The most common fracture of the hand is referred to as a “Boxer’s Fracture”. As the name implies, this fracture is most commonly the result of a striking a solid object with knuckle of the small finger. Usually from angrily punching a wall, other immobile object or from hitting someone else.
San Francisco Giant’s ace pitcher finished his spring training with a new twist on this common fracture. He found out that putting his hand in the way of a hard hit ball (off of his 101 mph pitch) is a good way to start the regular season late. Although I haven’t seen the x-rays, it looks like he suffered an impact to the small finger side of the hand. In this video excerpt from MLB baseball, concentrate on the ball and you can see Madison Bumgarner, in effect “punching” the ball, reportedly causing a fracture of his small finger metacarpal (bone in the hand from the knuckle to wrist bones). Find out more about fracture and sports injuries at TheHandDoctor.com and American Academy of Orthopaedic Surgeons.
Depending on the fracture pattern, these fractures can be set and held in a cast. If out of position, or if the break is toward the base of the metacarpal, (closer to the wrist) pins, or even a plate and screws are needed to correct and hold the fracture in position. In the case of a professional athlete, surgically fixing the fracture to leave nothing to chance, is the way to go. These fractures typically heal in 3 weeks. A professional pitcher will likely miss 6 weeks to rehab his throwing hand. Tough start for Bumgarner and the Giants.
Engagement ring piercings? Not the best way to show your love or good judgement!
While body piercings routinely heal and do well in clean, protected areas of healthy skin with good circulation, the implantation of a metal-backed, Microdermal ring finger piercing, is ill-advised. Since the circulation and healing potential of the hand is good it might be tempting to conclude that this is a safe idea. Not in this Hand Surgeon’s opinion. I do too much surgery already treating hand infections without introducing an implant. Even traditional rings can get caught and cause severe degloving injuries (just ask Jimmy Fallon). These piercings introduce a whole different level of concern.
The lack of padding in the area of the extensor surface of the finger, and the motion of the extensor tendon immediately below the skin is a formula for tendon injury. The tendon is at risk of damage from the procedure itself or erosion over time from constant motion of metal against extensor tendon. The backing (anchor) can become detached and migrate either after catching the ring during activity on or wear and tear failure. Finally, and most devastating, is the risk infection. Our hands are not the cleanest area of our bodies and the ring piercing is unlikely to wall off (epithelialize) around the implant in the same way piercings do in other parts of the body. Infection might be treated effectively with ring removal and a course of antibiotics, but it could also result in deep space infection requiring extensive surgery and require long term antibiotics. Such finger infections can be hard to eradicate and result in permanent loss of motion, or even finger loss.
Climber’s finger, like many injuries that can affect the hand and arm can occur from trauma but frequently develops from repetitive overuse. Because of the cause and nature of the injury it is difficult for the individual to stop the activity to allow the needed time to heal. With climber’s finger the problem develops from the forceful and repetitive use of one or more fingers, commonly the long finger for a fingertip hold. The injury can range from inflammation to a significant injury to the small but crucial pulleys and sheath that support the flexor tendons in the finger.
Example of possible injuries seen in climbers.
To slow the damage and inflammation, standard initial measures can help (ice, rest and activity restriction). Taping encircling the middle section (middle phalynx) of the involved fingers can support the most commonly injured pulley. If there is some relief in symptoms with these measures, then there is good reason to expect that with time the area will heal. Hand therapy can help to control symptoms and encourage healing. Such efforts are aimed at decreasing the inflammation while encouraging healing of any damaged structures. If symptoms respond then the injury is partial and most likely at the inflammatory end of the spectrum of such injuries.
With persistent pain and swelling, or if there is any sense that the tendon on the under surface of the finger is “loose” (pulls away from the finger like the line on a fishing rod when you’ve caught a big one!) more significant injury has likely occurred. An expert evaluation is needed. After examination by your hand specialist, an MRI scan or Ultrasound evaluation may be recommended in order to clarify the extent of injury. The physical exam and imaging studies can determine what is inflamed and what might be torn. If the injury to the pulley that supports the tendon is complete or near-complete then it cannot heal fully on its own and surgical reconstruction will be recommended.
This information is provided on the basis of a presumed conditions: “climber’s finger”. Many conditions can mimic the inflammation and swelling seen with climbing and my have different treatments and outcomes.
Please don’t ignore your symptoms. And once in a while call!
Such injuries from overuse include various tendonitis conditions and nerve entrapments (carpal tunnel syndrome etc.) Many were recognized 100 years and more ago.
Very interesting excerpt from a 1914 text on Occupational Disorders. It goes on to describe conservative treatment similar to measures we employ today! The more things change, the more they stay the same.
From a textbook on Occupational Diseases published in 1914
Check out the occupations associated with these conditions in 1914. No texting to be found!
Ok now that professional basketball season in underway.. I seem to be seeing an increase in “jammed” fingers. Probably just coincidence but when my son jammed his finger playing goalie it prompted me to start thinking about these injuries which do occur when flying spherical objects contact extended fingers as in “ball” sports (basketball, volleyball and soccer). I never fail to cringe when I see a patient who says there finger was jammed and crooked so they (or a teammate) pulled on it to straighten it! While this frequently works (there are a lot of jammed fingers out there that thankfully don’t make it to a surgeon’s office) when it doesn’t it can become a major problem. The joints of the fingers are actually quite complex and in delicate balance. One of the giants of Hand Surgery, J. Littler, called the extensor tendon function a “fugue of motion”, denoting a very complicated interaction of forces each dependent on the other to maintain balance and precise function.
Suffice to say that some these structure and certain injury patterns are very benign and heal without problem but others do not.
So look out the following “Red flags” that suggest problems may be lurking:
1. Obvious, even slight, persistent angulation or lack of finger extension (doesn’t stay straight)
2. Significant restriction in joint motion that does not improve over a few days.
3. Grating or clicking sensation with motion.
4. Pain that persists and if simple (“popsicle stick” splint) immobilization doesn’t give you relief.
5. Numbness or tingling in the fingertip.
By the way, Happy New Year and be careful out there!
– Greg Balourdas, MD