Sports Medicine: Just the Facts

CHAPTER 52 • SOFT TISSUE INJURIES OF THE WRIST IN ATHLETES 299

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52 SOFT TISSUE INJURIES OF

THE WRIST IN ATHLETES

Steven B Cohen, MD

Michael E Pannunzio, MD

INTRODUCTION

• Injuries to the wrist are common in sports. In the past,
  these injuries were frequently designated as sprains.
  More recently, however, the waste basket term wrist
  sprainhas given way to a specific diagnosis and a
  defined treatment plan. An understanding of wrist
  anatomy, biomechanics, and function allows the
  physician to pinpoint specific pathology and treat-
  ment, thus allowing quicker return to sport for the ath-
  lete with a wrist injury.

EPIDEMIOLOGY

• The incidence of injuries to the wrist varies according
  to sport. Hand and wrist injuries occur more fre-
  quently in younger athletes than adults. A study per-
  formed at the Cleveland Clinic found that 9% of all
  athletic participants under the age of 16 sustained
  injuries involving the wrist (Bergfeld et al, 1982). In
  another study, 35% of all injuries in adolescent foot-
  ball players involved the wrist (Roser and Clawson,
  1970). Ligamentous laxity is often seen in athletes.
  This joint hypermobility can lead to partial or com-
  plete ligament tears following a loading of the wrist or

may predispose to cumulative injury after repetitive

stress (Taleisnik, 1992). Overuse syndromes of the

wrist are also common in athletes as a result of tension

failure or shear stresses (Pitner, 1990).

DORSAL WRIST SYNDROMES

• Chronic wrist pain on the dorsal aspect of the wrist
  can be a result of occult dorsal ganglion or dorsal
  impaction/dorsal impingement syndromes. Ganglions
  account for the most frequent soft-tissue tumors of the
  wrist. Of these, 60% to 70% originate from the dorsal
  scapholunate ligament and are extra-articular mani-
  festations of a connection to the scapholunate joint. A
  history of wrist trauma is found in 15% of patients
  with a dorsal ganglion (Angelides and Wallace, 1976).
  An occult dorsal ganglion is difficult to detect on clin-
  ical examination and may only be palpable with
  extreme flexion (Angelides and Wallace, 1976).
  Symptoms are generally inversely related to the size
  of the ganglion, as smaller, tense ganglions produce
  more pain than larger, soft cysts. Patients often com-
  plain of localized tenderness, limitation of motion,
  and/or weakness of grip. Ultrasound or magnetic res-
  onance imaging(MRI) can be more useful than plain
  radiographs. Often the diagnosis is made by exclu-
  sion. Initial treatment should include steroid injection
  of the dorsal capsule followed by immobilization
  (Sanders, 1985). When conservative treatment has
  failed to relieve the symptoms, excision of the capsule
  and ganglion from the scapholunate ligament are per-
  formed. Results are generally favorable with ultimate
  full return to competition in the majority of cases.


• Dorsal impaction syndromes occur as a result of repet-
  itive loading of the wrist in maximum extension and
  happen most frequently to gymnasts. The shear forces
  created by this action may lead to localized synovitis
  or even osteocartilaginous fractures (Linscheid and
  Dobyns, 1985). The athlete will often complain of pain
  and point tenderness on the mid-dorsal aspect of the
  wrist, at the projection of the lunocapitate joint
  (Halikis and Taleisnik, 1996). Progression of the prob-
  lem may lead to radiographic changes including a
  hypertrophic ridge of the dorsal rim of the scaphoid, or
  the dorsal border of the lunate as a result of impinge-
  ment with the capitate during hyperextension.
  Successful treatment usually results from restriction of
  wrist hyperextension, strengthening of the wrist flex-
  ors, and local steroid injection. Failure of relief of
  symptoms should be followed by immobilization and
  cessation from sport for 4 to 6 weeks. If symptoms
  should continue to persist, either abandonment from
  the activity or surgical treatment consists of limited