Seattle Mariner, Mike Zunino, injured his left hand during the game against the Minnesota Twins at the end of July. Zunino suffers from a broken hamate bone.
Wrist and Hand Injuries From Bike Falls
I have always enjoyed cycling. There is something about grinding your way up a steady incline for a mile or greater and then riding over the hillcrest to claim your reward. Turning all the responsibility of propelling the bike over to gravity is one of those great feelings that only vigorous exercise can produce.
Here in Seattle, we have great opportunities for cycling, whether for fitness or just getting around the city. Seattle offers numerous roadways with bicycle lanes as well as separate bike paths for those who wish to stay clear of automobile traffic. Because of the popularity with riding in and around the city as well as on mountain trails, I do tend to see numerous wrist and hand injuries during the warmer months from bicycle falls.
The natural reaction when one falls off of or is thrown from a bike is to break the fall with their arms, and is the most common mechanism of injury. The impact of falling on an outstretched hand can cause several different types of injury that we will discuss.
Fractures
The impact of falling on an outstretched hand can be several times an individual’s body weight, leading to broken bones. In fact, 20% of all upper extremity injuries caused by bicycle falls are fractures.
Wrist Fracture
One of the most common fractures is of the distal radius, the large bone of the forearm that articulates with the smaller carpal bones in the wrist. The break will often lead to pain in the forearm, approximately one inch away from the wrist.
More severe breaks could show some deformity if the bones are displaced, which will likely cause the rider to seek immediate medical attention; however, it is important to know that the blood vessels and nerves that supply the hand are funneled into a fairly compressed area in the wrist, and a fracture or the subsequent swelling that occurs could disrupt this neurovascular integrity.
These symptoms include numbness or tingling, discoloration, and temperature change in the hand. Most bike injuries happen over the weekend, when your doctor’s office is closed. If this is the case and you have any of the above symptoms, then you should go to the emergency room. Even without these symptoms, it is important to get evaluated by a hand surgeon soon after the injury occurs in order to initiate treatment.
Wrist fractures, if non-displaced, may be treated with immobilization in a cast; however, any misalignment may cause a loss of function in the wrist and is difficult to correct without surgical fixation. Screws and plates may be placed internally, or a device called an external fixator may be placed to hold the fracture in place.
Scaphoid Fracture
The scaphoid is a small bone located in the wrist, at the base of the thumb. When a bike rider falls on an outstretched hand, the scaphoid is compressed and could fracture. The primary symptoms are acute pain and tenderness on the thumb side of the wrist lasting longer than a few days, swelling, and limited thumb function. Diagnosis is usually confirmed with X-ray; however, this type of fracture often will not be visible on X-ray until a week after the injury. In this case, I will splint the patient’s hand and have them return in one week for a repeat exam.
If the fracture is located further toward the thumb, then the treatment may be immobilization in a short arm cast for several weeks. If the bone is fractured more toward the forearm, surgical treatment may be necessary as the scaphoid has poor blood supply in this area.
Surgical treatment consists of placing a small screw or wire through the bone fragments to create proper alignment. In some cases where the scaphoid has broken into several pieces, a bone graft taken from another part of the patient’s body may be used to stimulate healing. In all cases, there will be a period of immobilization and limited activity, followed by physical or occupational therapy by one of our therapists that specialize in hand rehabilitation.
Wrist and Finger Sprains
A sprain occurs when a ligament holding one bone to another bone at a joint is torn, either partially or completely. With a fall from a bike, the ligaments most likely to be torn are on the palm side of the wrist and where the fingers meet the hand. Again, this is due to the extreme backward bending (extension) of the wrist and fingers as one tries to break their fall with the arms. Pain and swelling in the affected joint are likely, but should start to subside after a few days. If pain is severe or persistent, you should see a doctor in order to rule out a fracture.
Treatment for wrist sprains could be as simple as careful observation over several weeks or splinting and activity modification to allow the ligament to heal. In severe cases, surgical reconstruction using tendon grafts may be necessary to restore optimal function.
Not all bike falls will be avoided, but there are a few things that we can do as riders to prevent injuring ourselves:
- Being aware of your surroundings is paramount, which includes being able to hear approaching vehicles from the rear. Avoid listening to music when sharing the road with motorists.
- When cycling with others, break up your party into groups of no more than 3 riders in line. This will help avoid a driver from squeezing you off the road in the presence of oncoming traffic.
- Mountain bikers may want to reconnoiter a new obstacle or downhill challenge prior to attempting it at full speed.
- Wear padded gloves to avoid skin abrasions on the hands if you fall. They also protect against nerve compression in the wrists.
The FAQ’s on Thumb Arthritis
Try this experiment. On your dominant arm, take a piece of masking tape and strap your thumb to the side of your hand. Then leave it in place for a few hours as you try to go about your normal activities. You will soon find out just how integral this appendage is to getting through the day. Answering your cell phone, grabbing the coffee creamer from the refrigerator, turning the key to unlock the front door, are all activities that depend on proper functioning of your thumb.
Recreational activities such as golf or tennis – forget it. Now, if you have arthritis in the thumb joints, then this experiment does not end after only a few hours. It keeps going until treated medically by a qualified hand surgeon.
Degenerative arthritis of the thumb is one of the most common types of hand arthritis. It usually strikes at the base of the thumb where it meets the wrist. This joint, known as the carpometacarpal (CMC) joint, is a highly mobile joint that allows motion in all directions. It is also the joint that allows for a strong pinching motion.
However, because of its wide range of mobility, the bones that comprise the CMC joint must give up some stability, similar to the shoulder joint. Because of this, the ligaments around the joint are forced to bear most of the burden of stabilizing the thumb during hand use, and if they are unable to do it effectively then the aberrant motion in the joint over time can contribute to arthritis.
Diagnosis
The bones of the body at the joint surfaces are covered with cartilage, a slippery coating that allows smooth motion at the joints. Arthritis is an inflammation and eventual wearing away of the cartilage, creating rougher surfaces and painful motion. In my practice, arthritis of the thumb is a common occurrence with a straightforward diagnosis. Palpation of the joint as the patient moves the thumb will often reveal the typical grinding sensation as if the joint surfaces were lined with sandpaper. There also may be an audible grinding sound known as crepitus. I may also order an X-ray to confirm the extent of the arthritis and determine the most effective treatment options. Other tests such as the CT scan or MRI are most often unnecessary.
Treatment
In the earlier stages of the disease process, this type of arthritis is usually treated with anti-inflammatory medication. This is often successful for months to years, allowing the individual to fully use the hand at home and work. Thumb splinting may also be advantageous as it allows the thumb to rest in a neutral position where mechanical stress is at its least, which in turn may settle the inflammation.
However, arthritis is a generally a progressive condition and because the thumb is used so frequently and strenuously, the disease often progresses despite these measures. As more conservative treatments fail to provide adequate relief, I will attempt to reduce the joint inflammation with one or more cortisone injections to the affected joint.
In the later stages of arthritis, as more and more hand function is lost, surgical reconstruction is often the best course of action. Part of the diseased joint is removed and reconstructed using a tendon graft from another part of your body. Following surgery, you will have to wear a splint for several weeks to allow the surgical repair to strengthen. If your occupation depends upon heavy use of your hands, then you may need to be out of work during this time if you are not able to find restricted duty work.
It is important to factor this into your overall planning prior to surgery. After removal of the splint, occupational or physical therapy with a therapist who specializes in rehabilitation of the hand will be prescribed. This will help you regain strength and motion and allow you to fully utilize the thumb and hand.
If you believe you are suffering from degenerative arthritis of the thumb and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.
Kiteboarding – Common Injuries in a High-Risk Sport
Adventure and high-risk sports is thrilling and exciting. It’s a sport that attracts adventure enthusiasts like Richard Branson and the Secretary of State, John Kerry.
Doctors, presidents, CEO’s actors, and people who love the thrill of an adventure sport, kiteboarding offers “big air” as they fly above the water while maneuvering a giant wave.
It should be no surprise that there is an element of danger and injury in this sport; and although injury studies have not reached a scientific level, there are common injuries that have occurred. … read more
Enjoy the Fruits of Your Labor with these Summer Gardening Tips
Have you ever noticed how a tomato plucked from a garden tastes so much better than store bought? It’s near impossible to purchase that amount of flavor. Anybody that has ever planted a vegetable garden is sure to agree. Enjoying a salad or sandwich made with fresh vegetables from your own backyard is one of summer’s many benefits.
Flower gardening is also enjoyable for many people, and often those who like to be outside in the warm weather will spend considerable time planting, weeding, and harvesting the fruits of their labor. For those with chronic hand pain due to arthritis, this once pleasurable activity could now become a chore due to the aggressive hand movements that are involved, and the anticipated discomfort that it may cause. Luckily, there are some ergonomically designed tools on the market that will help those with hand pain continue with their hobby, and also some self-treatment strategies to minimize pain. So take heart, you can still get out there and enjoy one of your favorite activities with a little planning and strategy.
Pace yourself
You may be used to planting an entire garden or pruning an entire yard full of bushes in a day, but working with arthritis means that you should often work slower to minimize the cumulative stress on your hands. Whether you have osteoarthritis or rheumatoid arthritis, this is a good idea. Plan your activity so that you spread the work out over a few days. This will help keep the arthritis from flaring and causing increased pain.
Use arthritis friendly gardening tools
Gripping is one of the major movements in gardening work. Repetitive clamping of pruning tools can put excessive pressure on the joints of the fingers and thumb. Some tool manufacturers such as Fiskars® have designed garden tools specifically for those with limited hand and arm strength. Many of these tools have been commended by the Arthritis Foundation due to their ease of use. These tools include spring opened scissors and pruners which maximize leverage with the use of gears and longer handles.
Keep tools sharpened
Having a dull blade on your tools means that you will have to exert more pressure in order to cut branches and stems. Have your pruning tools sharpened annually to maximize their effectiveness. Many local hardware stores offer a sharpening service, and pricing is usually very reasonable compared with the cost of new tools.
Wrap tool handles in foam
Wrapping the handle of a trowel or hand rake in foam tubing increases the handle’s diameter and reduces the muscle pressure needed to keep the tool steady within your hand. Some tools made specifically for the arthritis sufferer already have a wider handle, but otherwise this is a great technique to alleviate hand stress. You can use water pipe insulation found at the same hardware store where you get your tools sharpened.
Wear gloves
Gardening gloves do more than just keep dirt from getting under your fingernails. They also absorb perspiration. This is important because as your hands get sweaty, they also get slippery. That means you must grip your tools harder to keep them from sliding in your hand. Wearing gloves mitigates this and results in less force needed to handle your tools.
Use a lightweight coiled hose
Managing a standard garden hose can be aggravating for anyone. The kinks that develop and cut off the water supply often lead the gardener to vigorously shaking the hose to untangle it. Of course, this adds to the cumulative strain on the arthritic hand and wrist. Today’s pre-coiled garden hoses are made of a lighter weight material than standard hoses, and they resist tangling. When you are finished, the hose automatically recoils, making clean up easier.
Stay ahead of the pain
Taking ibuprofen or naproxen based medications 30 minutes prior to gardening can reduce the inflammation associated with heavy use of the hands. If you know that working in the yard will produce some soreness, then you may wish to employ this strategy prior to starting.
So get out there and enjoy the nice weather. You don’t have to give up your gardening hobby because of arthritis. Try these tips, but if pain persists you should feel free to contact my office so we can discuss effective treatment options if further detail.