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Common wrist and hand injuries in skiing and snowboarding


1) Skiers thumb

  • The joint between your first phalange and metacarpal bone is known as your metacarpal joint (MCP) (the thumb knuckle between your hand bone and first thumb bone).

  • There are two ligaments either side of this joint to secure the bones together- the radial and ulnar collateral ligaments.

  • Spraining the Ulnar ligament (which lies on the inside aspect/web space of the thumb) is one of the most common hand injuries in sport and is often known as skiers thumb. Injury occurs due to a fall onto an outstretched thumb were the thumb is hyper extended and abducted (move outwards) and is more likely when gripping sometime thing- which is why it is common in skiers falling holding ski poles. If the force is great enough to the ligament it will result in it been sprained or ruptured.

Signs and symptoms

  • Pain and tenderness over the MCP joint

  • Weakness and an inability to do gripping/pinching

  • Bruising and swelling

  • Loss of stability at the joint

What will be done at assessment?

  • Xray- to ensure an avulsion fracture has not occurred (where part of the bone is pulled away)

  • Stability testing to determine the grade of sprain and whether it is torn or not- If the ligament is torn there will be excessive movement (10-20 degrees more movement) at the joint compared to the other side

Treatment

-Partial tear- immobilization for at least 4 weeks, taping and other protective splints may also have to be used when returning to sport

- Full tear- surgery

- You may need to see a physiotherapist after a prolonged immobilization period to help you regain the full range of movement and strength in your wrist/hand after the immobilization period to help

Rehabilitation after immobilization period

  • Range of movement (ROM) exercises for thumb- bending and straightening your thumb, moving your thumb to away from your fingers, getting your thumb to touch each finger

  • ROM exercises for wrist which may also have become stiff- bending and straightening and moving it side to side

(When you do ROM exercises try to move to the end range to gain further movement rather than just practicing the movement in the range you already have)

  • Strengthening exercises

  • To improve grip strength- squeeze a tennis ball for 5 seconds and repeating

  • To improve thumb strength- squeeze a small soft ball between your thumb and each finger, also try placing a rubber band around your thumb and each finger and pulling away

Prevention

  • Wear your ski poles correctly (or don’t put your hands through the loops at all)- your hands should go up through the loop and then hold the pole and strap together so that when you fall the pole will hang down

2) Wrist fractures

  • The natural protective response when falling is to outstretch your hand to protect yourself. Snowboarders are more vulnerable to falling as unlike skiers when they loose their balance they are unable to step out with the other leg to regain balance- which is why wrist fractures are much more common in snowboarders.

Radial fracture

  • The most common bone to break is the radius (which is the bone on the thumb side of your forearm)- this is known as a Colles fracture

Symptoms

  • Pain, swelling

  • Inability to move the wrist/hand

  • Numbness of fingers

  • Deformity

Scaphoid fracture

  • The scaphoid bone (located in the first row of carpal (hand) bones) just above the radius is also another common fracture following a fall onto an out stretched hand

A scaphoid fracture does not always show up immediately so it is important that if the pain persists a follow up x-ray is re done 2 weeks later

  • It is important not to ignore continuous pain as left un treated it can lead to complications such as osteoarthritis

Symptoms

  • Pain and swelling in the anatomical snuff box (when you bend your thumb backwards you will see an indentation between two ligaments)

  • Pain

  • Bruising, swelling

  • Pushing up from a chair test- if you push up from a chair with your hands you will feel the pain

Management of fractures

  • If the bone is displaced too much surgery will be required

  • Surgery and non surgical options will then require a cast for around 6 weeks

  • You will then see a physiotherapist to help you regain your strength and movement

Exercises

Whilst in cast:

  • It is important to keep your fingers, elbow and shoulder moving to prevent these joints becoming stiff

After cast is removed:

  • Bending and straightening the wrist

  • Moving your wrist side to side

  • Turning your hand over each way

  • Add some over pressure (until you feel a stretch) to these exercises and hold for 30 seconds

Strengthening

  • Grip strengthening with tennis ball- squeeze for 5 seconds and repeat

  • With your hand facing upwards and a weight in your hand, bend your hand upwards

  • With your hand facing down and a weight in your hand, lift your hand upwards

Prevention of wrist fractures

  • Consider wearing wrist supports/guards

  • Learn to fall correctly

  • Consider getting professional lessons when starting snowboarding to ensure you have the right technique


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