Thumb injury
A football
player is
tackling the
ball carrier
and his
thumb gets
caught in
the jersey
as he drags
the call
carrier to
the ground.
The athlete
felt a “pop”
and he is
unable to
grip with
his hand.
This could
be a simple
thumb
metacarpal-phalangeal
sprain (M-P)
commonly
known as
“game-keeper’s
thumb” or an
avulsion
fracture of
the
ligament.

A football
player is
tackling the
ball carrier
and his
thumb gets
caught in
the jersey
as he drags
the call
carrier to
the ground.
The athlete
felt a “pop”
and he is
unable to
grip with
his hand.
This could
be a simple
thumb
metacarpal-phalangeal
sprain (M-P)
commonly
known as
“game-keeper’s
thumb” or an
avulsion
fracture of
the
ligament.

The injury
evaluation
should begin
with a
detailed
history.
Simple
questions
such as: how
did the
injury
occur; which
direction
did the
thumb
displace;
did the
athlete “pop
it back into
socket;” and
did he feel
a “pop” at
the time of
injury.
These can
aid the
evaluator in
determining
the proper
course of
treatment
for the
injury. Also
look for
obvious
deformity,
swelling, or
changes in
skin
appearance.
If the M-P
joint is
dislocated,
qualified
medical care
professionals
can attempt
on-site
relocation.
If repeated
attempts to
relocate the
thumb are
unsuccessful,
the injury
may require
surgery.
This is
referred to
as a Stenner
lesion or
“key-hole”
injury.
With any
dislocation,
vascular
integrity
should be
assessed.
This can be
accomplished
by checking
for proper
capillary
refill. Also
a
neurological
exam should
be performed
to rule out
any damage.
If the
reduction is
carried out,
the athlete
will require
orthopaedic
evaluation
to determine
if a
fracture is
present and
to determine
the
appropriate
course of
treatment.
M-P Sprain

This X-Ray
shows a M-P
injury that
involves an
avulsion
fracture of
the ligament
from the
metacarpal.
This injury
needs to be
treated
properly so
that the
athlete does
not have
debilitating
injury.
Performing
ligament
stress tests
to determine
the
integrity of
the ligament
assesses
this injury.
The adjacent
picture
shows this
test. The
thumb is
abducted
while the
metacarpal
is held in
place.
Movement
greater than
the opposite
side is
indicative
of the
injury. The
relative
amount of
movement and
end feel
determine
the severity
of the
damage.
Excessive
joint motion
is not
indicative
of isolated
ligament
damage; an
avulsion
fracture
will display
the same
abnormal
motion. Due
to this, an
x-ray is
necessary to
determine if
there is a
fracture
present.
Simple
fractures
are
generally
treated by
splinting
while
avulsion
fracture if
displaced
may require
surgery
.
Avulsion
Injuries
(Thumb)
The
inability to
fully extend
the last
joint of the
thumb may be
the result
of an
avulsion or
avulsion
fracture of
the extensor
tendons.
This injury
typically
occurs when
the joint is
forcibly
flexed while
actively
attempting
to extend
the joint.
The injury
mechanism
most
commonly
seen is a
result of
the thumb
being caught
in a
football
jersey while
blocking or
tackling.
This results
in a tearing
of the
extensor
tendon from
its
attachment.
This is also
a surgical
case; the
tendon must
be
reattached
so that
normal
function of
the joint is
restored.
All of these
injuries
require
immediate
medical
attention.
Some
injuries
that do not
are
subungual
hematoma
(blood under
the nail),
torn nails,
and small
lacerations.
All of these
injuries are
common in
athletics
and do
require
proper
treatment to
prevent
complications.
Nail
Injuries &
Cuts
The
subungual
hematoma is
extremely
painful and
can result
in infection
and loss of
the nail if
not treated
properly. A
direct blow
to the tip
of a finger
can cause a
contusion of
the nail bed
resulting in
a hematoma.
This blood
causes great
pain and
pressure.
Draining the
blood can
relieve
this. This
is
accomplished
by using a
nail drill
or heated
straight
pin. In both
cases the
implement is
used to make
a hole in
the nail so
that the
accumulating
blood can
escape. This
results in a
decrease in
the pain and
may save the
nail.

If the
blood, and
resulting
pressure, is
not removed
the nail may
fall off.
This exposes
the
sensitive
nail bed to
repeated
trauma and
possible
infection.
After
removal of
the blood,
the nail and
surrounding
tissue needs
to be
cleaned and
treated like
any open
wound.
Lacerations
should be
cleaned and
dressed
appropriately.
If the
laceration
is large
enough,
sutures may
be required
to close the
wound to
speed
healing.
Nail tears
need to be
cared for
appropriately.
This begins
with
educating
athletes as
to the
proper
length of
nails. An
athlete
should keep
their nails
short and
well
groomed. A
long nail is
extremely
susceptible
to tearing.
Also, long
nails can
result in
cuts on
teammates or
opponents.
This greatly
increases
the chance
of
transmitting
blood-borne
pathogens.
Caring for
torn nails
leads to
delays in
participation
for
treatment
and blood
cleanup.
Treatment
for nail
tears
includes
smoothing
the rough
edge,
cleaning and
appropriate
dressing
application.
|