EPIDEMIOLOGY OF HAND AND WRIST INJURIES IN SPORTS

  • Author Footnotes
    * Methodist Sports Medicine Center, Thomas A. Brady Clinic, Indianapolis; and Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
    Arthur C. Rettig
    Footnotes
    * Methodist Sports Medicine Center, Thomas A. Brady Clinic, Indianapolis; and Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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  • Author Footnotes
    * Methodist Sports Medicine Center, Thomas A. Brady Clinic, Indianapolis; and Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
      Hand and wrist injuries are common in all sports. The types of injuries range from traumatic fractures, which are most often seen in contact sports, such as football and hockey, to stress and overuse injuries seen in gymnastics, racquet sports, and golf.
      Although the exact incidence of hand and wrist injuries in different sports is difficult to assess accurately, the literature is replete with studies indicating certain trends in several sports.
      It is of note that hand and wrist injuries are more common in adolescents than in adults. Over a 10-year period, the Cleveland Clinic found that 14.8% of athletic participants under the age of 16 years sustained upper extremity injuries. Of these, 16% involved the hand, whereas 9% involved the wrist.
      • Bergfeld J.A.
      • Weiker G.G.
      • Andrish J.T.
      • et al.
      Soft playing splint for protection of significant hand and wrist injuries in sports.
      The overall incidence of hand and wrist injuries in sports has been studied by Bergfeld and colleagues at the Cleveland Clinic,
      • Bergfeld J.A.
      • Weiker G.G.
      • Andrish J.T.
      • et al.
      Soft playing splint for protection of significant hand and wrist injuries in sports.
      Dehaven and Lintner at the University of Rochester Sports Medicine Department,
      • DeHaven K.E.
      • Lintner D.M.
      Athletic injuries: Comparison by age, sport, and gender.
      and Rettig and associates at Methodist Sports Medicine Center in Indianapolis.
      • Rettig A.C.
      • Ryan R.O.
      • Stone J.A.
      Epidemiology of hand injuries in sports.
      In the Cleveland Clinic study, a series of 113 hand and wrist injuries were examined. Ninety-seven of the injuries occurred in football, 6 in soccer, 3 in wrestling, 3 in baseball, 2 in basketball, 1 in ice hockey, and 1 in rugby. The study reported 96 fractures, 13 sprains, and 4 dislocations. Metacarpal fractures accounted for 38 of the 96 fractures reported. There were 12 distal radius fractures and 11 scaphoid fractures in the series. The study reported 27 thumb injuries including 12 ulnar collateral ligament tears and 10 proximal phalangeal fractures. The Cleveland Clinic study primarily reflects a football population and is consistent with other studies of injuries in football.
      Dehaven and Lintner
      • DeHaven K.E.
      • Lintner D.M.
      Athletic injuries: Comparison by age, sport, and gender.
      reported on data from 3431 cases reported at the University of Rochester Sports Medicine Center. They noted that hand injuries constituted 5%, or 171, of all patients treated. They reported 102 fractures, which represented 60% of all hand injuries. There were 72 phalangeal fractures, 27 metacarpal fractures, 2 carpal fractures, and 7 fracture dislocations.
      Rettig and colleagues
      • Rettig A.C.
      • Ryan R.O.
      • Stone J.A.
      Epidemiology of hand injuries in sports.
      reported on a 1-year survey of all hand injuries at the Methodist Sports Medicine Center in Indianapolis. They noted that 213 injuries were seen in 207 people. This represented 3% of the total number of new patients seen at the Center over this period of time. Injuries included 125 fractures, 13 dislocations, and 45 sprains. Eighty percent of the injuries occurred in males.
      Eight sports were selected for study with regard to the quantity and type of injury and compared with the incidence in the overall group. Fractures accounted for 55% of the injuries in these eight sports. Sprains accounted for 21%, whereas dislocations accounted for 7%. Amount of time lost from sport was calculated and averaged 16.7 days with a range of 0 to 84 days.
      It was noted that football accounted for the highest number of injuries as well as the highest number of fractures (52%), dislocations (61%), and sprains (38%). Basketball injuries included fractures (32%), dislocations (15%), and sprains (25%).
      The situation in which the injury occurred also was studied, that is, practice, competition, or recreational competition. It was noted that 28% of the injuries occurred in practice, 41% in competition, and 15.8% in recreational competition.
      Another study that evaluated the incidence of hand and wrist injuries was reported by Rettig and associates.
      • Rettig A.C.
      • Ryan R.O.
      • Stone J.A.
      Epidemiology of hand injuries in sports.
      In this particular study, all of the injuries at the Olympic Training Center in Colorado Springs, CO, over a 10-year period were reported. Of the 8311 injuries reported, 729 of the injuries were to the hand or wrist, which represented 8.7% of all reported injuries. The injuries to the hand or wrist were reported in 36 sports and represented 731,000 athletic days. It is of note that football was not included in this study because it is not an Olympic sport.
      A breakdown of the incidence per sport is as follows: roller hockey, 30%; baseball, 25%; boxing, 17%; basketball, 17%; volleyball, 13%; weight lifting, 13%; ice hockey, 12%; wrestling, 7%; and judo, 6%.
      Sprains were the most common type of injury to the hand and wrist (49%), followed by contusions (15%) and fractures (10%). It is of note that the Olympic Training Center studied “grassroots” injuries, or those reported directly to the athletic trainer. The prior studies were based on a referral population. Therefore, sprains and contusions are the most common injuries seen in sports even though fractures are the most common injuries seen at referral centers.
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