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Context:Jam injuries of the finger are frequently encountered in general orthopaedic and sports medicine practice. The finger joints in particular are very susceptible to traumatic injury, but in the absence of severe deformity, digital trauma is often downplayed in the hopes of a more rapid return to game play.Evidence Acquisition:Articles published from 1966 to 2015 were reviewed to capture historical and current views on the presentation, diagnosis, and treatment of jam injuries in athletes.Study Design:Clinical review.Level of Evidence:Level 5.Results:Although jam injuries are frequently grouped together, they represent a host of injuries that can be challenging to differentiate. A thorough knowledge of finger joint anatomy and injury mechanism is critical to perform an appropriate examination, establish an accurate diagnosis, and identify a treatment plan for each patient.Conclusion:Every member of the athletic care team must be aware of the spectrum of digital injuries, including the basic signs present on examination, which may indicate the need for more formal workup. Additionally, preventing injury through athlete education is paramount to athletic care.

Background: Traditional rehabilitation for basal joint arthroplasty involves postoperative immobilization. We hypothesize that early motion is safe and will result in equivalent clinical outcomes to traditional rehabilitation. Methods: Patients undergoing ligament reconstruction and tendon interposition were randomized into 2 rehabilitation protocols. All patients were immobilized postoperatively in a thumb-spica splint for 2 weeks. The accelerated group (Group 1) was transitioned into a removable Carpometacarpal (CMC)-wrap with activity as tolerated, while the traditional group (Group 2) were immobilized for an additional 4 weeks. Patients were examined preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analog scale for pain (VAS), pinch and grip strength and thumb range of motion. Results: Ninety-three thumbs were randomized, 48 in group 1 and 45 in group 2. There were no statistically significant differences between the 2 groups preoperatively. DASH scores were significantly lower in the accelerated rehabilitation group at 6 weeks postoperatively compared to the traditional rehabilitation group, but these became equivalent by 12 weeks postoperatively. There were no statistically significant differences between the 2 groups with respect to postoperative VAS, key, pinch, or grip strength or thumb range of motion at all time points postoperatively. Conclusions: Early (12-week and 1-year) outcomes suggest early mobilization of patients following CMC arthroplasty does not compromise clinical results. Long-term data will determine the lasting effects of accelerated rehabilitation but may offer earlier return to function than traditional rehabilitation.

Despite the increasing availability of healthcare utilization data and emphasis on price transparency, little is known about the extent to which physician charges and Medicare payments for hand surgery vary across the United States. We assessed national and state-level variation in physician charges and Medicare payments for common hand procedures. Methods: Using the Medicare Provider Utilization and Payment Data Public Use File for 2012, we evaluated national and state variation in physician charges and Medicare payments for carpal tunnel release, trigger finger release, trigger finger injection, closed treatment of distal radius fracture, and interposition arthroplasty, intercarpal or carpometacarpal joints. We assessed variation using the coefficient of variation. We also determined the correlation between charges and payments, as well as the association of patient volume with charges and payments. Results: There was wide state-level variation in physician charges for carpal tunnel release (11-fold), trigger finger release (9.6-fold), and trigger finger injection (5.5-fold). On a national level, physician charges varied substantially for carpal tunnel release, trigger finger release, trigger finger injection, closed treatment of distal radius fracture, and interposition arthroplasty, intercarpal or carpometacarpal joints. Medicare payments varied to a lesser extent. The correlations between physician charges and Medicare reimbursements were not strong. Weak to no correlations were noted between patient volume and both charges and payments. Summary Point:Physician charges for hand surgery vary substantially across states and nationally, and they do not correlate well with Medicare payments and surgeon volume. REFERENCE 1. Brennan N, Conway PH, Tavenner M. The Medicare physician-data releasecontext and rationale. N Engl J Med. 2014;371(2):99e101.