Sports Medicine: Just the Facts

CHAPTER 53 • SOFT TISSUE INJURIES OF THE HAND IN ATHLETES 307

• Reduction is usually uncomplicated. Dynamic and
  static stability should be assessed after reduction,
  including collateral ligament stability (Kahler and
  McCue, 1992).


• If there is no associated fracture or ligament injury,
  splinting in 30°of flexion for 1–2 weeks, followed by
  buddy taping for sports for 4–6 weeks, is effective.
  Recurrent dislocation is rare. Swelling and tenderness
  can persist for several months. Motion exercises as
  soon as comfort permits can help to prevent stiffness
  (Rettig, Coyle, and Hunt, 2002).

VOLARDISLOCATIONS
•Volar dislocations of the PIP joint are less common
injuries, are more difficult to reduce, and are associ-
ated with more complications than are dorsal disloca-
tions. They are caused by compression and rotation
with PIP joint flexion. Pathology usually includes
extensor tendon central slip avulsion, volar plate dis-
ruption, and collateral ligament tears (Rettig, Coyle,
and Hunt, 2002; Kahler and McCue, 1992).

• If closed reduction is successful, the PIP joint should
  be splinted in full extension for 3–4 weeks to protect
  the central slip, allowing the DIP joint to remain free,
  followed by night splinting for an additional 3–4
  weeks. If closed reduction is not possible, open reduc-
  tion and pinning are necessary (Rettig, Coyle, and
  Hunt, 2002).
  •Late development of boutonnière deformity is a
  potential complication.

ROTARYPIP SUBLUXATION

• This injury typically presents as an irreducible dislo-
  cation of the PIP joint. It involves buttonholing of one
  condyle of the proximal phalanx through a longitudi-
  nal rent in the extensor hood between the central slip
  and lateral band. A lateral profile of the proximal pha-
  lanx with an oblique profile of the middle phalanx is
  seen on lateral radiograph (Kahler and McCue, 1992).


• If closed reduction is successful, buddy taping with
  full active range of motion is usually sufficient. Open
  reduction is often necessary to disengage the proximal
  phalanx condyle from the central slip and lateral band.

COLLATERALLIGAMENTINJURIES

• Collateral ligament injuries occur as a result of radial
  or ulnar stress on the joint, most commonly in foot-
  ball, wrestling, and basketball. Disruption usually
  occurs at the proximal attachment, with radial collat-
  eral injury more common than ulnar collateral injury.
  The most commonly involved digit is the index finger
  (Rettig, Coyle, and Hunt, 2002).
  •Tenderness and ecchymosis are usually present on
  examination. Radiographs should be obtained to rule

out fracture. Examination and radiographs should be

used to assess stability.

•Most collateral ligament injuries are treated with

buddy taping to an adjacent finger, with continued

participation in athletic activity. If the tear is associ-

ated with significant instability, the digit should be

immobilized in a dorsal splint for 3–4 weeks. (Rettig,

Coyle, and Hunt, 2002).

METACARPOPHALANGEAL JOINT

• Metacarpophalangeal (MCP) dislocations are rela-
  tively rare and usually involve dorsal dislocation of
  the proximal phalanx on the metacarpal. Most occur
  in the index or small finger.


• Simple dislocations may be reduced by closed reduction,
  and if stable following reduction, then consider buddy
  taping alone and allowing immediate active motion.
  Complex dislocations involve buttonholing of the
  metacarpal head between the flexor tendon and the lum-
  brical with volar plate interposition into the dislocated
  joint. These usually require formal open reduction.

JOINT INJURIES OF THE THUMB

INTERPHALANGEAL JOINT

• Thumb interphalangeal(IP) dislocations are uncom-
  mon injuries and are managed similarly to finger DIP
  dislocations.

METACARPOPHALANGEAL JOINT

• Dislocations of the thumb MCP joint are usually
  dorsal dislocations, resulting from hyperextension at
  the MCP joint with volar plate rupture. The
  metacarpal head may protrude through the volar plate,
  where it becomes buttonholed between the flexor pol-
  licus longus and flexor pollicus brevis tendons
  (Kahler and McCue, 1992).


• The volar plate, flexor pollicus longus, or sesamoids
  may be interposed and prevent reduction, but closed
  reduction is usually possible, with splinting recom-
  mended for 3–4 weeks after reduction.

GAMEKEEPER’S THUMB

•Also known as skier’s thumb, this refers to the acute

rupture of the ulnar collateral ligament (UCL) of the

thumb MCP joint. The mechanism of injury involves