period of immobilization and splinting in conjunction with anti-inflammatory medication and cold compression – followed by a series of range of motion rehabilitative exercises. More serious sprains involving a dislocation or fracture may require surgery in order to properly repair and realign the joint.

Also called “Skier’s Thumb” and “Gamekeepers Thumb,” injury to the Ulnar Collateral Ligament (UCL) of the thumb jeopardizes the strength of the ligament and its ability to secure the bones at the base of the thumb (metacarpophalangeal or MCP joint) and prevent the thumb from extending out too far away from the hand.

This type of injury is defined as an acute injury when it occurs as the result of stress placed on the ulnar collateral ligament from an extreme force (valgus force) – such as that experienced when the thumb is caught in a ski pole during a fall. In this situation the ligament undergoes an exaggerated stretch and often tears as a result.

Those at Risk
When a repetitive activity or sport eventually leads to the loosening of the ulnar collateral ligament over time, it is referred to as a chronic injury. Often times tennis players and baseball players will experience this.

Diagnosis
Those suffering from this type of injury generally experience some instability and difficulty griping things tightly. Though those with an acute tear of the UCL report pain and swelling directly over the torn ligament at the base of the thumb.

Both a physical examination and X-ray are done to confirm diagnosis and determine the extent of the injury. A valgus stress test is also performed in order to check the strength of the ligament and corresponding stability of the joint.

Treatment
Depending on the extent of the injury and other patient factors, either a thumb spica cast will be used to stabilize and encourage healing for approximately four to six weeks – followed by range of motion exercises to strengthen grip – or surgery is recommended.

Surgery is considered in the case of a complete tear (rupture) of the ligament and evidence of significant instability. It is usually done several weeks following the injury and is considered an outpatient procedure. Patients generally see results within four weeks following the surgery and regain thumb strength. Occasionally the MCP joint continues to be unstable and causes pain during pinching or grasping activities. Since chronic instability and looseness of the thumb eventually results in the development of arthritis, other procedures may be considered – including grafting in new tissue to reconstruct the ligaments, or arthrodesis in order to fuse the joint.