QUIZZ INTERACTIVE SESSION: SPORTS INJURIES OF THE HAND I

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QUIZZ INTERACTIVE SESSIONSPORTS INJURIESOF THE
HAND

• I . AUQUIT-AUCKBUR, MD
• Hand Surgery Unit
• F. DUPARC, MD, PhD
• Department of orthopedic and traumatologic
  surgery
• Institut Régional de Médecine du Sport de
  Haute-Normandie
• Rouen University Hospital, France

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M. F D, golf player, right-handed,
Q1

• complains since 2 months of pain
• in the anteromedial part of the right hand,
• that mainly occurs during golf playing,
• and makes impossible a complete game.

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Location of the pain

• For the assessment of the diagnosis
• You need some standard radiographs
• You need specific X-ray views
• A CT-Scan is necessary
• An ulnar nerve entrapment must be considered
• A tendonitis of the flexor carpi ulnaris
• must be considered

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B C Fracture of the hook (hamulus) of the
hamatum
Q1
Specific X-Rays
TDM
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Fracture of the hookof the hamatum
Indication of removal of the non-union part
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Miss P Pong,table-tennis player, right-handed,
Q2

• Presents pain with increasing intensity during
• rest or at the beginning of playing, mainly in
• backhand lift.
• Location lateral side of the right forearm,
• 5 cm above the styloid process of the radius.
• The palpation is very painful,
• with a crepitus sign.
• The pain intensity is not increased during active
• ulnar deviation.

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Do you propose

• Stop any sport activity
• Tenosynovitis of wrist extensors
• Tendonitis of the Extensor Carpi Ulnaris
• A gangrenous infection
• An intersection-syndrome (cross- syndrome)

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Q2
E Intersection syndrome (Cross-syndrome) Tenosy
novitis at the intersection ECRLECRB / APLEPB
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Intersection syndrome treatment
Steroid injection
If the steroid injections do not achieve a good
recovering Surgical treatment
synovectomy around the APL and EPB tendons
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Differential diagnosis tenosynovitis of the APL
and EPB (de Quervain)
Location more distal synovitis and
entrapment of the tendons under the
retinaculum Finkelsteins test
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Q3
During rock climbing, a 23 year-old man
presented a sudden pain with snapping in the
index finger. The physical examination shows the
location of pain on the volar side of the
interphalangeal joint, and a painful loss of
strength in flexion of the PIP joint.
What is your diagnosis? A Stress fracture of
the second metacarpal bone? B Stress fracture
of the proximal phalanx of the index finger? C
Rupture of the distal insertion of the
Flexor Profundus tendon? D Rupture of the
distal insertion of the Flexor
Superficialis tendon? E Rupture of one or more
digital pulley(s)?
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E Rupture of the digital pulleys
Q3
Dynamic ultrasonography Tomodensitometry
Annular and Cruciate digital pulleys of the
flexor tendons
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M. S., coming back from holidaysin Courmayeur,
Q4

• presents pain at the level of the first right
• metacarpophalangeal joint, since three days,
• after a ski injury.
• The hand shows an important swelling,
• an ecchymosis begins to extend
• into the first commissure.
• The abduction of the thumb is very painful.

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The passive hyperabduction of the thumb is
important.Which diagnosis must be proposed?
A fracture of the first metacarpal bone? B
radial nerve palsy? C ulnar nerve palsy? D
rupture of the adductor pollicis brevis? E
Acute sprain of the Ulnar Collateral Ligament of
the metacarpophalangeal joint of the thumb?
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E Skiers thumb X-Rays with stress imaging are
necessary.
Q4
ABD gt 20
TREATMENT?
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Skiers thumb the risk is chronic instability
Surgical treatment is indicated in severe
high-grade 1st MP joint sprains. A cast
immobilisation is necessary during 6 weeks
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M. F D., coming back from a bicycle raid in Chile,
Q5

• presents hypoesthesia and numbness
• in the fifth finger and medial side of the fourth
  finger, a weakness in the fingers abduction
  related to the axis of the third finger,
• a decreased strength in thumb adduction.

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Do you think it could be

• A radiculalgia C8 T1?
• An ulnar nerve entrapment at the elbow?
• A distal ulnar nerve entrapment?
• A neuropathy related to anabolic drugs?
• A thoracic outlet syndrome?

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C. Ulnar nerve entrapment of the cyclist
Q5
Treatment Rest Gloves and protection Changing
the position
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Sports trauma
Hand examination always comparative!
Bad equipment?
Bad practice?
Bad movement?
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THANK YOU
Anima Sana In Corpore Sano
Sport provides good health!