position and riding posture can help to prevent a
recurrence.BOWLER’S THUMB
•Bowler’s thumb involves recurrent trauma to the ulnar
digital nerve as a result of direct pressure from the
edge of the bowling ball hole. This causes prolifera-
tion of the surrounding fibrous tissue and decreased
nerve mobility. Findings include a positive Tinel’s
sign and possible decreased two-point discrimination
in the nerve distribution (Rettig, 2001; Dobyns et al,
1972).
•Treatment consists of rest, anti-inflammatory medica-
tions, and redrilling of the bowling ball to remove
pressure areas. Surgical decompression or nerve
transfer is rarely indicated (Rettig, 2001).
VASCULAR INJURIES
CHRONIC DIGITAL ISCHEMIA
- Chronic compression or microtrauma to the hand and
digital vasculature may cause distal ischemia. This is
occasionally seen in baseball pitchers and catchers
and handball players. Typical symptoms include cold
intolerance, pallor, and pain in the involved digits
(Rettig, 2001; Sugawara et al, 1986). - Increased padding during causative activities, use of
pharmacologic agents, or surgical decompression may
be appropriate treatments.
FROSTBITE
- Ischemic cold injury depends on the duration and
severity of exposure, as well as the presence of con-
strictive clothes, vasospasm, and wetness. Early
symptoms include erythema, burning, and itching (the
chilblains). The involved part later becomes numb as
injury progresses. Vesicles and ulcers may also
develop (Idler et al, 1990b; Murphy et al, 2000).
•First-degree frostbite is a superficial injury from which
full recovery is expected. Second-degree injury
involves partial-thickness dermal loss. In third-degree
injury, full thickness dermal loss occurs, whereas
involvement of deeper structures, including tendon and
bone, indicates fourth degree injury (Idler et al, 1990b).
•Treatment involves gradual rewarming of involved
digits in 40–42°C water. Advanced injuries and gan-
grenous areas will require surgical debridement,
amputation, or skin grafting (Murphy et al, 2000).
HYPOTHENAR HAMMER SYNDROME- This syndrome is caused by repetitive impact to the
hypothenar region of the hand, with trauma to the
ulnar nerve distal to Guyon’s Canal resulting in arte-
rial constriction, thickening, thrombosis, and possible
aneurysm formation. It is most commonly seen in
judo, karate, and lacrosse (Rettig, 2001). - Symptoms are caused by distal ischemia and include
cold intolerance, pain in the palm or ulnar digits, and
an abnormal Allen’s test. Ulnar nerve compression
and the corresponding symptoms may occur second-
ary to aneurysm formation.
•Treatment includes rest from inciting activities,
increased padding of the hypothenar area, vasolytic
agents, or surgical intervention with excision of the
thrombosed segment and artery ligation or reconstruc-
tion (Rettig, 2001).
REFERENCES
Abrahamson SO, Sollerman C, Lundborg G, et al: Diagnosis of
displaced ulnar collateral ligament of the metacarpophalangeal
joint of the thumb. J Hand Surg (Am)15:457, 1990.
Aronowitz ER, Leddy JP: Closed tendon injuries of the hand and
wrist in athletes. Clin Sports Med17:449, 1998.
Dobyns JH, O’Brien ET, Linscheid RL, et al: Bowler’s thumb
diagnosis and treatment: Review of 17 cases. J Bone Joint Surg
(Am)54:751, 1972.
Fassler PR: Fingertip injuries. Evaluation and treatment. J Am
Acad Orthop Surg4:84, 1996.
Hame SL, Melone CP: Boxer’s Knuckle. Traumatic disruption of
the extensor hood. Hand Clin16:345, 2000.
Idler RS, Manktelow RT, Lucas G, et al: The Hand Examination
and Diagnosis,3rd ed. New York, NY, Churchill Livingstone,
1990 a.
Idler RS, Manktelow RT, Lucas G, et al: The hand Primary care
of common problems,2nd ed. New York, NY, Churchill
Livingstone, 1990b.
Kahler DM, McCue FC: Metacarpophalangeal and proximal
interphalangeal joint injuries of the hand, including the thumb.
Clin Sports Med11:57, 1992.
Leddy JP: Avulsions of the flexor digitorum profundus. Hand
Clin1:77, 1985.
Leddy JP: Soft-tissue injuries of the hand in athletes. Am Acad
Orthop Surg Instr Course Lect47:181, 1998.
Morgan WJ, Slowman LS: Acute hand and wrist injuries in ath-
letes: Evaluation and management. J Am Acad Orthop Surg
9:389, 2001.
Murphy JV, Banwell PE, Roberts AH, et al: Frostbite:
Pathogenesis and treatment. J Trauma Injury Infect Crit Care
48:171, 2000.
Rettig AC: Closed tendon injuries of the hand and wrist in ath-
letes. Clin Sports Med11:77, 1992.310 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE