Prevention and treatment of ligamentous sports injuries to the hand

Sports-related injuries to the intricate small joints of the hand are quite frequent. The majority of such injuries result in joint contusions, partial tears or ligament sprains which do not jeopardise the basic stability of the joint and readily respond to a short course of protective splinting with rapid recovery of motion, strength and function. In fact, many patients never seek medical attention unless persisting pain, chronic swelling or restriction of motion persuade them to do so. Partial tears or sprains need to be distinguished from more serious injuries that cause profound ligamentous and capsular disruption resulting in dislocations, articular incongruency, joint instability or fracture-dislocations. While simple dislocations are readily reducible and generally stable, a complex dislocation by definition implies irreducibility by closed means. This category of complex joint injury requires prompt diagnosis, as optimal management warrants active surgical intervention to achieve a stable and congruous reduction. Following surgical repairs the injured joint is immobilised for a variable length of time, determined by the type, extent and the nature of the specific injury, prior to initiating remobilisation efforts. A supervised and well-executed rehabilitation programme should encompass all the various modalities of physical therapy that are effective in increasing mobility, correcting deformity and restoring strength and function to the injured hand. The ultimate goal of treatment is to enable the athlete to resume sports, unimpaired with the same skill, dexterity and competitive edge as before.