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

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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

Jay Cutler, quarterback for the Chicago Bears, underwent surgery today for a Bennet’s fracture or break on his throwing thumb.  What is this injury?  Can he make it back to play this season?

ANATOMY

The human hand is composed of 27 bones.   These bones are grouped into categories:  the carpal, metacarpal, and phalanges.  The human hand has five metacarpals. 

A Bennett’s fracture is a break at the base of the metacarpal of the thumb.  

This injury is usually accompanied by a dislocation or a subluxation (partial dislocation) of the thumb.  This injury makes the thumb unstable, particularly for gripping activities, such as holding a football.

There are a number of strong ligaments and tendons that attach to the smaller piece of bone that is broken. 

CAUSES

The most common causes of Bennett’s fractures are: a punch or a direct blow against a football helmet or skull, or a fall, particularly while holding a handle bar of a bike or motorcycle.

SYMPTOMS

Athletes with a Bennett’s fracture will have pain at the base of the thumb.  There will be instability of the thumb with gripping or pinching motions.   There will be weakness with these activities as well. There will be pain, swelling and bruising around the base of the thumb.

TREATMENTS

Athletes with a Bennett’s fracture will require surgery.  Surgery can be performed in a variety of manners:  with small incisions and screws, with screws and plates, or with pins alone.  If the smaller piece is very small and not out of place, a “thumb” spica cast can be placed for non surgical treatment.  Whether surgical or non surgical treatment is performed, a cast for 4-6 weeks is needed.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have a Bennett’s fracture, you should seek medical care within hours of the injury.  A good physical exam, x-rays, and perhaps a CT scan or MRI may be needed to evaluate the hand.

RETURN TO ACTIVITIES/OUTCOMES

Regardless of the type of treatment, a cast is needed for 4-6 weeks.  Thereafter, physical therapy and rehabilitation is required.  It is usually 6 to 8 weeks before throwing activities can be started without pain.

If lucky, Cutler may be able to return late this season, especially if the Bears make is deep into the playoffs. 

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

The third week of the NFL continues to bring drama to the field due to injuries.  Week 2 saw Michael Vick exit the game from a concussion. Today, he left the game because of a broken right 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 Vick’s injury.  Given that this is his non-dominant, non-throwing hand, if a metacarpal is fractured he should be able to play next week.  A special cast may be made for him to protect the hand during play.  However, if one of his wrist bones is fractured, he could be out of action for 6-8 weeks.  The CT scan that he is scheduled to get on Monday should give us a lot of insight into the nature of his injury and the time to return to play.

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