Opinions Regarding the Management of Hand and Wrist Injuries in Elite Athletes

Abstract

Injuries to the hand and wrist are commonly encountered in athletes. Decisions regarding the most appropriate treatment, the timing of treatment, and return to play are made while balancing desires to resume athletic activities and sound orthopedic principles. Little recognition in the literature exists regarding the need for a different approach when treating these injuries in elite athletes and the timing to return to play. This study explored the complexities of treating hand and wrist injuries in the elite athlete. Thirty-seven consultant hand surgeons for teams in the National Football League, National Basketball Association, and Major League Baseball completed a brief electronic survey about the management of 10 common hand injuries. Notable variability existed in responses for initial management, return to protected play, and return to unprotected play for all injuries, aside from near consensus agreement (94%) that elite athletes with stable proximal interphalangeal dislocations could immediately return to protected play. Basketball surgeons were less likely to recommend early return to protected play than non-basketball surgeons. Baseball surgeons were more likely to recommend early unprotected play after scaphoid fixation. Football surgeons were more likely to recommend earlier return to protected play after thumb ulnar collateral ligament injuries, whereas basketball surgeons were less likely to recommend earlier return to protected play. This study demonstrated wide variability in how consultant hand surgeons approach the treatment of hand and wrist injuries. The findings emphasize the need to individually tailor treatment decisions to the patient's desires and demands, particularly in high-performance athletes.

Finger Injuries in Football and Rugby

“…27 64% of consultant hand surgeons surveyed by Carlson et al recommended waiting 12 weeks prior to return to unprotected play for NFL players. 7 …”

“…15 Others believe that athletes may return immediately to play if the joint is stable following reduction. 7 Buddy taping or protective splinting, as permitted by league rules, is used to protect the digit when the athlete returns to play. Buddy taping decreases the incidence of recurrent hyperextension and lateral displacement.…”

“…A study surveying 37 consultant hand surgeons for teams in the National Football League, National Basketball Association, and Major League Baseball demonstrated consideration variability for the initial management and return to protected and unprotected play for professional athletes, highlighting the need for individualized management for each injured athlete. 7 …”

Scapholunate and perilunate injuries in the athlete

“…One must understand that there may be incredible pressure from parents, coaches, teammates, agents, and/or trainers, but ultimately, the treating physician must do what is in the athlete's best interest, while maintaining sound ethical principles. A recent survey of consultant hand surgeons managing professional athletes showed that there was significant variability in the management of hand and wrist injuries, a finding that demonstrates that treatments are very specifically individualized [22]. The management of these injuries in athletes depends on the age of the athlete, the sport, the position the athlete plays, and the timing in regard to the current season as well as future seasons [23].…”

“…These factors include personal demands and coaching expectations such that many physicians consider caring for athletes different from managing others in the general population [22]. One must not only consider the actual injury, but the athlete as a whole [10].…”