When is a wrist sprain more than a simple sprain? If you followed the Yankees during the pre-season, you may have asked yourself the same thing. When Mark Teixera injured his wrist while swinging a bat, the initial diagnosis was that of a simple sprain. Soon after, however, it was revealed that the star first baseman’s injury was a torn tendon sheath, an injury that put him on the disable list for an unplanned couple of months. He has still not yet returned to Yankee Stadium.
It goes to show that even at the highest level, wrist injuries can be, well, complicated. So what sowed such confusion? Sprains themselves refer to ligament injuries, but it’s often hard to tell at first glance whether a wrist injury requires a little TLC versus professional intervention.
That’s because most wrist injuries, whether simple or complicated, are going to involve a little swelling and stiffness. But when wrist injuries don’t get better after two or three weeks, it’s usually a sign that the injury may be worse than a mild sprain. These nagging injuries shouldn’t be taken lightly either. Persistent pain, clicking in the wrist, or excessive swelling, are red flags that could indicate either a torn ligament, or even a broken bone, both of which require immediate treatment.
The wrist’s anatomy lends itself to a range of injuries, depending on the forces at work. The most common side for sprains to pop up is on the dorsal, or back, side of the wrist. The ligaments along the outside of the wrist, just below the small finger, are also frequent sites of sprains.
So how do you go about healing yourself when your sprain is just a mild simple sprain? Rest, ice, splinting, and anti-inflammatory medicine are the simplest and most effective treatments of minor to moderate wrist sprains. Over the counter wrist splints may not always match a three-piece suit, but it’s worth sporting a simple brace that stabilizes the wrist and gives it the support it needs to properly heal.
A simple regimen of the aforementioned ice and rest routine should lead to a complete recovery in two to four weeks, in most mild sprains. If the pain or swelling persists after three weeks or longer, then you should make an appointment to see your local orthopedist for further assessment.
Imaging is one of a doctor’s most powerful tools in making a diagnosis about wrist injuries, but individuals should also take note of how the injury happened. Tennis players, golfers, and baseball players are prone to the type of twisting injuries seen in Teixera’s wrist. The forceful rotating motion of swinging a tennis racket or baseball bat may injure the ligaments of the wrist, as opposed to direct traumatic injuries such as a fall to the outstretched hand, where it’s more likely for a fracture to result. Significant ruptured ligaments may require surgery. Some ligament ruptures can be directly repaired, while others require more complex procedures involving grafts and screws.
The reality is that any injury is never going to be as straightforward as you think, and as we get back on the courts or on the baseball diamonds this spring, a number of us are going to feel that all-too-familiar twinge somewhere in our wrist. The important thing to remember is to never underestimate a wrist injury. And even when it’s worse than you think, the pros at Manhattan Orthopedic will always have you covered.
We sacrifice many things for our children—sleep and a small slice of sanity are just two examples that come to mind. But for many new mothers, the constant lifting and toting of a young child can lead to a condition much more agonizing and confusing than a few sleepless nights.
If you’ve never heard of it before, “New Mom’s Syndrome” may sound like a good description of overprotective mothers. In reality, it is a painful form of tendonitis that affects the tendons on the outside of the thumb and wrist. This occurs when the repetitive stresses of carrying a child results in inflammation of the tendons in this region.
Most of the people who are affected by “New Mom’s Syndrome”—known clinically as De Quervain’s Tendonitis—have often never experienced this type of pain or discomfort in their hands or wrists. Some of the blame can be placed on the natural swelling associated with the later part of pregnancy and after delivery, which intensifies the natural strains on one’s ligaments and tendons.
Indeed, some pregnant women develop carpal tunnel in the last trimester, due to the increased swelling of the wrist tendon’s that sit next to the nerve within the carpal tunnel. And if that weren’t enough, just as a new mother’s carpal tunnel syndrome is receding, De Quervain’s Tendonitis starts kicking in after delivery.
It’s true, however, that “New Mom’s Syndrome” is not exclusive to new moms. De Quarvain’s tendonitis can affect both genders, both the young and the old, but rarely do men’s bodies swell after their wives pregnancy—unless they’ve been sneaking in a few too many candy bars.
Luckily for everyone, “New Mom’s Syndrome” can be easily treated. In some cases, pain can improve by modifying the way one hold’s the child and by wearing a splint to relieve some of the strains on the wrist tendons. Physical or occupational therapy can be helpful as well. The most common and effective treatment, however, is usually a simple cortisone shot, which permanently solves the issue in most patients. If that doesn’t work, well, you might want to get your child a scooter to cruise around on. We’re totally kidding, but at least then you wouldn’t have to carry them as much!
For those of us with a few gray hairs, it’s about now in the middle of the summer that all those pickup games from May and June are starting to show their wear. An ache in the knee or a pulled bicep; these are pretty normal for an older sportsman on the weekend pitch. As frustrating as these injuries are, the real rub is how your kids can go full speed all summer long without some nagging pain to remind them of their age.
The tortoise did beat the hare, however, so a little insight into what type of injuries we get at different ages will hopefully lead to a longer and stronger summer season. The most important place to start is with conditioning. Gentle stretching goes along with any type of cardiovascular as a good base, but with games like softball or tennis, resting and icing your favored arm will help you recover faster and guard against the chance of future strains.
Once you start to hit middle age, those strains become measurable. The effects of age on the body are such that older athletes tend to experience bursitis and rotator cuff injuries at a much higher rate than their younger counterparts. Comparatively, younger athletes are affected by injuries such as labrum tears and other such trauma; in other words, there’s usually no doubt about the injury.
The good news is that as long as we stay fit at any age, we can usually sweat the small stuff out with some rest and ice. But as we get older, the small stuff should still be watched. Amazingly, it’s been found that 10% of patients 50 years and older have rotator tears—and most don’t’ even realize it. At 60 years old, that percentage goes up 20%. And at 70 years old, the percentage of people with rotator cuff injuries rises to an astounding 40%.
When a pain persists, it’s always best to see your doctor. If it’s a rotator cuff injury, a quick cortisone shot will sometimes be prescribed for the short term, while some form of physical therapy can provide for a lasting recovery. And while it’s never good to be out of the game, the recovery from a rotator cuff strain or inflamed bursa takes about as long as the recovery of a labrum tear, which often requires MRI’s, therapy, and sometimes surgery. The recovery from a full rotator cuff tear that requires surgery will put you out of the whole season.
Staying fit and watching those aches goes a long way to staying in the game, so know your limits. Lamenting the young for their youth is as old as the hills, but that doesn’t mean you can’t compete.
Spring heralds the start of the baseball season—or is it the other way around? Either way, the diamonds are filling up with millions of little leaguers as the new season starts after a long winter. These first few weeks are of particular import because of the new strains on young athletes after the off-season. Little League injuries can be as stressful for parents as they are for their children, so we’d like to offer some background as well as a few tips on how to prevent injury in one of the most injury-prone positions on any baseball team: The pitcher.
Feel that chill? For some, fall is just a precursor to the joys of winding down the slopes on the opening weekend of their favorite ski resort. That’s why getting the most out of a quick trip to the mountains means getting prepared now through exercise and the proper equipment. Read more…
Tennis season is undeniably underway for those of us who dust off our rackets when the weather hits 75 degrees. We’ve all heard of tennis elbow, but the muscles and tendons of the shoulder are just as susceptible to inflammation and pain as the elbow. Even if it’s just a light rally with a friend, your swings make repeated demands on the tissue in your shoulder and can cause injury through overuse; the result: tendinitis.
The two most common shoulder injuries for tennis players are tendinitis and bursitis. Bursitis affects the tiny fluid-filled bursa that provides a cushion between the bones and tendons around a joint. Tendinitis is a result of inflammation and damage to the tendons. Read more…
In our last newsletter, we talked about the range of outdoor activities that spring’s warm weather affords. A bad case of tennis or golfer’s elbow, however, can seriously dampen the enjoyment in a round on the course or a friendly rally on the court.
Tennis elbow is the result of micro-tears to the tendon that originates from the bony prominence on the outside of the elbow, known as the lateral epicondyle. Tennis elbow, or lateral epicondylitis, affects 1% to 3% of the population as a whole, but gets its name from the fact that it affects almost half of all tennis players at some point in time.
Golfer’s elbow is similar, but its discomfort is due to microtears affecting the tendon located at the inside of the elbow. Golfer’s elbow, also known as medial epicondylitis, affects mostly golfers, but weight lifting, gardening, or other activities that strain this part of the elbow can cause this condition in non-golfers alike.
Mechanism of Injury
“Skier’s thumb” represents an injury to the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb. As the eponym implies, it can be secondary to a fall while skiing, when the thumb is forcibly radial deviated when the hand is caught in a ski pole. These injuries can also occur secondary to any injury, such as a fall, which stresses the ulnar collateral ligament of the thumb MCP joint. Read more…
Dr. Richard Gilbert has recently had a book chapter on Boutonniere Deformity published in the textbook “Plastic Surgery: Clinical Problem Solving.”
You may purchase the book here.
Dr. Richard Gilbert and Dr. Marvin Gilbert recently collaborated on a research project together, entitled: “Cubital Tunnel Syndrome in Patients with Haemophilia” which was published in the journal “Haemophilia”