Wrist Injuries in Sports - An Overview

Introduction:

The wrist is a complex joint that transmits forces generated from the hand through the forearm.The wrist is a condyloid synovial joint of the distal upper limb that serves as a transition between the forearm and hand. It is a modified ball and socket joint that allows forward, backward, and side-to-side movements and does not allow rotations. There are two layers surrounding the wrist that forms the wrist capsule. The outer layer is fibrous and attaches to the radius, ulnar, and carpal bones. The inner layer appears thin and flimsy and is named the synovial membrane. The synovial membrane secretes synovial fluid and helps lubricate.

What Are the Types of Wrist Injuries?

Acute Injuries: Acute injuries depend on various factors, such as the force of the fall, types of sports, and injured areas. They are common in athletes with a high level of contact with other players during sports such as boxing, kabaddi, football, handball, and wrestling. The common acute injuries:

A. Strains and Sprains: Sprains are damage to ligaments (tissue that connects bone to bone). Sprains may range from a minor tear to a complete rupture. For example, a wrist sprain occurs due to a ligament tear and occurs due to breaking the fall with the support of the palm. This leads to hyperextension of the wrist and causes a sprain.

B. Joint Disorders: Ulnocarpal impaction syndrome is a chronic impaction between the ulnar head, triangular fibrocartilage complex, and ulnar carpus. They are common in racket sports players and gymnasts. They are provoked by movements like a firm grip, ulnar deviation of the wrist, and pronation (palm facing downwards).

C. Inflammation: Ligament injuries lead to progressive instability and deterioration of the joints.

• Scapholunate Ligament Injury: It is a scapholunate dissociation and the most common form of carpal instability. It is caused due to violent contact with other players, leading to hyperextended wrist and cumulative micro traumatic injuries.

• Triangular Fibrocartilage Ligament Injury: These injuries often result from forced axial load on the wrist in an extension position and the application of distraction force to the wrist, as in racket sports.

D. Fractures: Scaphoid fracture is the most common wrist fracture. This occurs due to a fall with an outstretched hand. They are seen in contact sports such as football and rugby and also in high-velocity sports such as skating and rollerblading. Symptoms include mild swelling and decreased range of motion. There is a possibility of missing an occult fracture in these cases. Fractures are classified as stable and unstable fractures depending on the treatment plan. Stable fractures are where the fractured fragments are in a favorable place for healing as in scaphoid tubercle fractures and are treated through non-surgical methods. Fractured fragments that do not favor healing, as in comminuted fractures, are treated through surgery.

Chronic Injuries: Chronic injuries occur due to repeated motions during sports such as basketball, volleyball, tennis, cricket, and golf. They are less likely to cause long-term disability. The common chronic injuries are:

E. Tendonitis: It is a tendon inflammation and tear.

• De Quervain syndrome is a common wrist tendinopathy in athletes. This is a painful stenosing tenosynovitis due to shear microtrauma and repeated gliding movements of the muscles and tendons. Sports requiring forceful gripping along with repetitive use of the thumb, such as playing volleyball, golf, and fly fishing, predispose athletes to this disorder.

• Intersection syndrome is an inflammatory condition seen at the intersection of the first and second dorsal compartment tendons. They are common in rocket sports, horse riding, skiing, weight training, and sports requiring repetitive wrist extension.

F. Tendinosis: Tendinosis is microtear in the tendon tissue without inflammation.

G. Nerve Injuries: Neurovascular disorder occurs due to repetitive microtrauma. Carpal tunnel syndrome is the compression of the median nerve in the carpal tunnel, which causes tingling and numbness of the first three digits. Guyon canal syndrome is the entrapment of the ulnar nerve in the Guyon canal (an anatomical canal situated in the middle part of the hand). It causes ulnar side wrist pain along with difficulties in pinching and hand coordination (ulnar nerve is responsible for fine movement of the fingers). This condition is seen in wheelchair athletes and cyclists because of their grip and handlebar positions, and also sports requiring repeated push-ups are performed on a hard surface.

H. Stress Fracture: Stress fractures are due to repeated microtrauma. The gymnast’s wrist is due to repetitive stress to the distal radius physis. This is more common in young individuals. Gymnast plates are at high risk for injury because athletes bear weight on their upper extremities, where huge axial loads are transmitted through the wrist.

What Are the Other Categories of Wrist Injury?

• Overuse Injuries: They occur due to repetitive motions and are seen in volleyball players.

• Nerve Injuries: They are of a compressive type and are seen in cyclists.

• Traumatic Injuries: They occur due to a fall or a direct blow.

• Weight-Bearing Injuries: They result from repetitive, excessive compressive forces and are common in gymnastics.

What Are the Risk Factors?

• Wearing jewels while training or participating in sports.

• Overuse of muscles with previous injury or sprain.

• Inability to master sports-specific skills.

• Negligence to wear safety gear in sports such as cricket and boxing.

How to Diagnose?

• X-Rays: X-rays are performed to check the extent and location of the fracture or any bone abnormality.

• Computed Tomography Scan (CT): CT scan uses a combination of X-rays and computer technology to generate images of the internal structures for a detailed examination and diagnosis.

• Magnetic Resonance Imaging (MRI): In this imaging study, the images are generated in a magnetic field and computer generated radio waves to obtain detailed images of the internal organs and structures.

What Is the Treatment?

• Medications: Physicians may prescribe painkillers, ointments, and anti-inflammatory medicines for pain relief.

• Physiotherapy: Physiotherapy exercises are recommended to relieve sprains and strains along with medications.

• Non-surgical Treatment: Wrist support braces, splints, and casts help in minimal movement of the injured site, which leads to faster recovery. Cast is put during strains.

• Surgical Treatment: When there is no improvement with other treatments, surgery is done. Under general anesthesia, surgery will help with tendon repair, fractures, dislocations, and ligament tears.

What Are the Preventive Measures?

• Wearing safety gear such as gloves, guards, and wrist braces.

• Warm up before training to prevent muscle injuries and shock.

• Taking breaks in between the training.

• Mild stretching after physical activity.

• Maintaining correct posture.

• Avoid exercising in case of a previous history of muscle pain.

Conclusion:

Wrist injuries are sport-specific injuries that affect physical and mental wellbeing when left untreated. Precaution and care are essential during rehabilitation to not further stress or worsen the condition. During rehabilitation, the rate of adaptation of the athletes depends on their ability and will be unique for each individual. Delaying the treatment will result in long-term or permanent disability. However, with prompt diagnosis and treatment the injury can be treated and can improve the living condition of the patient.