March 12, 2025 • 40 mins
Discuss the anatomy relevant to hand injuries, Describe the management of common hand injuries, Discuss the return to play process after common hand injuries
Timestamps
(3:42) Anatomy of the phalanges
(9:00) Flexor pulley system
(12:45) Jersey Finger
(19:26) Mallet Finger
(24:21) Flexor pulley Injuries
(28:30) Return to play from hand injuries
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-Sandy & Randy
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
ups and downs, and we're here toshowcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we havea handy dandy See you episode.
(00:23):
From Randy and Sandy, I had to do, I had to do that.
Man, that works. Man, that was a great way to
start this bad boy. So what are we talking about
today? We're going to talk about hand
injuries and there's no sleight of hand here.
I wish I had something to come back from that, but I I don't.
(00:45):
Man, I didn't realize there wereso many hand jokes that you can
do until just now apparently. And we're just getting started.
So this is ACU episode if you'reinterested in that.
Thank you so much to Clinically Pressed and athletic training
chat. If you are listening to this as
it comes out, it is a free category ACU if you if it is a
(01:06):
little bit older, it is purchasable.
And for National Athletic Training Month, all of our Cus
through Clinically Pressed are 25% off using code and ATM 25
Sweet. If you're interested, the link
is down below in the show notes or the description wherever
you're listening to this. So for this episode, we will be
(01:30):
talking about the anatomy relevant to hand injuries.
So of course got to talk about the anatomy of the hand.
We're going to describe some of the management of some common
hand injuries and then we're going to just kind of discuss
some kind of return to play considerations for these kind of
hand injuries. I feel like hand injuries are
those ones that are so importantto the person who's dealing with
(01:53):
it, but I feel like to an out inan outside perspective, like a
coach or a teammate, they're like, it's just your hand.
Oh yes, I'm never going to forget.
I've had a coach before with oneof my athletes having a a like a
finger injury hit him with it's just a finger.
No. What do you what do you use most
(02:15):
often during the day? Yes, and then let's not forget
Ronnie Lott, famous Niners safety.
I can't remember what the actualinjury was, but cut off part of
his finger so he can return to play sooner.
So I think that's where it really stems from.
That's just a finger. So this evidence based episode
brings you amputation as the primary treatment.
(02:38):
Option maybe what not to do? So what is the anatomy we're
talking? About yeah, so for for injuries
of the hand, it's really interesting.
Like a lot of the literature really focused like on the
fingers. I mean, obviously there's other
stuff that can go go on in the hand.
And then like it's also really hard 'cause it's like hand and
wrist get kind of lumped in together.
And then again, same with the fingers, right?
(02:59):
So we're really kind of focusingmore on the fingers 'cause I
feel like there's more going on there that we can kind of deal
with. Like mostly the forefingers.
Yeah, yeah, we're we took out the thumbs for this one.
So the the first Phalangi is is not in this episode that.
May be a different. Episode yes, there's.
Enough going on with that appendage.
(03:20):
For sure. And I think too, like with like
finger injuries, I feel like there's a lot more that we can
kind of play with and there's a lot more considerations and
maybe just truly the hand itself, because really there's
like the metacarpals and it's like, what are you going to do?
All right. Like if it's a fracture, like we
kind of have an idea there. So I think the fingers was kind
of a nice one to kind of talk about.
(03:41):
And with the fingers, there's a lot of tendons and ligaments
that are actually around the fingers that made it very
interesting. And I feel like in school, we I
don't feel like we really talkedabout it that much about how
complex the anatomy of the fingers actually are, at least
from what I remember. I was just like, yeah, you.
They're like my favorite was like, they're like mini knees.
(04:02):
And I'm like, oh, but there's a lot more going on than just mini
knees. That's happening.
OK, but you have therapists who are literally for the just for
the hand. Yeah, and and that's why you
have surgeons that specialize inthe hand, right, Right.
So, yeah, no, it's true. Like there's a reason why
there's a special specialty because there is so much to
(04:23):
consider and go on that. I think it's important as
athletic trainers to know that like it's OK if you don't feel
like you're the expert on the hand and fingers, but it's good
to have an idea of I may not be the expert and I might need a
little assistance with this and know who to go to and how to
help facilitate. Exactly.
And that's what that's what we're here for.
For sure. So of course, we're going to
(04:44):
talk about the phalanges, right?And of course, we kind of know
the basic right that you have the proximal middle and distal
failings, right? And then those bones kind of
articulate to make up your proximal interphalangeal joint
and then your distal interphalangeal joint.
How do you remember those? For our students, the way I
remember it is the DIP I. Just I just know DIP&PIP.
(05:07):
I could never, I would always mix them up so the DIP how I
remember it is like if you dip your finger in water like.
That's genius. That's the first part that
that's the first joint. That's genius.
You just dip your finger. So what do you dip?
The DIP, it's the other one. It's the one that's not been
dipped. I've heard something really good
but I can't remember it. I just remember.
(05:27):
That's that's pretty good. I just remember proximal is
proximal. Yeah.
Well, you have to like think about that one.
No, I like that, that dip one, that's pretty dope.
And then of course, these these joints are protected by a
collateral ligament. So this is where the idea comes
in like, oh, they're like mini knees, which in a way they kind
of are. But what was also interesting is
(05:48):
there's kind of two sections of this collateral ligament of
these collateral ligaments. And again, I feel like this
isn't like, I don't, I don't remember talking about this in
school. So you have the kind of like
what's referred to as the propercollateral ligament, which this
is where anatomy always gets crazy because that's abbreviated
PCL. Oh yeah.
(06:08):
PCL of the finger. Yes.
And this actually stabilizes more in kind of flexion,
especially like kind of like like the deeper flexion you go
and you'd really isolate. This is on both medial and
lateral. Yes, OK.
And then you have the accessory collateral ligament or your ACL
in the finger. That is so funny how that works.
(06:29):
Yes. And this stabilizes in
extension, right. So you can kind of already start
to kind of think about your evaluation of the collateral
ligaments as far as, again, it'slike a mini LCLMCL kind of thing
where you test valgus varus in extension and 30° of flexion to
kind of isolate each each structure.
(06:52):
These joints are also protected by what's referred to as the
volar plate, right? So that's more on the Palmer
side. And literally it's like a kind
of a sheet of tendon that kind of spans that joint on the
Palmer side. And this kind of helps protect
against that hyperextension. Which you can also get irritated
or in the way when a dislocationoccurs.
Absolutely, and that's what it'strying to help prevent is those
(07:16):
dislocations. Sometimes that doesn't happen.
Yeah, sometimes it just gets in the way.
In the proximal interphalangeal joint, there is what's referred
to as the central slip. This kind of supports that
dorsal aspect of the joint and really prevents kind of volar
subluxation and dislocation as well.
All right. So that's kind of giving you
(07:36):
that kind of dorsal protection for the joint.
And then in the distal interphalangeal joint, right,
you have what's referred, which I thought was interesting
because again, like I feel like when you look at anatomy text or
like kind of how we like talk about like the extensor tendons,
like it makes it sound like, oh,the extensor tendon just runs
(07:57):
all the way to that distal distal phalanx and just starts
pulling on it. But this is actually a whole
more complex where the extensor digitorum tendon actually as it
runs down into the actual finger, it actually like breaks
off into like 3 different branches.
All right. Part of it comes into the
central slip and then other sections of it actually go into
(08:19):
what's referred to at these lateral bands.
And all it is, is like like 2 bands, not like 2 bands going
kind of lateral and like attaching to the distal failings
like they almost attach like in AV kind of pattern.
That's why that's where, like Boutonniere.
Yeah, and that's how you get those kind of formations from
(08:40):
like how you get like the weird swan neck boutonniere, pseudo
boutonniere is like cause of reasons like that, cause of it's
not just one continuous tendon. It actually separates and kind
of goes through different bands to actually get there.
It was pretty. It was really interesting.
That is pretty cool. Another thing that I learned
from this reading, again, I learned a lot from this bad boy,
(09:01):
is there's actually like a system called the flexor pulley
system and basically what these are just like kind of little
mini retinaculums that hold the flexor tendons basically against
the phalange. This is what climbers talk about
all the time. Rock climbers.
What I mean, yes, because this is important for this and we'll
(09:24):
talk about it during the injuries, but I was like, I've
never, I feel like I've never heard of this.
You have not looked at climbing injuries.
I have not, apparently. Well, because I don't have a lot
of climbers. You are a climber.
I am, I am not. Doing not someone who's been
injured, not someone who's injured their flexor pulleys.
(09:45):
Yes, knock on wood, but I'm alsonot doing the climbs that are
really going to fire this bad boy, which we'll talk about,
we'll talk about injuries. But essentially they're just
kind of right neck and that kindof run from basically the MCP.
And they kind of they're in different sections all the way
to the DIP and you can kind of break them down into zones and
(10:06):
that it's basically from A1 to A5 S A1 is basically on the
Palmer side of the MCP joint. A 2 is on the Palmer side of the
proximal phalanx. A three is on the Palmer side of
the PIPA, 4 Palmer side of metalphalanx and then a 5 is that
(10:27):
Palmer side of the DIP. All right, so those are areas
where the flexor pulleys are themost common sites.
Just kind of see injuries to theflexor pulleys tend to be A2 and
A4. So like right along those
proximal or right along those phalanx, the Palmer side of the
phalanx. Exactly.
Yep. Which kind of makes sense
(10:50):
because like at the joints it seems like it has a little bit
more support. Yeah.
And there's a lot more kind of going on.
Obviously, there's more motion there, whereas over the face
there's not necessarily motion. You're literally just rocking
with tension, right? Yeah.
So now that we kind of have thatkind of baseline anatomy right
now, we're kind of going to the actual pathologies of the hands.
(11:13):
And anytime you're talking abouthand finger stuff, there could
definitely be just countless injuries, right?
Again, there's a lot of deform like like dysfunction
misformations like swan necks and stuff like that, right?
And it's actually kind of interesting how like the hand
and wrist, you really don't think about it.
But I feel like like it does make up a lot of injuries.
(11:35):
And some reports have shown likearound 25% of all sport injuries
are hand and wrist. I mean, honestly, I don't know
about all sports, but I see it alot in football.
I've been seeing it a lot because of now I do have a lot
more hand required sports but I've over the past few years
I've seen it a lot with between volleyball and basketball.
(11:58):
I would. I could see basketball.
I haven't seen any. I don't think I've seen any in
volleyball. Maybe like 1?
All all my blockers, man. Interesting.
I could. I mean, I could see it.
I just haven't really experienced that.
But you know my stunt performers, I've had a lot of
finger. Injuries.
Oh, interesting. I mean, I guess I see it right
(12:20):
hand going to the ground and just going on people.
I could see that. Or like any other like fights?
Yeah, true. Or if they're like passing some
sort of prop back and forth to one another.
Yeah, for sure. So, so kind of for this episode,
we're really kind of focusing ona little bit more of the common
ones that I feel like you're going to like feel like or
(12:41):
probably more common to see. First one was kind of Jersey
finger. This is the rupture of the
flexor digitorum profundus, and this is really caused by any
forced extension of a finger that's flexed, right?
So the reason it's called jerseyfinger is like, oh, you going up
against another athlete on theirjersey, right?
They pull away and it forces youinto that extension while you're
(13:03):
like gripping. That's basically the mechanism.
And what's actually interesting is it it is divided into kind of
four types. So a type 1 jersey finger is
basically the tendon retracts tothe palm.
Oh gosh. Normally you don't think type 1
is, so is is usually like oh, that's minor.
Right. You think like grade one, but
(13:25):
like no. No, Type 1 is just 100 real
quick. Yeah.
And the problem with this one isthe blood supply to that tendon
is obviously compromised becauseof how much damage has been
done. All right, so the, the tendon
and the blood supply is very just kind of like delicate in
(13:46):
this area. So when you have something that
significant, right, that blood supply has been disrupted and it
it could lead to it just is going to have a poor, more poor
prognosis. All right, type 2, the tendon is
going to retract just to the level of the PIP.
What's nice about this is blood supply still pretty intact.
(14:07):
So it has a pretty good healing potential.
I love how we went from the palmto the PIP.
Yes, Type 3. You kind of get an avulsion
fracture with this one. So the tendon actually is
pulling a chunk of the bone off.What's kind of interesting about
this one is it actually gets stuck at the A4 pulley, so it
can't retract any further because it got stuck.
(14:28):
That's where the phalanx one of the failings.
Yes, that would be what would be, I think that was.
The proximal. The middle, yeah, that'd be the
middle failing, so it doesn't have a chance to go much
further. And then type 4, basically you
get an avulsion fracture and then the tendon actually pulls
(14:49):
away from that fracture. So it's a combination of like a
Type 1 and type 3. Wow.
Yeah, that's a lot of damage that happened on.
That one. Seriously.
So type 1 and type 4 like no go like those are.
Yeah, those are bad news. They're all bad news.
Yes, they're all bad those. Are definitely bad news.
So when you're evaluating this, this patient, right, you're
(15:10):
going to probably you're going to see some swelling, there's
going to be some pain, there might be some ecchymosis as
well. But obviously the biggest thing
that really identifies this is just that DIP flexion just
dysfunction, all right? So you're not really going to
see the DIP want to go into flexion because obviously
there's no connection there that's pulling it anymore.
But one thing that is interesting to kind of consider
(15:33):
is when you ask the patient so to do this, like ideally, right,
you should stabilize the middle and proximal phalanx and then
ask for DIP flexion. In some cases, like in a type 3,
you actually might see slight flexion, right?
So what they've kind of advocated for is add slight
(15:54):
resistance to see how that kind of strength is, because if you
add slight resistance with a type 3, you should just overcome
that really easily. Wait, what do you mean?
Like you might see some flexion,so they might be able to flex a
little bit they. Might be able to flex it a
little. Bit if they have an evulsion
fracture, they. Might be able to, yeah.
Because of how far it because ofwhere it got stuck, it still
(16:16):
might be able. To create it because it gets
stuck, you know? Yeah, it.
Still might create the motion. So that's why they advocate for
slight resistance, because if you had resistance, they they
shouldn't be able to resist you because there's no pull on that
DIP, but it's the pull and the pulley that is what was creating
that. OK.
Yeah. So if you actually had the
resistance, you'll be like way overpowering them.
(16:38):
And then you'll know, oh, it's probably a Type 3 Jersey finger.
Yeah, I guess your fingers are pretty strong.
Yeah, yeah. So if you do see that and you
like you see, oh, it's slightly flex, but you're like, this is
weird, add a little resistance to it and if it if they're able
to resist it, you can probably feel good.
It's not a Jersey finger, but ifyou're like Pew, probably
(17:01):
Jerseyfinger. So the management of
Jerseyfinger, it pretty much tends to be surgically managed.
And a lot of stuff has advocatedlike surgery as soon as possible
kind of thing. But in general, some kind of
guidelines that that I was noticing is like in a Type 1,
like this is kind of like surgery's got to be pretty
quick. So type 1 is the yeah.
(17:25):
Oh, the one that goes all the way to the.
Palm yeah, Like that has to be surgery pretty quick.
But what's interesting is what Iwas reading is just like, oh,
within seven to 10 days, which Iguess for like surgery, like for
most cases tends to be I guess pretty quick.
But like, for our athletes, it'sprobably going to be a lot
sooner depending on your setting.
(17:45):
And then the ones that I've had,they've sent for, I've sent and
they've made them specific like splints or braces for.
And usually they're in the slight flexion.
Yes, because they want that tendon to be able to heal.
Yeah, for sure, for sure. And Type 2, right surgery can
(18:08):
kind of get put off at least within one to two weeks.
Type 3 is kind of the same surgery within one to two weeks.
But some things did say you could maybe get away with three
to six weeks. For an avulsion fracture, I
mean, I guess that makes sense alittle bit.
I mean, fractures in the hand kind of heal within three weeks.
Yeah, So that's really interesting.
(18:28):
And I guess it is an avulsion fracture, but still like.
Yeah, for sure. Just some thoughts.
I just love how it's like, oh, well, it's stuck.
It's gonna, it didn't go very far.
It might. We can we can wait a little bit.
And again, that's more kind of like that get away with three to
six weeks. Like some of it might be, hey,
like maybe season, like at a certain point season, the
(18:48):
physician might be OK with it. But a lot of times that three to
six weeks is more like the athlete didn't say anything and
didn't think it was like a big deal.
Like they may not have thought like, oh, whatever, like, oh, I
jammed my finger or something like that.
And then they come see you at like Week 2.
All right. So it's not like the end of the
world. It's almost kind of yeah.
You gotta love that. Oh, the story of athletes and
(19:09):
their fingers. And and then type 4 is again
surgery within 710 days. This is an ASAP situation.
Well, yeah, yeah, the tendons tearing away from the fracture
too. Yeah, that's not that's no boy.
No, no thanks. So next we have is mallet finger
and finally this year I broke the streak because my first like
(19:33):
I've had two basketball seasons where I've had one athlete with
a mallet figure I had 1-2 years ago, one last year.
This is the first year that I didn't have a mallet.
Figure what did they do? How did they get a?
Mallet the ball just would hit their finger and force them into
Yeah, like literally jam their finger from the ball but force
(19:53):
them into. Wow.
Yeah, I'm lucky. And and this is basically just a
rupture of basically where that kind of V from the extensor
tendon joins the distal phalanx,right?
You get that rupture now you don't, you can't extend that
distal phalanx, all right? So you get just forced flexion
against a contraction and boom. So like basically mallet finger
(20:16):
and jersey finger are the opposite?
Yes, yeah, exactly. All right, So your evaluation
it, it's pretty self-explanatory.
You kind of just see a dropped distal phalanx, right?
Like it's kind of weird to thinkabout it, but like we have good
tension in in our fingers. So you don't really see it.
But if it's like ruptured, like you'll see like it just drops,
(20:36):
like nothing's just holding it there and the flexor tendons are
still pulling on it. Well, also like if you ask them
to open their hand like you can see it pretty obviously.
And I was going to say, that's the next thing, right?
Inability to extend that distal failing.
So yeah, good idea, right? To just extend.
Sometimes I'll hold the middle phalanx and just ask them to
extend their fingers to see so Ican actually truly just look at
(20:57):
it to see if it moves. If it actually extends, you
might see some dorsal swelling as well.
And sometimes you can actually palpate where that tendon
retracted to. You know, Dang, I've never
thought about palpating to like,feel the tendon.
Sometimes you can, sometimes youcan feel the bulge.
Yeah, I've never thought about that.
Now next time I get. That's the same with the Jersey
(21:20):
finger too. Sometimes you can actually
palpate like where the swelling's at.
Sometimes you palpate there and you'll feel the like the bulge
of the tendon as well. I've never.
Thought to do that. Interesting.
Management for this tends to be pretty conservative.
You can get away with throwing them in a splint and
hyperextension. OK.
(21:40):
Yes you can, but if they're going to be compliant.
That's that is the big thing is the compliance aspect, right?
They have to be in this splint for a minimum six weeks.
And it's and like you can't takeit off, like if you take it off,
you have to keep it an extension.
And I think that's that's something that my Co head wanted
(22:01):
is a really good job of explaining with our athletes
like, like hold your finger and then, you know, if you like take
the. The.
Splint off, wash your hand, whatever.
Wash your splint and you're holding your finger the entire
time and then you put it back onbecause as soon as it bends,
you're basically. Just you could just.
(22:23):
Damaging that. All that work.
Going right, right. And so splinting in
hyperextension for those six to eight weeks, the surgical
consideration IS1 non compliancepossibly or, or they might just
be like, well, you just you willnot be able to extend that DIP
(22:43):
as much anymore, right, right. And what was interesting too is
if there is laxity too at the PIP joint, like maybe someone
who has just generalized laxity.That's how you get a swan neck
deformity. I can't, I can't do a swan neck
very well. Yes, you, yes, you do a good
swan neck, right. So if you have laxin that PIP
(23:07):
and you just have a chronic mallet finger, a swan neck
deformity can form because it's almost like a compensation for
not being able to do DIP extension.
So yeah, that's a fun fact. But surgery might be considered
also if there is an avulsion fracture that is taking up a 40%
(23:29):
or more of the articular surfaceof the distal failings.
So they might, yeah. So that there they might be
saying, hey, we need to do surgery to kind of pin stuff
back. There might be some success with
conservative treatment on an avulsion of 30 to 40%, right.
(23:49):
I think that's kind of probably surgeon preference and kind of
what they've seen. But yeah, I've kind of, that's
what I've kind of heard like if it's just the tendon, you're
pretty good with conservative. Once you start talking about
avulsion fracture, surgery tendsto be in the conversation.
I mean, that makes sense, especially when you're talking
about fingers. Yeah.
(24:10):
Especially when you talk. About things that like you're
you, you're gripping or you're moving your hands like dominant
versus non dominant. Yeah, for sure.
And then the next one is those kind of pulley tears.
And this is this is where we aregoing to talk about the climbing
stuff, right? And like this was interesting
(24:30):
for me because again, like I didn't really, I haven't really
heard of these kind of injuries.So I think this was really kind
of dope to kind of read about. I'm so surprised still, like I'm
so surprised. This is like all over my feet.
Oh, interesting. Apparently I'm not on climbing,
but these interests are going tocome from that, like kind of
that crimp grip activity. And you love the crimpy.
(24:53):
Climbs. Those are my climbs.
These are like. That they blow up my pulleys.
That's probably why it's so uncomfortable for.
Me they're like the like, you know, it's like if you think of
sign language like the letter E like like bending in the DIP and
the PIP, but extension of the I was going.
To say but not the. MCP, yeah, that's kind of like
(25:16):
your. Crimp.
I do not like those climbs. We call them the fingery climbs,
yeah. I don't like the fingery climbs,
but yeah, so those kind of crimpactivities are or grip
activities are going to be the the kind of mechanisms because
they do put a lot of strain on the flexor pulley system.
(25:39):
And again, this tends to be, andthe literature even acknowledged
this tends to be in climbers. But for your traditional
athletes, you'll see this in pitchers, right?
Because there are some pitches that do require some kind of
like like kind of crimp like grip.
I could see that, yeah. I could see that.
So you could get this and you'restill in your traditional
sports, not just like oak climbers.
(26:01):
The problem is you're not going to get a pitcher in a finger
splint. This could be very detrimental
for a pitcher. Right, Right.
Yeah. Especially if you don't have
like activation of your fingers for sure.
You know, I noticed something like when we go climbing, if I'm
not properly warmed up and if I try like a climb that's too hard
(26:23):
before, like I warm up properly.Like I can't fully extend my
fingers like like that. Like the when I'm climbing I
just can't do a full like extension of my fingers.
Yeah. Interesting.
Oh yeah, You. Yeah.
And you're like, you've seen it.Yeah, I've seen it like it's
(26:43):
legit. You're like almost in like
contracture. Exactly.
Like my flexors have taken on too quickly.
So I think like, I'm thinking like in a pitcher, yeah, like,
obviously that's not from injury, that's from improper
warm up. But like, I'm thinking like in a
pitcher, like pitchers have to be able to really control their
grip. Yeah, yeah, for sure.
You. Do so it really it really would
(27:04):
change things. Yeah.
So your evaluation is fairly simple with these, right?
You're going to look for swelling and then you could
actually see a bow string of thetendons.
All right, so this is basically the tendon kind of popping out
because again, the job of the pull is hold this tendon in so
you can actually get a mechanical advantage and
actually like be able to grip and like all that stuff.
(27:24):
All right, So if that's gone nowyou get like that bow string and
that tendons going to like just pop out.
So that's kind of a good sign of, hey, you probably have a
pulley tear manage. What?
No thanks. Management for this is mostly
non surgical and it definitely can be splinted in with like a
pulley ring. Splint basically just looks like
a ring over basically wherever that pulley is and it's just
(27:46):
replacing that, right? You're basically replacing the
pulley by having something that pushes the tendon back in.
That's just crazy. Yeah, they did say you could
tape it too or you could add tape like so to add like the
little tape rings and that can help keep that kind of tendon in
as well. It's like a weight belt but for
your finger. Yeah, for sure.
(28:08):
And higher grade tears of this, So tears that kind of involve
multiple structures might need surgery, but conservative tends
to be pretty successful and kindof lower grade tears for.
These they say like how long? Yes, we do have a little bit of
timelines, right. So, and some of that is the
return to play consideration as well.
(28:28):
OK. You just want to do that for
everything, Yeah. So a lot of these pathologies do
have a quick return to play evenearly in the recovery process,
right? So it kind of depends on the
sport and just how splinting canbe applied, right?
Like like for me, like basketball, right, A lot of
basketball guys don't really like or basketball athletes, I
(28:50):
should say, don't like a lot of things on their hands, right?
It's kind of weird to shoot if your shooting hand is all taped
up, splinted, you know? I think it's also worthy to take
a look at what splints you have available to you because for
example, like everyone knows the, the blue foam with the
metal like that's not really commonly like used in sport, you
(29:15):
know, like, but like you could transfer to like an or like I
make orthoplast splints for fingers all the time in
football. Or you could use like those,
like little thumb caps, I have no idea what they're called, but
like those little finger caps, like those.
Are that that one's often used with like mallet finger too,
Yeah. Those or you ones that we
(29:39):
really, really like are called protective splints and they're
basically just like it's a big roll and you just cut however
much you need and it's like a little U shape and you can put
it underneath the finger. You can put it on top of the
finger, you can put it on the side.
I really, really like those. And I just like round the edges
so they're not sharp. And then like put a little tape
(29:59):
on them and then just tape them on.
And they're like, yeah, pretty quick.
Sometimes I cut them ahead of time and then like in a game,
like I could just put it on someone real quick and then they
can go in it. And those are pretty like small.
Yeah. So depending on what sport it
is, it's and depending on what position or depending on what
finger and what joint. Like sometimes they can just go
(30:21):
back in pretty quickly or like aquick buddy tape with extra
support. So yeah, it it definitely all
those factors really determine when someone can return to play,
how they're going to return to play.
So like Jersey finger, right, you're looking at a full return
in about 10 to 12 weeks. Sooner is possible if it's a
(30:43):
sport where hands aren't quite as important, right?
So like, if you're a track athlete, right, you're probably
going to get back pretty quickly, right?
Maybe. Maybe the baton, yeah.
I don't know, you might be not be on the relay, right or like a
soccer athlete, right, That might be doable because there's
not a lot of hand necessary, right?
(31:05):
Unless you're the goalie. Unless you're the goalkeeper for
sure, and obviously there's the risk of falling too, right?
So, so there are ways to do it, especially if you're able to
protect that splint as well. So again, like again, you see
this a lot with football. It tends to be like you can
really pad something right. And if they're in a position
where they don't really need to use their hand right, they're
probably going to be able to come back a lot sooner compared
(31:27):
to like someone who's like receiver who's going to need his
hand. You know, I, so one season I had
a quarterback with a pinky. He had a pinky dislocation and a
fracture. It was an avulsion fracture.
And then in the in the same season I also did O line with a
(31:49):
pinky fracture. And I just took a picture of
like the two of their splints together that I made the
orthoplas splints because they were completely different.
And it was just really cool to see like they both had the same
injury, like both had a pinky fracture, but the management of
(32:10):
them and like position specific was just so different.
So I'll find that and I'll post that on our Instagram.
So if you're interested in that,make sure you check that out
for. Sure.
And really the position that they're going to be kind of
splinted in, especially when they're starting to return to
play is almost like a loose fist, right?
So they're not going complete fist, right?
It's going to be almost like 1/2fist kind of thing, right?
(32:31):
They're going to be kind of splinted in that position for
which one Jersey finger. Oh good.
Yeah, like their whole hand. Yes, it would be whole hand.
I believe that that was my interpretation of when I how I
was reading it. I haven't seen a whole hand when
I sent a jersey finger, but I don't know, maybe that.
(32:52):
Did you see it? How did they splint it when you
saw it? Just the single, yeah.
Oh yeah, when I was reading it said loose fist.
So I just took it as like, oh, whole hand because I guess maybe
it was, it would be hard to I, Idon't know.
Maybe it depends on if it's the one that goes all the way to
the. Yeah, maybe.
Possibly. Yeah, yeah, could be next.
(33:14):
Again, mount finger, right? If it's being treated
conservatively, they could be a really return to a quick return
to play, especially if the splinting's tolerated.
And again, it depends on the sport as well.
Like for one of my basketball guys, when we had them, we had
him return to play, right. Like, again, it's kind of weird
to have the splint on the Palmerside because you know, if you're
dribbling a ball. Can't feel it, Yeah.
(33:36):
Yeah, and it's going to be kind of in the way compared to
everything else. And so I did a dorsal splint
that held them up into a hyperextension so that that
helped kind of make it a little more tolerable to play.
But really, again, you're splinting for six to eight weeks
and if compliance was great, everything went well, you can
actually wean them off the splint around week 6 and use
(34:00):
those final two weeks of a nightsplint only.
So they put it on at night and then they can take it off,
right? Again, if it's surgical, that's
going to be a little more complex and now you're probably
looking at more closer to that three month kind of timeline.
Again, I've seen that too, where, you know, sent the kid to
the doctor for the mount finger and they they wanted to do
(34:21):
surgery with them. So I've seen that too, to where
he, his season of fortune was done because of a mount finger.
So again, it really depends what's going on in there if it
could be treated conservatively or not.
Dang, yeah. And then for your pulley, pulley
tears, this one had a very just wide range of things to do like
like or like what you're kind oflike timeline looked it could be
(34:43):
from six weeks to three months. Yeah, try telling that to
someone who needs their fingers.And the best part is as with
most things, delaying treatment could just lead to a lot worse
outcomes, right? So again, it you can kind of
tape and split in this timeline to maintain kind of that
(35:04):
activity. And if everything go is going
well and there's not a lot of other structures damage, you
probably don't need surgery withthis.
So again, it, it really kind of depends, but that's kind of your
game plan and you're looking at least six weeks for stuff that's
pretty minor. Anything that's a little bit
more major, you could just startpushing that three months
(35:25):
aspect. And again, a sport is going to
be kind of dependent, right? Again, like a pitcher, right?
This could be pretty detrimental.
Or someone who puts their entirebody weight on their finger.
Exactly. Right.
And then, and apparently I was reading that a lot of climbers
just basically tape these, thosefingers, those areas of their
fingers just preventatively. Yeah.
(35:47):
And they feel like it gives themmore grip.
Now I want to try it. Maybe I can just start doing the
group. Maybe I can start doing the
fingery ones if I tape. There you go.
I should try it see if it does make a difference because it
does hurt my hand. I don't like it because it hurts
my hand. But you can do.
It and it's maybe my pulleys, soI'm going to try it.
Don't hurt your pulleys. It could take six weeks to three
months to heal. Yeah.
But if I tape them as classic AThow can we tape it?
(36:14):
Yeah. So that's the hand.
Well, what's your action item for this?
Don't mess with the fingers, man.
You never know. You just they're not just it's
just a finger injury. Now these these could be really
detrimental and can affect quality of life, but also try to
(36:35):
work with like your physicians on what does return to play look
like and how can you safely get them to return to play.
Yeah, that's a good point. Honestly, when I've sent finger
or hand injuries, like a lot of times, like they'll get a splint
and then like I will make a splint.
So like they'll have a splint for like the day-to-day and then
(36:55):
I'll make a splint. Yeah.
And then I'll make a splint for like the sports specific portion
for sure. And then like, we didn't even
talk about rehab, but you know, incorporating like specific
rehab exercises and strengthening not just in the
(37:17):
fingers in hand, but also the wrist and the forearm flexors
and the extensors and. And a lot of this stuff because
again it is going off of the tendon and for a lot of the pro
surgical stuff too, tendon glides were huge in this.
And especially looking at for a lot of the surgical stuff, it
was starting right around week 3post op was when they were
(37:39):
starting to do the how did it go?
Tendon. Glides, there we go.
Bend straight. Bend straight, Yeah.
Like that I don't do attending. Just have to remember your
thumb. Yeah, I always forget my thumb.
But yeah, right around week 3 post op ish for a lot of these
(38:03):
in general was when they starteddoing that.
I was trying to do the glides. That's cool.
I mean, and if you're you're someone is getting surgery like
you'll, you'll be able to get anidea of what the surgeon would.
Like what their parameters are and what their protocol looks
like for sure. Suite, again, if you're
(38:24):
interested in this CEU, make sure you check out
clinicallypressed.org and find our course on there.
Randy, how many references did you use for this?
So this one, this was a little bit on the lower end, I think we
had right probably around 8:00. OK, nice.
If you're interested in those references, they are on our
website. Again for NATM we are doing 25%
(38:49):
off Cus with NATM 25. If you're listening to this as
it comes out, it is free. If you are looking for more C us
we are still working with Medbridge for $101.00 off for
your subscription for a year. You can use code 80 corner.
And then lastly if you guys are new, we do every episode as
(39:10):
either education like this. We do story episodes with
stories from real life athletic trainers or we do interview
episodes where we bring on someone and we talk about
something really cool for athletic trainers.
So make sure you check out thoseother episodes.
If you guys have anything else, make sure to reach out to us on
our Instagram at 80 Corner podcast.
And I think that's all I got. Just one more action item.
(39:33):
I apologize. It's always a good idea to have
some splints on hand. It is.
It is. Get it on hand.
On hand. Man, it really took us to the
end of this episode to get another pun all.
Right. Well, thank you for helping us
showcase athlete training behindthe tape.
Bye.
Hey, this is Sandy. And Randy?
And we're here on AT Corner. Being an Athi trainer comes with
ups and downs, and we're here toshowcase it all.
Join us as we share our world insports medicine.
Welcome back to another episode of AT Corner.
For this week's episode, we havea handy dandy See you episode.
(00:23):
From Randy and Sandy, I had to do, I had to do that.
Man, that works. Man, that was a great way to
start this bad boy. So what are we talking about
today? We're going to talk about hand
injuries and there's no sleight of hand here.
I wish I had something to come back from that, but I I don't.
(00:45):
Man, I didn't realize there wereso many hand jokes that you can
do until just now apparently. And we're just getting started.
So this is ACU episode if you'reinterested in that.
Thank you so much to Clinically Pressed and athletic training
chat. If you are listening to this as
it comes out, it is a free category ACU if you if it is a
(01:06):
little bit older, it is purchasable.
And for National Athletic Training Month, all of our Cus
through Clinically Pressed are 25% off using code and ATM 25
Sweet. If you're interested, the link
is down below in the show notes or the description wherever
you're listening to this. So for this episode, we will be
(01:30):
talking about the anatomy relevant to hand injuries.
So of course got to talk about the anatomy of the hand.
We're going to describe some of the management of some common
hand injuries and then we're going to just kind of discuss
some kind of return to play considerations for these kind of
hand injuries. I feel like hand injuries are
those ones that are so importantto the person who's dealing with
(01:53):
it, but I feel like to an out inan outside perspective, like a
coach or a teammate, they're like, it's just your hand.
Oh yes, I'm never going to forget.
I've had a coach before with oneof my athletes having a a like a
finger injury hit him with it's just a finger.
No. What do you what do you use most
(02:15):
often during the day? Yes, and then let's not forget
Ronnie Lott, famous Niners safety.
I can't remember what the actualinjury was, but cut off part of
his finger so he can return to play sooner.
So I think that's where it really stems from.
That's just a finger. So this evidence based episode
brings you amputation as the primary treatment.
(02:38):
Option maybe what not to do? So what is the anatomy we're
talking? About yeah, so for for injuries
of the hand, it's really interesting.
Like a lot of the literature really focused like on the
fingers. I mean, obviously there's other
stuff that can go go on in the hand.
And then like it's also really hard 'cause it's like hand and
wrist get kind of lumped in together.
And then again, same with the fingers, right?
(02:59):
So we're really kind of focusingmore on the fingers 'cause I
feel like there's more going on there that we can kind of deal
with. Like mostly the forefingers.
Yeah, yeah, we're we took out the thumbs for this one.
So the the first Phalangi is is not in this episode that.
May be a different. Episode yes, there's.
Enough going on with that appendage.
(03:20):
For sure. And I think too, like with like
finger injuries, I feel like there's a lot more that we can
kind of play with and there's a lot more considerations and
maybe just truly the hand itself, because really there's
like the metacarpals and it's like, what are you going to do?
All right. Like if it's a fracture, like we
kind of have an idea there. So I think the fingers was kind
of a nice one to kind of talk about.
(03:41):
And with the fingers, there's a lot of tendons and ligaments
that are actually around the fingers that made it very
interesting. And I feel like in school, we I
don't feel like we really talkedabout it that much about how
complex the anatomy of the fingers actually are, at least
from what I remember. I was just like, yeah, you.
They're like my favorite was like, they're like mini knees.
(04:02):
And I'm like, oh, but there's a lot more going on than just mini
knees. That's happening.
OK, but you have therapists who are literally for the just for
the hand. Yeah, and and that's why you
have surgeons that specialize inthe hand, right, Right.
So, yeah, no, it's true. Like there's a reason why
there's a special specialty because there is so much to
(04:23):
consider and go on that. I think it's important as
athletic trainers to know that like it's OK if you don't feel
like you're the expert on the hand and fingers, but it's good
to have an idea of I may not be the expert and I might need a
little assistance with this and know who to go to and how to
help facilitate. Exactly.
And that's what that's what we're here for.
For sure. So of course, we're going to
(04:44):
talk about the phalanges, right?And of course, we kind of know
the basic right that you have the proximal middle and distal
failings, right? And then those bones kind of
articulate to make up your proximal interphalangeal joint
and then your distal interphalangeal joint.
How do you remember those? For our students, the way I
remember it is the DIP I. Just I just know DIP&PIP.
(05:07):
I could never, I would always mix them up so the DIP how I
remember it is like if you dip your finger in water like.
That's genius. That's the first part that
that's the first joint. That's genius.
You just dip your finger. So what do you dip?
The DIP, it's the other one. It's the one that's not been
dipped. I've heard something really good
but I can't remember it. I just remember.
(05:27):
That's that's pretty good. I just remember proximal is
proximal. Yeah.
Well, you have to like think about that one.
No, I like that, that dip one, that's pretty dope.
And then of course, these these joints are protected by a
collateral ligament. So this is where the idea comes
in like, oh, they're like mini knees, which in a way they kind
of are. But what was also interesting is
(05:48):
there's kind of two sections of this collateral ligament of
these collateral ligaments. And again, I feel like this
isn't like, I don't, I don't remember talking about this in
school. So you have the kind of like
what's referred to as the propercollateral ligament, which this
is where anatomy always gets crazy because that's abbreviated
PCL. Oh yeah.
(06:08):
PCL of the finger. Yes.
And this actually stabilizes more in kind of flexion,
especially like kind of like like the deeper flexion you go
and you'd really isolate. This is on both medial and
lateral. Yes, OK.
And then you have the accessory collateral ligament or your ACL
in the finger. That is so funny how that works.
(06:29):
Yes. And this stabilizes in
extension, right. So you can kind of already start
to kind of think about your evaluation of the collateral
ligaments as far as, again, it'slike a mini LCLMCL kind of thing
where you test valgus varus in extension and 30° of flexion to
kind of isolate each each structure.
(06:52):
These joints are also protected by what's referred to as the
volar plate, right? So that's more on the Palmer
side. And literally it's like a kind
of a sheet of tendon that kind of spans that joint on the
Palmer side. And this kind of helps protect
against that hyperextension. Which you can also get irritated
or in the way when a dislocationoccurs.
Absolutely, and that's what it'strying to help prevent is those
(07:16):
dislocations. Sometimes that doesn't happen.
Yeah, sometimes it just gets in the way.
In the proximal interphalangeal joint, there is what's referred
to as the central slip. This kind of supports that
dorsal aspect of the joint and really prevents kind of volar
subluxation and dislocation as well.
All right. So that's kind of giving you
(07:36):
that kind of dorsal protection for the joint.
And then in the distal interphalangeal joint, right,
you have what's referred, which I thought was interesting
because again, like I feel like when you look at anatomy text or
like kind of how we like talk about like the extensor tendons,
like it makes it sound like, oh,the extensor tendon just runs
(07:57):
all the way to that distal distal phalanx and just starts
pulling on it. But this is actually a whole
more complex where the extensor digitorum tendon actually as it
runs down into the actual finger, it actually like breaks
off into like 3 different branches.
All right. Part of it comes into the
central slip and then other sections of it actually go into
(08:19):
what's referred to at these lateral bands.
And all it is, is like like 2 bands, not like 2 bands going
kind of lateral and like attaching to the distal failings
like they almost attach like in AV kind of pattern.
That's why that's where, like Boutonniere.
Yeah, and that's how you get those kind of formations from
(08:40):
like how you get like the weird swan neck boutonniere, pseudo
boutonniere is like cause of reasons like that, cause of it's
not just one continuous tendon. It actually separates and kind
of goes through different bands to actually get there.
It was pretty. It was really interesting.
That is pretty cool. Another thing that I learned
from this reading, again, I learned a lot from this bad boy,
(09:01):
is there's actually like a system called the flexor pulley
system and basically what these are just like kind of little
mini retinaculums that hold the flexor tendons basically against
the phalange. This is what climbers talk about
all the time. Rock climbers.
What I mean, yes, because this is important for this and we'll
(09:24):
talk about it during the injuries, but I was like, I've
never, I feel like I've never heard of this.
You have not looked at climbing injuries.
I have not, apparently. Well, because I don't have a lot
of climbers. You are a climber.
I am, I am not. Doing not someone who's been
injured, not someone who's injured their flexor pulleys.
(09:45):
Yes, knock on wood, but I'm alsonot doing the climbs that are
really going to fire this bad boy, which we'll talk about,
we'll talk about injuries. But essentially they're just
kind of right neck and that kindof run from basically the MCP.
And they kind of they're in different sections all the way
to the DIP and you can kind of break them down into zones and
(10:06):
that it's basically from A1 to A5 S A1 is basically on the
Palmer side of the MCP joint. A 2 is on the Palmer side of the
proximal phalanx. A three is on the Palmer side of
the PIPA, 4 Palmer side of metalphalanx and then a 5 is that
(10:27):
Palmer side of the DIP. All right, so those are areas
where the flexor pulleys are themost common sites.
Just kind of see injuries to theflexor pulleys tend to be A2 and
A4. So like right along those
proximal or right along those phalanx, the Palmer side of the
phalanx. Exactly.
Yep. Which kind of makes sense
(10:50):
because like at the joints it seems like it has a little bit
more support. Yeah.
And there's a lot more kind of going on.
Obviously, there's more motion there, whereas over the face
there's not necessarily motion. You're literally just rocking
with tension, right? Yeah.
So now that we kind of have thatkind of baseline anatomy right
now, we're kind of going to the actual pathologies of the hands.
(11:13):
And anytime you're talking abouthand finger stuff, there could
definitely be just countless injuries, right?
Again, there's a lot of deform like like dysfunction
misformations like swan necks and stuff like that, right?
And it's actually kind of interesting how like the hand
and wrist, you really don't think about it.
But I feel like like it does make up a lot of injuries.
(11:35):
And some reports have shown likearound 25% of all sport injuries
are hand and wrist. I mean, honestly, I don't know
about all sports, but I see it alot in football.
I've been seeing it a lot because of now I do have a lot
more hand required sports but I've over the past few years
I've seen it a lot with between volleyball and basketball.
(11:58):
I would. I could see basketball.
I haven't seen any. I don't think I've seen any in
volleyball. Maybe like 1?
All all my blockers, man. Interesting.
I could. I mean, I could see it.
I just haven't really experienced that.
But you know my stunt performers, I've had a lot of
finger. Injuries.
Oh, interesting. I mean, I guess I see it right
(12:20):
hand going to the ground and just going on people.
I could see that. Or like any other like fights?
Yeah, true. Or if they're like passing some
sort of prop back and forth to one another.
Yeah, for sure. So, so kind of for this episode,
we're really kind of focusing ona little bit more of the common
ones that I feel like you're going to like feel like or
(12:41):
probably more common to see. First one was kind of Jersey
finger. This is the rupture of the
flexor digitorum profundus, and this is really caused by any
forced extension of a finger that's flexed, right?
So the reason it's called jerseyfinger is like, oh, you going up
against another athlete on theirjersey, right?
They pull away and it forces youinto that extension while you're
(13:03):
like gripping. That's basically the mechanism.
And what's actually interesting is it it is divided into kind of
four types. So a type 1 jersey finger is
basically the tendon retracts tothe palm.
Oh gosh. Normally you don't think type 1
is, so is is usually like oh, that's minor.
Right. You think like grade one, but
(13:25):
like no. No, Type 1 is just 100 real
quick. Yeah.
And the problem with this one isthe blood supply to that tendon
is obviously compromised becauseof how much damage has been
done. All right, so the, the tendon
and the blood supply is very just kind of like delicate in
(13:46):
this area. So when you have something that
significant, right, that blood supply has been disrupted and it
it could lead to it just is going to have a poor, more poor
prognosis. All right, type 2, the tendon is
going to retract just to the level of the PIP.
What's nice about this is blood supply still pretty intact.
(14:07):
So it has a pretty good healing potential.
I love how we went from the palmto the PIP.
Yes, Type 3. You kind of get an avulsion
fracture with this one. So the tendon actually is
pulling a chunk of the bone off.What's kind of interesting about
this one is it actually gets stuck at the A4 pulley, so it
can't retract any further because it got stuck.
(14:28):
That's where the phalanx one of the failings.
Yes, that would be what would be, I think that was.
The proximal. The middle, yeah, that'd be the
middle failing, so it doesn't have a chance to go much
further. And then type 4, basically you
get an avulsion fracture and then the tendon actually pulls
(14:49):
away from that fracture. So it's a combination of like a
Type 1 and type 3. Wow.
Yeah, that's a lot of damage that happened on.
That one. Seriously.
So type 1 and type 4 like no go like those are.
Yeah, those are bad news. They're all bad news.
Yes, they're all bad those. Are definitely bad news.
So when you're evaluating this, this patient, right, you're
(15:10):
going to probably you're going to see some swelling, there's
going to be some pain, there might be some ecchymosis as
well. But obviously the biggest thing
that really identifies this is just that DIP flexion just
dysfunction, all right? So you're not really going to
see the DIP want to go into flexion because obviously
there's no connection there that's pulling it anymore.
But one thing that is interesting to kind of consider
(15:33):
is when you ask the patient so to do this, like ideally, right,
you should stabilize the middle and proximal phalanx and then
ask for DIP flexion. In some cases, like in a type 3,
you actually might see slight flexion, right?
So what they've kind of advocated for is add slight
(15:54):
resistance to see how that kind of strength is, because if you
add slight resistance with a type 3, you should just overcome
that really easily. Wait, what do you mean?
Like you might see some flexion,so they might be able to flex a
little bit they. Might be able to flex it a
little. Bit if they have an evulsion
fracture, they. Might be able to, yeah.
Because of how far it because ofwhere it got stuck, it still
(16:16):
might be able. To create it because it gets
stuck, you know? Yeah, it.
Still might create the motion. So that's why they advocate for
slight resistance, because if you had resistance, they they
shouldn't be able to resist you because there's no pull on that
DIP, but it's the pull and the pulley that is what was creating
that. OK.
Yeah. So if you actually had the
resistance, you'll be like way overpowering them.
(16:38):
And then you'll know, oh, it's probably a Type 3 Jersey finger.
Yeah, I guess your fingers are pretty strong.
Yeah, yeah. So if you do see that and you
like you see, oh, it's slightly flex, but you're like, this is
weird, add a little resistance to it and if it if they're able
to resist it, you can probably feel good.
It's not a Jersey finger, but ifyou're like Pew, probably
(17:01):
Jerseyfinger. So the management of
Jerseyfinger, it pretty much tends to be surgically managed.
And a lot of stuff has advocatedlike surgery as soon as possible
kind of thing. But in general, some kind of
guidelines that that I was noticing is like in a Type 1,
like this is kind of like surgery's got to be pretty
quick. So type 1 is the yeah.
(17:25):
Oh, the one that goes all the way to the.
Palm yeah, Like that has to be surgery pretty quick.
But what's interesting is what Iwas reading is just like, oh,
within seven to 10 days, which Iguess for like surgery, like for
most cases tends to be I guess pretty quick.
But like, for our athletes, it'sprobably going to be a lot
sooner depending on your setting.
(17:45):
And then the ones that I've had,they've sent for, I've sent and
they've made them specific like splints or braces for.
And usually they're in the slight flexion.
Yes, because they want that tendon to be able to heal.
Yeah, for sure, for sure. And Type 2, right surgery can
(18:08):
kind of get put off at least within one to two weeks.
Type 3 is kind of the same surgery within one to two weeks.
But some things did say you could maybe get away with three
to six weeks. For an avulsion fracture, I
mean, I guess that makes sense alittle bit.
I mean, fractures in the hand kind of heal within three weeks.
Yeah, So that's really interesting.
(18:28):
And I guess it is an avulsion fracture, but still like.
Yeah, for sure. Just some thoughts.
I just love how it's like, oh, well, it's stuck.
It's gonna, it didn't go very far.
It might. We can we can wait a little bit.
And again, that's more kind of like that get away with three to
six weeks. Like some of it might be, hey,
like maybe season, like at a certain point season, the
(18:48):
physician might be OK with it. But a lot of times that three to
six weeks is more like the athlete didn't say anything and
didn't think it was like a big deal.
Like they may not have thought like, oh, whatever, like, oh, I
jammed my finger or something like that.
And then they come see you at like Week 2.
All right. So it's not like the end of the
world. It's almost kind of yeah.
You gotta love that. Oh, the story of athletes and
(19:09):
their fingers. And and then type 4 is again
surgery within 710 days. This is an ASAP situation.
Well, yeah, yeah, the tendons tearing away from the fracture
too. Yeah, that's not that's no boy.
No, no thanks. So next we have is mallet finger
and finally this year I broke the streak because my first like
(19:33):
I've had two basketball seasons where I've had one athlete with
a mallet figure I had 1-2 years ago, one last year.
This is the first year that I didn't have a mallet.
Figure what did they do? How did they get a?
Mallet the ball just would hit their finger and force them into
Yeah, like literally jam their finger from the ball but force
(19:53):
them into. Wow.
Yeah, I'm lucky. And and this is basically just a
rupture of basically where that kind of V from the extensor
tendon joins the distal phalanx,right?
You get that rupture now you don't, you can't extend that
distal phalanx, all right? So you get just forced flexion
against a contraction and boom. So like basically mallet finger
(20:16):
and jersey finger are the opposite?
Yes, yeah, exactly. All right, So your evaluation
it, it's pretty self-explanatory.
You kind of just see a dropped distal phalanx, right?
Like it's kind of weird to thinkabout it, but like we have good
tension in in our fingers. So you don't really see it.
But if it's like ruptured, like you'll see like it just drops,
(20:36):
like nothing's just holding it there and the flexor tendons are
still pulling on it. Well, also like if you ask them
to open their hand like you can see it pretty obviously.
And I was going to say, that's the next thing, right?
Inability to extend that distal failing.
So yeah, good idea, right? To just extend.
Sometimes I'll hold the middle phalanx and just ask them to
extend their fingers to see so Ican actually truly just look at
(20:57):
it to see if it moves. If it actually extends, you
might see some dorsal swelling as well.
And sometimes you can actually palpate where that tendon
retracted to. You know, Dang, I've never
thought about palpating to like,feel the tendon.
Sometimes you can, sometimes youcan feel the bulge.
Yeah, I've never thought about that.
Now next time I get. That's the same with the Jersey
(21:20):
finger too. Sometimes you can actually
palpate like where the swelling's at.
Sometimes you palpate there and you'll feel the like the bulge
of the tendon as well. I've never.
Thought to do that. Interesting.
Management for this tends to be pretty conservative.
You can get away with throwing them in a splint and
hyperextension. OK.
(21:40):
Yes you can, but if they're going to be compliant.
That's that is the big thing is the compliance aspect, right?
They have to be in this splint for a minimum six weeks.
And it's and like you can't takeit off, like if you take it off,
you have to keep it an extension.
And I think that's that's something that my Co head wanted
(22:01):
is a really good job of explaining with our athletes
like, like hold your finger and then, you know, if you like take
the. The.
Splint off, wash your hand, whatever.
Wash your splint and you're holding your finger the entire
time and then you put it back onbecause as soon as it bends,
you're basically. Just you could just.
(22:23):
Damaging that. All that work.
Going right, right. And so splinting in
hyperextension for those six to eight weeks, the surgical
consideration IS1 non compliancepossibly or, or they might just
be like, well, you just you willnot be able to extend that DIP
(22:43):
as much anymore, right, right. And what was interesting too is
if there is laxity too at the PIP joint, like maybe someone
who has just generalized laxity.That's how you get a swan neck
deformity. I can't, I can't do a swan neck
very well. Yes, you, yes, you do a good
swan neck, right. So if you have laxin that PIP
(23:07):
and you just have a chronic mallet finger, a swan neck
deformity can form because it's almost like a compensation for
not being able to do DIP extension.
So yeah, that's a fun fact. But surgery might be considered
also if there is an avulsion fracture that is taking up a 40%
(23:29):
or more of the articular surfaceof the distal failings.
So they might, yeah. So that there they might be
saying, hey, we need to do surgery to kind of pin stuff
back. There might be some success with
conservative treatment on an avulsion of 30 to 40%, right.
(23:49):
I think that's kind of probably surgeon preference and kind of
what they've seen. But yeah, I've kind of, that's
what I've kind of heard like if it's just the tendon, you're
pretty good with conservative. Once you start talking about
avulsion fracture, surgery tendsto be in the conversation.
I mean, that makes sense, especially when you're talking
about fingers. Yeah.
(24:10):
Especially when you talk. About things that like you're
you, you're gripping or you're moving your hands like dominant
versus non dominant. Yeah, for sure.
And then the next one is those kind of pulley tears.
And this is this is where we aregoing to talk about the climbing
stuff, right? And like this was interesting
(24:30):
for me because again, like I didn't really, I haven't really
heard of these kind of injuries.So I think this was really kind
of dope to kind of read about. I'm so surprised still, like I'm
so surprised. This is like all over my feet.
Oh, interesting. Apparently I'm not on climbing,
but these interests are going tocome from that, like kind of
that crimp grip activity. And you love the crimpy.
(24:53):
Climbs. Those are my climbs.
These are like. That they blow up my pulleys.
That's probably why it's so uncomfortable for.
Me they're like the like, you know, it's like if you think of
sign language like the letter E like like bending in the DIP and
the PIP, but extension of the I was going.
To say but not the. MCP, yeah, that's kind of like
(25:16):
your. Crimp.
I do not like those climbs. We call them the fingery climbs,
yeah. I don't like the fingery climbs,
but yeah, so those kind of crimpactivities are or grip
activities are going to be the the kind of mechanisms because
they do put a lot of strain on the flexor pulley system.
(25:39):
And again, this tends to be, andthe literature even acknowledged
this tends to be in climbers. But for your traditional
athletes, you'll see this in pitchers, right?
Because there are some pitches that do require some kind of
like like kind of crimp like grip.
I could see that, yeah. I could see that.
So you could get this and you'restill in your traditional
sports, not just like oak climbers.
(26:01):
The problem is you're not going to get a pitcher in a finger
splint. This could be very detrimental
for a pitcher. Right, Right.
Yeah. Especially if you don't have
like activation of your fingers for sure.
You know, I noticed something like when we go climbing, if I'm
not properly warmed up and if I try like a climb that's too hard
(26:23):
before, like I warm up properly.Like I can't fully extend my
fingers like like that. Like the when I'm climbing I
just can't do a full like extension of my fingers.
Yeah. Interesting.
Oh yeah, You. Yeah.
And you're like, you've seen it.Yeah, I've seen it like it's
(26:43):
legit. You're like almost in like
contracture. Exactly.
Like my flexors have taken on too quickly.
So I think like, I'm thinking like in a pitcher, yeah, like,
obviously that's not from injury, that's from improper
warm up. But like, I'm thinking like in a
pitcher, like pitchers have to be able to really control their
grip. Yeah, yeah, for sure.
You. Do so it really it really would
(27:04):
change things. Yeah.
So your evaluation is fairly simple with these, right?
You're going to look for swelling and then you could
actually see a bow string of thetendons.
All right, so this is basically the tendon kind of popping out
because again, the job of the pull is hold this tendon in so
you can actually get a mechanical advantage and
actually like be able to grip and like all that stuff.
(27:24):
All right, So if that's gone nowyou get like that bow string and
that tendons going to like just pop out.
So that's kind of a good sign of, hey, you probably have a
pulley tear manage. What?
No thanks. Management for this is mostly
non surgical and it definitely can be splinted in with like a
pulley ring. Splint basically just looks like
a ring over basically wherever that pulley is and it's just
(27:46):
replacing that, right? You're basically replacing the
pulley by having something that pushes the tendon back in.
That's just crazy. Yeah, they did say you could
tape it too or you could add tape like so to add like the
little tape rings and that can help keep that kind of tendon in
as well. It's like a weight belt but for
your finger. Yeah, for sure.
(28:08):
And higher grade tears of this, So tears that kind of involve
multiple structures might need surgery, but conservative tends
to be pretty successful and kindof lower grade tears for.
These they say like how long? Yes, we do have a little bit of
timelines, right. So, and some of that is the
return to play consideration as well.
(28:28):
OK. You just want to do that for
everything, Yeah. So a lot of these pathologies do
have a quick return to play evenearly in the recovery process,
right? So it kind of depends on the
sport and just how splinting canbe applied, right?
Like like for me, like basketball, right, A lot of
basketball guys don't really like or basketball athletes, I
(28:50):
should say, don't like a lot of things on their hands, right?
It's kind of weird to shoot if your shooting hand is all taped
up, splinted, you know? I think it's also worthy to take
a look at what splints you have available to you because for
example, like everyone knows the, the blue foam with the
metal like that's not really commonly like used in sport, you
(29:15):
know, like, but like you could transfer to like an or like I
make orthoplast splints for fingers all the time in
football. Or you could use like those,
like little thumb caps, I have no idea what they're called, but
like those little finger caps, like those.
Are that that one's often used with like mallet finger too,
Yeah. Those or you ones that we
(29:39):
really, really like are called protective splints and they're
basically just like it's a big roll and you just cut however
much you need and it's like a little U shape and you can put
it underneath the finger. You can put it on top of the
finger, you can put it on the side.
I really, really like those. And I just like round the edges
so they're not sharp. And then like put a little tape
(29:59):
on them and then just tape them on.
And they're like, yeah, pretty quick.
Sometimes I cut them ahead of time and then like in a game,
like I could just put it on someone real quick and then they
can go in it. And those are pretty like small.
Yeah. So depending on what sport it
is, it's and depending on what position or depending on what
finger and what joint. Like sometimes they can just go
(30:21):
back in pretty quickly or like aquick buddy tape with extra
support. So yeah, it it definitely all
those factors really determine when someone can return to play,
how they're going to return to play.
So like Jersey finger, right, you're looking at a full return
in about 10 to 12 weeks. Sooner is possible if it's a
(30:43):
sport where hands aren't quite as important, right?
So like, if you're a track athlete, right, you're probably
going to get back pretty quickly, right?
Maybe. Maybe the baton, yeah.
I don't know, you might be not be on the relay, right or like a
soccer athlete, right, That might be doable because there's
not a lot of hand necessary, right?
(31:05):
Unless you're the goalie. Unless you're the goalkeeper for
sure, and obviously there's the risk of falling too, right?
So, so there are ways to do it, especially if you're able to
protect that splint as well. So again, like again, you see
this a lot with football. It tends to be like you can
really pad something right. And if they're in a position
where they don't really need to use their hand right, they're
probably going to be able to come back a lot sooner compared
(31:27):
to like someone who's like receiver who's going to need his
hand. You know, I, so one season I had
a quarterback with a pinky. He had a pinky dislocation and a
fracture. It was an avulsion fracture.
And then in the in the same season I also did O line with a
(31:49):
pinky fracture. And I just took a picture of
like the two of their splints together that I made the
orthoplas splints because they were completely different.
And it was just really cool to see like they both had the same
injury, like both had a pinky fracture, but the management of
(32:10):
them and like position specific was just so different.
So I'll find that and I'll post that on our Instagram.
So if you're interested in that,make sure you check that out
for. Sure.
And really the position that they're going to be kind of
splinted in, especially when they're starting to return to
play is almost like a loose fist, right?
So they're not going complete fist, right?
It's going to be almost like 1/2fist kind of thing, right?
(32:31):
They're going to be kind of splinted in that position for
which one Jersey finger. Oh good.
Yeah, like their whole hand. Yes, it would be whole hand.
I believe that that was my interpretation of when I how I
was reading it. I haven't seen a whole hand when
I sent a jersey finger, but I don't know, maybe that.
(32:52):
Did you see it? How did they splint it when you
saw it? Just the single, yeah.
Oh yeah, when I was reading it said loose fist.
So I just took it as like, oh, whole hand because I guess maybe
it was, it would be hard to I, Idon't know.
Maybe it depends on if it's the one that goes all the way to
the. Yeah, maybe.
Possibly. Yeah, yeah, could be next.
(33:14):
Again, mount finger, right? If it's being treated
conservatively, they could be a really return to a quick return
to play, especially if the splinting's tolerated.
And again, it depends on the sport as well.
Like for one of my basketball guys, when we had them, we had
him return to play, right. Like, again, it's kind of weird
to have the splint on the Palmerside because you know, if you're
dribbling a ball. Can't feel it, Yeah.
(33:36):
Yeah, and it's going to be kind of in the way compared to
everything else. And so I did a dorsal splint
that held them up into a hyperextension so that that
helped kind of make it a little more tolerable to play.
But really, again, you're splinting for six to eight weeks
and if compliance was great, everything went well, you can
actually wean them off the splint around week 6 and use
(34:00):
those final two weeks of a nightsplint only.
So they put it on at night and then they can take it off,
right? Again, if it's surgical, that's
going to be a little more complex and now you're probably
looking at more closer to that three month kind of timeline.
Again, I've seen that too, where, you know, sent the kid to
the doctor for the mount finger and they they wanted to do
(34:21):
surgery with them. So I've seen that too, to where
he, his season of fortune was done because of a mount finger.
So again, it really depends what's going on in there if it
could be treated conservatively or not.
Dang, yeah. And then for your pulley, pulley
tears, this one had a very just wide range of things to do like
like or like what you're kind oflike timeline looked it could be
(34:43):
from six weeks to three months. Yeah, try telling that to
someone who needs their fingers.And the best part is as with
most things, delaying treatment could just lead to a lot worse
outcomes, right? So again, it you can kind of
tape and split in this timeline to maintain kind of that
(35:04):
activity. And if everything go is going
well and there's not a lot of other structures damage, you
probably don't need surgery withthis.
So again, it, it really kind of depends, but that's kind of your
game plan and you're looking at least six weeks for stuff that's
pretty minor. Anything that's a little bit
more major, you could just startpushing that three months
(35:25):
aspect. And again, a sport is going to
be kind of dependent, right? Again, like a pitcher, right?
This could be pretty detrimental.
Or someone who puts their entirebody weight on their finger.
Exactly. Right.
And then, and apparently I was reading that a lot of climbers
just basically tape these, thosefingers, those areas of their
fingers just preventatively. Yeah.
(35:47):
And they feel like it gives themmore grip.
Now I want to try it. Maybe I can just start doing the
group. Maybe I can start doing the
fingery ones if I tape. There you go.
I should try it see if it does make a difference because it
does hurt my hand. I don't like it because it hurts
my hand. But you can do.
It and it's maybe my pulleys, soI'm going to try it.
Don't hurt your pulleys. It could take six weeks to three
months to heal. Yeah.
But if I tape them as classic AThow can we tape it?
(36:14):
Yeah. So that's the hand.
Well, what's your action item for this?
Don't mess with the fingers, man.
You never know. You just they're not just it's
just a finger injury. Now these these could be really
detrimental and can affect quality of life, but also try to
(36:35):
work with like your physicians on what does return to play look
like and how can you safely get them to return to play.
Yeah, that's a good point. Honestly, when I've sent finger
or hand injuries, like a lot of times, like they'll get a splint
and then like I will make a splint.
So like they'll have a splint for like the day-to-day and then
(36:55):
I'll make a splint. Yeah.
And then I'll make a splint for like the sports specific portion
for sure. And then like, we didn't even
talk about rehab, but you know, incorporating like specific
rehab exercises and strengthening not just in the
(37:17):
fingers in hand, but also the wrist and the forearm flexors
and the extensors and. And a lot of this stuff because
again it is going off of the tendon and for a lot of the pro
surgical stuff too, tendon glides were huge in this.
And especially looking at for a lot of the surgical stuff, it
was starting right around week 3post op was when they were
(37:39):
starting to do the how did it go?
Tendon. Glides, there we go.
Bend straight. Bend straight, Yeah.
Like that I don't do attending. Just have to remember your
thumb. Yeah, I always forget my thumb.
But yeah, right around week 3 post op ish for a lot of these
(38:03):
in general was when they starteddoing that.
I was trying to do the glides. That's cool.
I mean, and if you're you're someone is getting surgery like
you'll, you'll be able to get anidea of what the surgeon would.
Like what their parameters are and what their protocol looks
like for sure. Suite, again, if you're
(38:24):
interested in this CEU, make sure you check out
clinicallypressed.org and find our course on there.
Randy, how many references did you use for this?
So this one, this was a little bit on the lower end, I think we
had right probably around 8:00. OK, nice.
If you're interested in those references, they are on our
website. Again for NATM we are doing 25%
(38:49):
off Cus with NATM 25. If you're listening to this as
it comes out, it is free. If you are looking for more C us
we are still working with Medbridge for $101.00 off for
your subscription for a year. You can use code 80 corner.
And then lastly if you guys are new, we do every episode as
(39:10):
either education like this. We do story episodes with
stories from real life athletic trainers or we do interview
episodes where we bring on someone and we talk about
something really cool for athletic trainers.
So make sure you check out thoseother episodes.
If you guys have anything else, make sure to reach out to us on
our Instagram at 80 Corner podcast.
And I think that's all I got. Just one more action item.
(39:33):
I apologize. It's always a good idea to have
some splints on hand. It is.
It is. Get it on hand.
On hand. Man, it really took us to the
end of this episode to get another pun all.
Right. Well, thank you for helping us
showcase athlete training behindthe tape.
Bye.
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