CHAPTER 52 • SOFT TISSUE INJURIES OF THE WRIST IN ATHLETES 303only in de Quervain’s tenosynovitis (Eaton and Lister,
1992). A Tinel’s sign is commonly positive. Wrist
motion is full and pain free ruling out overuse condi-
tions. Electrodiagnostic results are variable. Treatment
consists of initial conservative treatment including
rest, ice, anti-inflammatory medication, splinting,
padding, and activity modification. Surgical treatment
is considered if relief of symptoms has not occurred
after 6 to 12 months. Decompression consists of exten-
sive release of the deep fascia along the course of the
superficial radial nerve with good to excellent results
achieved in 86% following surgical decompression
(Dellon and Mackinnon, 1986).VASCULAR INJURY
HYPOTHENAR HAMMER SYNDROME
•Covered in chapter 53—Hand Injuries.
OVERUSE INJURIES
- The incidence of wrist problems in athletes is
extremely high. Wrist syndromes account for the most
common upper extremity overuse injuries (Rettig,
2001). Repetitive activities such as gymnastics, rac-
quet sports, rowing, and throwing sports result in a
high number of overuse injuries.
DE QUERVAIN’S TENOSYNOVITIS
- Stenosis of the first dorsal compartment (abductor pol-
licis long(APL) and extensor pollicis brevis(EPB)) is
referred as de Quervain’s tenosynovitis. It occurs in
athletes who perform forceful grasp with repetitive use
of the thumb and ulnar deviation (Kiefhaber and Stern,
1992). Sports that are more susceptible to this injury
include racquet sports, golf (particularly the left thumb
in right handed golfers (Rettig and Patel, 1995)), fly-
fishing, javelin, and discus throwing. Athletes classi-
cally complain of pain over the radial styloid
particularly with range of motion of the thumb and
ulnar deviation of the wrist. Generally, there is tender-
ness over the first dorsal compartment along with
swelling and occasional crepitus or triggering. The
Finklestein test is frequently positive with wrist ulnar
deviation while the thumb is adducted, and is pathog-
nomonic for the diagnosis (Rettig, 2001). Initial treat-
ment includes anti-inflammatory medication, thumb
spica splinting, and corticosteroid injection into the
first dorsal compartment. Poor response from injection
may be due to a longitudinal septum, which separates
the APL and EPB in 20% to 30% of cases (Froimson,
1992), and may improve with a second more dorsal
injection. If there is no improvement of symptoms,
surgical treatment involves decompression of the first
dorsal compartment with division of any septum when
present. Complications of surgery include persistence
of symptoms (possibly due to inadequate release),
adhesions, injury to the superficial radial nerve, and
volar tendon subluxation. Most athletes are able to
return to full participation following surgical decom-
pression in 6 to 9 weeks.INTERSECTION SYNDROME- Intersection syndrome is pain in the dorsoradial wrist
where the first dorsal compartment crosses the second
dorsal compartment (ECRL and extensor carpi radialis
brevis(ECRB)). It occurs in athletes exposed to repeti-
tive wrist motions such as rowers, racquet sports,
weightlifters, and canoeists (Wood and Dobyns, 1986).
It appears to be caused by tenosynovitis of the tendons
in the second dorsal compartment. Athletes complain
of dorsoradial pain and tenderness proximal to the wrist
and may have swelling or crepitus 4 to 6 cm proximal
to Lister’s tubercle (Plancher, Peterson, and Steichen,
1996). Initial treatment consists of rest, splinting, anti-
inflammatory medication, corticosteroid injection, and
activity modification, and is successful 95% of the time
(Plancher, Peterson, and Steichen, 1996). For the rare
failure of conservative treatment, surgical management
includes release of the second dorsal compartment,
exploration and debridement of the intersection zone
and bursal tissue, and release of the fascial sheaths of
the tendons in the first dorsal compartment (Kiefhaber
and Stern, 1992). Postoperatively, the wrist is splinted
for 7 to 10 days followed by a stretching and strength-
ening program, and return to sport is allowed when the
patient is symptom free.
EXTENSOR CARPI ULNARIS TENDINITIS/
SUBLUXATION- Extensor carpi ulnaris(ECU) tendonitis is the second
most common stenosis tenosynovitis of the hand after
de Quervain’s (Wood and Dobyns, 1986). It occurs in
athletes involved in repetitive wrist motion such as rac-
quet sports, baseball, golf, and rowing. It may also
happen following traumatic ECU subluxation with
rupture of the fibrous sheath overlying the ECU during
forced supination, flexion, and ulnar deviation of the
wrist (similar to that seen in a baseball swing)