Wednesday, July 29, 2015

Sports Injuries of the Upper Extremity in the Young Athlete

By: Charles A. Goldfarb, MD
Washington University Orthopedics

Sports injuries to the hand and upper extremity are common in all ages. These can be bruises, sprains, injuries of ligaments, tendons, and cartilage, and fractures. These can be acute (meaning happened just now) or chronic (older than 6 weeks). Most often, it is a hand surgeon who cares for injuries to the hand and wrist but sometimes another doctor or surgeon with particular expertise in this area may be the caregiver. Sports injuries to the young athlete (for the purposes of this discussion, less than 18 years of age) are a bit more complicated than injuries to the adult as 1) the injury patterns are different compared to the adult and 2) the growth plate must be considered.

The injury patterns may be different in the young athlete. Often, in kids, the bone (and maybe the growth plate) are weaker than ligaments (definition- a ligament connects two bones together and provides stability). Therefore, instead of ligament tears, the bone may break instead. While this sounds worse, most of us believe that this is a better injury because bones heal better and more predictably than ligaments. The classic example of this injury is to the thumb- the skier thumb or gamekeeper thumb. In adults, it is always a ligament that tears but in kids, the bone breaks.

Another reason that kids’ injuries are different is related to their developing bones and joints. This includes their growth plates (definition: the part of the bone responsible for its growth, seen as a line on x-ray). With overuse (such as too much pitching or too much gymnastics), the bone, the joint, the growth plates, and the ligaments may all be affected. The classic example is the gymnast wrist (to be discussed in more detail in a later post). But briefly, this is an overuse injury of the wrist with a stoppage of growth of the radius.

Yet another reason that kids are different than adults is that when a bone breaks (or fractures)- and we all know this happens in sports- the injury often affects the growth plate. We believe this type of injury is especially common as the growth plate start to close at ages 10-15, depending on the particular area. The growth plate that is nearly finished growing becomes an area of weakness until it completely closes and, therefore, can be the site of a fracture. A growth plate fracture can be stressful for everyone, but in most cases these injuries do quite well. It is important, however, to see a doctor who treats kids regularly to increase the chance of a great result.

A few examples of the most common upper extremity sports injuries in young athletes include:

1) Elbow
    a. Ligament injury (most common, MCL)
    b. OCD (osteochondritis dissecans of the capitellum)
    c. Dislocation
    d. Fracture of humerus including condyles, olecranon, radius
    e. Ulnar nerve injury or instability

2) Wrist
    a. ligament injury (most common, scapholunate ligament tear)
    b. gymnast wrist (injury to radius growth plate)
    c. TFCC tear (cartilage of wrist)
    d. Wrist instability
    e. Tendonitis
    f. Fractures of the forearm and wrist (most common, scaphoid fracture)

3) Hand
    a. Fracture of any bone
    b. Ligament injury (skier thumb)
    c. Joint dislocation (most common, PIP joint)
    d. Tendon injury (most common, mallet finger or FDP avulsion)

Thankfully, most injuries to the young athlete heal well and we can return the athlete to sports soon after healing. But, some injuries require specialized care including prompt diagnosis with consideration of age, the effect of growth, and the particular sport to allow ideal treatment. This is true for all injuries including those of the upper extremity, hand and wrist.

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