Wrist and Hand Injuries

What is gymnast wrist?

Gymnast wrist is an overuse injury to the growth area of the radius (large bone of the forearm) near the wrist. It occurs in up to 40% of gymnasts and is caused by the enormous pressure placed on a backward-bent wrist (dorsiflexed) while a gymnast is vaulting or tumbling. Symptoms include wrist pain with impact activities, and the injury can sometimes be seen on X-rays, but typically the diagnosis is made from clinical history and a physical exam.

How is gymnast wrist treated?

Treatment involves a period of rest to allow the growth area to heal. Wrist braces, such as tiger paws, are particularly helpful with symptoms. A child or teen can return to activities when symptoms subside.

What is ulnar impaction syndrome?

Ulnar impaction syndrome is one of the many causes of ulnar (pinky-sided) wrist pain and is typically a result of excessive loading of the wrist.

How is ulnar impaction syndrome treated?

X-rays are useful in diagnosing ulnar impaction syndrome, especially when comparing the injury to the other wrist. Treatment often means bracing, injections and physical therapy. Surgery is reserved for cases when other treatments have not worked.

What is a buckle fracture?

A buckle (or torus) fracture is the result of an injury to a child’s bone because it is softer and less calcified than adult bones. This injury causes the bone to “buckle” because it is forced on itself, but it does not break all the way through. This injury can often happen when children stretch out their arms to catch themselves during a fall.

How is a buckle fracture treated?

Typically, a child is in a cast for three to four weeks. Buckle fractures are not typically as painful as other types of fractures and heal quickly with few long-term effects.

What is a greenstick fracture?

A greenstick fracture is a variation of a buckle fracture. This is a fracture of a young bone that bends like a tree limb. The bone does not break into two pieces; rather, it bends and remains intact on the inside but fractures on the outside of the curve.

And although it is called a wrist fracture, the bones actually breaks at the end of the radius and ulna near the wrist joint. The radius is on the side of the thumb, while the ulna is on the side of the wrist near the pinky. These bones break in one of three ways:

1. Both bones break away from the growth plate.
2. One or both bones break within the growth plate.
3. One or both bones buckle in a relatively weaker part of the bone.

How is a greenstick fracture treated?

If the bone breaks away from the growth plate, the pieces are often separated far from each other and may need to be put back into place under sedation. Typically, once the pieces are lined up, your child will be placed in a cast that goes above the elbow for a month and then in a shorter cast for several more weeks. At first, weekly office visits may be necessary until the fracture heals enough that the bone won’t move in the cast. Once casting is done, your child may need to wear a wrist brace for several weeks for extra support.

If the bone breaks within the growth plate, your child’s doctor will line up the bones as straight as possible and place the arm in a cast. After the cast is removed, a follow-up visit may be necessary six months after the fracture to help make sure the bone is growing normally.

What is a growth plate fracture?

A growth plate wrist fracture (distal radius physis fracture) is very common in children and teens, as they happen in an area called the physis where bone growth takes place.

How is a growth plate wrist fracture treated?

This type of fracture is treated differently than other types of fractures, mostly because of the risk of future growth problems, which depend on the severity of the initial injury.

Most children require a long cast for about six weeks to help prevent the forearm from rotating. Once the fracture has undergone its initial healing (somewhere between two and four weeks), your child may receive a new cast that ends below the elbow for the duration of treatment. A follow-up visit may be necessary six to nine months after the injury to evaluate your child’s bone growth ability.

If your child has a break through the growth plate and the bones are separated away from each other, the bone may need to be realigned under heavy sedation. Too many attempts to manipulate the bones can damage the growth plate, but our team is specially trained to treat growing bones. We won’t move the bone once it begins the initial stage of healing (typically after the first week) because it’s more likely to hurt future growth than help. Over time, the fracture and bone will often straighten itself out over time.

What are wrist strains and sprains?

Wrist strains and sprains are common sports injuries and occur when a growing athlete attempts to break a fall with outstretched hands. Most of the injuries produce pain and mild swelling on the radial (thumb) side of the wrist, but any part of the wrist may be in pain.

How are wrist strains and sprains treated?

An X-ray is often needed to differentiate between a fracture and a sprain. Then a wrist brace may be recommended for comfort and can allow a faster return to sports, with your child’s doctor’s approval. Most mild sprains heal within two to four weeks, but more significant sprains may take four to six weeks before your child can return to normal function.

What is a dislocated finger?

Finger dislocations can occur at any of the three joints along the finger, including the metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint or distal interphalangeal (DIP) joint.

These dislocations commonly occur when teens are playing sports and can sometimes be put back into place on the sidelines during a game. After a finger dislocation, you should consult with your child’s doctor.

How is a dislocated finger treated?

After the injured finger is set back in place, it will either be placed in a cast or buddy-taped for about four to six weeks. As with most finger injuries, mild swelling and soreness may continue for several months. Depending on what your child’s doctor recommends, he will likely be able to return quickly to sports.

What is mallet finger?

Mallet finger is an injury caused by a direct blow to the tip of a finger. It can happen when a ball is being caught, hitting an outstretched finger and forcefully flexing it downward, tearing the extensor digitorum tendon.

Often, mallet finger may be treated with a finger splint called a stack splint that must be worn 100 percent of the time for six to eight weeks while the tendon is reattaching. If the finger flexes, even only for a moment, the entire treatment must begin again. The majority of mallet fingers heal without surgery.

What is a metacarpal fracture?

Metacarpal fractures occur with any of the five bones in the hand. They are characterized by being articular (involving the joint) or extra-articular (not involving the joint) and by location on the hand (base, shaft, neck or head). Typically, fractures of the fourth and fifth metacarpals can be left crooked because there is increased flexibility in this area. A metacarpal fracture is diagnosed with a physical exam and an X-ray.

How is a metacarpal fracture treated?

Treatment is usually a cast or splint immobilization for two to three weeks. Surgery may be recommended if your child’s fingers are not properly aligned, movement is impaired, the fracture is open (compound), the joint is displaced, or the fracture is unable to be controlled by casting or splinting.

What is a broken thumb?

With a thumb fracture, your child will usually have pain and will notice bruising in his thumb area. X-rays are used to confirm the diagnosis.

How is a broken thumb treated?

Treatment involves either setting the thumb (with or without pins) or merely immobilizing it with casting. Healing typically takes about six weeks.

What is a sprained thumb?

A sprained thumb is sometimes called a gamekeeper’s thumb. This is a sprain of the ulnar collateral ligament (UCL) at the base of the thumb. These injuries often occur when a growing athlete falls or catches his thumb on an object and forcibly pulls the thumb in the opposite direction.

How is a sprained thumb treated?

A sprained thumb may require splinting, bracing or casting. If the ligament tears completely (skier’s thumb), then more extensive testing and treatment will be needed, sometimes resulting in your child needing surgery.