In the first quarter of today's game, Dallas Cowboys Quarterback, Tony Romo was knocked out of the game with a right hand injury.  He is on the sideline with a tight wrap.  Pictures show a highly swollen hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising. Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Romo's injury.  Given that this is his dominant, throwing hand, if a metacarpal is fractured it could be a big deal. A CT scan may be needed to evaluate the injury further.  If broken, he could be out next week.

VIDEO/ANIMATIONS

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

America’s Team’s quarterback, Tony Romo, was taken out of Sunday’s game for a broken rib.  Remarkably, he was able to return to play in the second half.  Today we learned that he had punctured a lung, a condition known as a pneumothorax.  What is this and how long will he be out?

ANATOMY

The rib cage is made up of the ribs, collar bone (clavicle), and breast plate (sternum) of the chest.  These bones and the tendons, muscles, and ligaments that connect them serve to protect the internal organs of the chest.  These organs include the lungs, heart, esophagus (a tube running from the mouth to the stomach), and trachea (the tube running from the mouth to the lungs).  There are 12 ribs on either side of the sternum.

CAUSES

Rib breaks or fractures are usually due to a blunt trauma, as with Romo, or a sharp trauma, such as with a gunshot wound.    A break of the ribs can potentially cause damage to the underlying organs.  If the force is great enough, the broken bone can be plunged into the lungs.  The air that was in the lungs now escapes and enters the space between the ribs and the lungs.  This is known as a pneumothorax.    The pneumothorax can be small.  In this case, the puncture usually seals itself and the body removes the air over time.  In a large pneumothorax, the air pressure can build up to the point that the trachea starts to close down.  This is life threatening and can lead to death.

SYMPTOMS

Individuals with a rib break will experience pain, difficulty with deep breathing, coughing, sneezing or even swallowing.  There will be pain when pushing on the rib.  If a pneumothorax develops, the individual may suffer from shortness of breath, difficulty with breathing, difficulty with swallowing, and see a shift of the trachea in the neck.

WHEN TO SEEK MEDICAL CARE

If you suspect that a rib fracture or pneumothorax, you should seek immediate medical attention.  A physical exam and x-rays are usually performed.

TREATMENT

Most rib fractures are treated without surgery.  These breaks usually do not penetrate the underlying organs but are painful.  Pain medications, anti-inflammatories, a brace, ice, rest, and activity modifications are usually enough to treat these injuries.

If a small pneumothorax is present, chest xrays are obtained every day to make sure that the air is going away.  If it enlarges, a chest tube may be needed.  A chest tube is a device that is placed through the skin and between the ribs.  The tube is placed into the space between the lungs and the ribs.  It serves to rest the lungs and get rid of the air between the ribs and the lungs. Very rarely is surgery needed.

If a large pneumothorax is present, a chest tube is needed.  Very rarely is surgery needed.

OUTCOMES

Most athletes with a simple rib fracture can return to all activities within a few days, as long as the pain is being managed well.  For those with a small pneumothorax, they are able to return to sports within 1-2 weeks. For those with a large pneumothorax, they are able to return to sports within 4-6 weeks.

RETURN TO ACTIVITIES

From the current reports, as long as Romo’s pneumothorax stays small, and if his pain is well controlled, he will be able to play this weekend.  However, he will likely be wearing extra protection around his ribs.

VIDEO/ANIMATIONS

None

Dr. P

---------------------------------------------------------------------------------

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics