Hand injuries in sports, the countless incidence of incidents

How can it be possible that one of the most essential and vulnerable body parts is left so unprotected during sports? Is that not a little contradictory?

Published June 28, 2021 • 3 min read

The hand frequently plays an essential role in performing unique athletic movements. Oddly enough, the hand is also often the least protected and most vulnerable body part during sports. As a result of this contradictory fact, there is a high incidence of hand injuries during sports. Scientific evidence indicates that hand injuries account for approximately 3%-25% of all sports-related injuries (Rosenbaum & Awan, 2017). Sports with the highest numbers of injuries to the hand include rugby, combat sports, field hockey, basketball and handball. A recent study on injury occurrence in basketball players, for example, determined that injuries to the hand account for 10% of all musculoskeletal injuries, regardless of age, gender and player level (Andreola et al., 2018). This number even increases to approximately 30% in combat sports, such as judo or Brazilian jiu-jitsu (Moriarty et al., 2019; Pocecco et al., 2013).

What do we know about hand injuries?

In general, sports injuries can be divided into acute and overuse injuries. Overuse injuries result from repetitive, low-load tissue stress (during athletic movements) that causes structural microtrauma (Bahr et al., 2012). They are characterized by an injury mechanism that is hard to identify, combined with symptoms that often go unnoticed. Even though overuse injuries of the hand are relatively common (Rettig, 2004), hand injuries during sports are more frequently the result of acute incidents, which can be distinguished by one clearly identifiable injury event (Bahr et al. 2012). It should come as no surprise that there is an increased risk of acute hand injuries in sports with a high rate of player-to-player contact or contact with sports equipment. An important reason why the hand is more susceptible to acute injuries is the fact that many bony, tendinous and ligamentous structures within the hand are only superficially protected by a thin layer of fat and skin. This increases the vulnerability to injuries caused by high-impact forces or blunt athletic trauma.

Looking at the different types of acute hand injuries, we can see there is a wide array of injuries that can go from minor contusions to severely incapacitating injuries, such as bone fractures (Mall et al., 2008). Injury types include muscle-tendon injuries (e.g., strain, tendon avulsion and tendon subluxation), bone fractures and ligamentous injury/joint instabilities (e.g., sprain, dislocation, or subluxation with associated ligamentous strain or rupture). Although acute injuries can occur almost anywhere on the hand, the interphalangeal (IP) finger joints are particularly susceptible to sustain an injury. An example of a common injury to the IP joints is a dislocation in combination with a collateral ligament injury resulting from a direct impact or forced sideways deviation of the finger (Mall et al., 2008).

Given the importance of a healthy and fully functioning hand in many sports, sustaining a hand injury can really affect athletes of all levels. Injuries can negatively impact physical as well as psychosocial wellbeing, and some injuries might prevent athletes from participating in sports activities for considerable time periods. From a purely physical point of view, hand injuries range from minor problems that are sometimes neglected to more severe injuries like a joint dislocation. Besides the immediate physical consequences, hand injuries can also be associated with long-term dysfunctions, such as chronic stiffness, pain and deformity (Peterson et al., 2006). The risk of permanent tissue damage is not only linked to serious injuries but can be associated with minor or neglected injuries as well. A prime example of the long-term consequences of sports-related finger injuries is the development of traumatic finger polyarthritis in combat sports athletes (Fray et al., 2019). Extensive combat sports practice and competition are considered to hold a risk factor for bone and soft-tissue changes associated with polyarthritis. This results from chronic, repetitive micro- and macrotrauma to the fingers. Just take a look at the hands of a professional Brazilian jiu-jitsu athlete and compare them to your own. You can really imagine the kind of activities that led to such deformations of the hand and fingers.

In general, the increasingly competitive nature and growing physical demands of sports are undeniably related to surging injury numbers. As discussed, these injuries are often associated with a multitude of short- and long-term negative consequences. The high incidence of sports-related hand injuries further highlights the need for protective measures that can adequately prevent and manage these injuries.

References

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