Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Epidemiology of hand and wrist injuries treated in a reference specialty center over a year.

INTRODUCTION: Hand injuries constitute 6.6% to 28.6% of all injuries in the musculoskeletal system. Little information has been reported on the non-laboring, non-insured population with no social security. We describe the epidemiology of hand and wrist injuries treated over a year in the emergency department of a reference hospital in Mexico City that treats patients with no social security. OBJECTIVE: To describe the epidemiology of hand and wrist injuries treated in the ED of a high specialty reference medical facility over a year. MATERIAL AND METHODS: Medical records for patients treated for hand and wrist injuries in the emergency department in 2015 were reviewed. A descriptive statistical analysis was performed. RESULTS: Hand and wrist injuries constituted 8.9% of all emergencies treated in the emergency department of INR-LGII during 2015. Young, male patients, between 21 and 30 years of age were the most commonly affected age group. Students and housewives constituted almost half the population treated for hand and wrist injuries. The most common injuries were fractures, contusions and sprains. CONCLUSION: Hand and wrist injuries are common. There is currently not enough epidemiological data on non-laboring hand injuries in Mexico or the world. Hand and wrist injuries need to receive specialized treatment to avoid complications and permanent disability.

INTRODUCCIÓN: Las lesiones en las manos constituyen entre 6.6 y 28.6% de las lesiones del sistema musculoesquelético. Existe poca información en el mundo sobre las lesiones de las manos en la población sin seguridad social y no trabajadora. Describimos la epidemiología de las lesiones de mano y muñeca tratadas durante un año en el Servicio de Urgencias de un Centro de Tercer Nivel de la Ciudad de México que trata a pacientes sin seguridad social. OBJETIVO: Describir la epidemiología de las lesiones de mano y muñeca tratadas durante un año en el servicio de urgencias de un Centro Hospitalario de Tercer Nivel. MATERIAL Y MÉTODOS: Revisión de expedientes electrónicos de los pacientes tratados por lesiones de mano y muñeca en el servicio de urgencias durante 2015. Se llevó a cabo un análisis estadístico descriptivo. RESULTADOS: Las lesiones de mano y muñeca constituyeron 8.9% de todas las emergencias tratadas en el Servicio de Urgencias del Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra" (INR-LGII) durante 2015. Los pacientes hombres, jóvenes entre 21 y 30 años de edad fueron el grupo más afectado. Los estudiantes y amas de casa fueron casi la mitad de la población tratada por lesiones de mano y muñeca. Las lesiones más comúnmente tratadas fueron fracturas, contusiones y esguinces. CONCLUSIÓN: Las lesiones de mano y muñeca son comunes y requieren tratamiento especializado oportuno para evitar complicaciones y discapacidad permanente.

Retrospective Study of Risk Factors and the Prevalence of Injuries in HIFT.

The aim of this study was to investigate the risk factors and the incidence of injuries in high-intensity functional training (HIFT) practitioners. A survey was administered to 213 HIFT practitioners. Participants reported the number of injuries, the location of the injuries, and training exposure during the preceding six months and answered questions regarding potential risk factors for injury. We found there were 7.1 injuries for every 1000 hours of training. In addition, we found that individuals with experience in the modality (>2 years) were 3.77 times more likely to be affected by injury when compared with beginner individuals (<6 months) (CI95%=1.59-8.92; p=0.003). When the analysis was performed only for the competitive level, we found that practitioners competing at the national level were 5.69 times more likely to experience an injury than competitors who do not compete (CI95%=1.10-29.54; p=0.038). We also found that the injuries mainly affect the shoulder and lumbar regions. It was possible to conclude that subjects with a higher level of experience in the modality are more likely to be affected by injuries and that the shoulder and lumbar areas are most likely to be injured during HIFT.

Luxación aislada del escafoides / Isolated Dislocation of the Scaphoid

El funcionamiento armónico de la mano desempeña un papel fundamental para el desarrollo de la vida del hombre. En la sociedad moderna las lesiones a este nivel, a pesar de su baja incidencia, son causa frecuente de discapacidad funcional. Se presenta un paciente blanco, masculino, de 38 años, atendido por el Servicio de Urgencias tras un trauma de alta energía con hiperflexión forzada de la muñeca. Se diagnostica una luxación aislada del escafoides que se reduce bajo anestesia con ayuda del intensificador de imágenes. Se inmoviliza por 6 semanas con férula braquial, tomando primer dedo, y posteriormente comienza el proceso de rehabilitación. El tratamiento oportuno y adecuado de la afección mencionada es indispensable para obtener los mejores resultados en la recuperación funcional(AU)

The orderly functioning of the hand plays a key role for the development of human life. In modern society injuries at this level are a frequent cause of functional disability, despite its low incidence. A case of a white, male patient, 38, attended by the emergency department after a high-energy trauma with forced hyperflexion of the wrist is presented here. An isolated dislocation of the scaphoid is diagnosed and it is reduced under anesthesia using the image intensifier. It is immobilized for 6 weeks with brachial splint, taking first finger, and then the rehabilitation process begins. The timely and proper treatment of this condition is essential to obtain the best results in functional recovery.

Opioid Use and Risk of Nonvertebral Fractures in Adults With Rheumatoid Arthritis: A Nested Case-Control Study Using Administrative Databases.

OBJECTIVE: To assess the risk of nonvertebral fractures in patients with rheumatoid arthritis (RA) who were exposed to opioids. METHODS: A population-based, nested case-control study was conducted using health services administrative databases (Quebec, Canada) from 1997 to 2012. Among RA patients, cases of nonvertebral fractures from 2007 to 2012 were identified using a validated algorithm. The date of the first fracture was the index date for the case and his/her matched control. Controls were selected using incidence density sampling and were matched 5:1 to cases for age, sex, and date of RA diagnosis. Opioid exposure was classified as current use, recent past use, remote past use, and nonuse. Conditional logistic regression was used to assess the association of nonvertebral fractures with opioid exposure, adjusting for comorbidity, indicators of RA severity, drugs influencing fracture risk, and health care utilization. RESULTS: In total, 1,723 cases and 8,046 controls were identified. Among these patients, 2,595 (722 cases and 1,873 controls) had been exposed to opioids. Current use (versus nonuse) increased the risk of nonvertebral fracture. Cumulative current use of opioids according to the quartile distribution was also associated with the risk of nonvertebral fracture: for continuous use for 1-20 days before the index date, odds ratio (OR) 11.49 (95% confidence interval [95% CI] 8.81-14.99); for 21-155 days, OR 1.75 (95% CI 1.31-2.33); for 156-355 days, OR 1.54 (95% CI 1.17-2.04); and for ≥356 days, OR 1.73 (95% CI 1.31-2.30). No association between the risk of nonvertebral fractures and recent past use or remote past use of opioids was observed. CONCLUSION: Among RA patients, the risk of nonvertebral fracture is increased in those treated with opioids.

Perfil dos pacientes com lesões traumáticas do membro superior atendidos pela fisioterapia em hospital do nível terciário / Profile of patients with traumatic injuries of the upper limb treated in a tertiary hospital

A incidência de lesões traumáticas dos membros superiores em um hospital terciário além de ser elevada, possui uma grande variedade. Neste sentido torna-se importante a criação de um banco de dados único, para conhecer o perfil dos pacientes atendidos. Objetivo: traçar o perfil dos pacientes com lesões traumáticas dos membros superiores, atendidos pela Fisioterapia no Centro de Reabilitação do Hospital das Clínicas de Ribeirão. Método: foram avaliadas 223 fichas de pacientes (58 mulheres e 116 homens), com idade média de 34,54 (± 19,05) anos, encaminhados pelo ambulatório de ortopedia do referido hospital. Resultados: do total de casos analisados, as lesões de punho e mão obtiveram maior incidência (60,99%), seguidos por lesões de ombro (20,63%), cotovelo (12,55%), braço (3,59%) e antebraço (2,24%). Nas lesões de punho e mão o mecanismo de trauma com maior porcentagem foi o acidente de moto, relacionado com as fraturas múltiplas de ossos da mão. Queda da própria altura, acidente motociclístico e queda de escada foram os mecanismos de trauma, correlacionando com as fraturas de úmero proximal, luxação de ombro e fraturas de escápula respectivamente. Conclusão: Foi verificada a incidência de lesão, mecanismo de trauma e as características da população para futuramente aprimorar os protocolos específicos para as disfunções e investir em campanhas de prevenção.

The incidence of traumatic injuries of the upper limbs in a tertiary hospital has a wide variety. This is why the creation of a unified database becomes important-to know the patients’ profile. Objective: this study sought to determine the profile of patients with traumatic injuries of the upper limbs, treated by Physical Therapy in Rehabilitation Center of the Clinics Hospital of Ribeirão Preto. Method: Two hundred and twenty-three patient records were evaluated (58 women and 116 men). They had an average age of 34.54 (± 19.05) years and were referred by the orthopedic clinic of this hospital. Results: of the cases studied, wrist and hand injuries had the highest incidence (60.99%), followed by injuries of the shoulder (20.63%), elbow (12.55%), arm (3.59%) and forearm (2.24%). In injuries of wrist and hand, the trauma mechanism with the highest percentage was the motorcycle accident, associated with multiple handbone fractures. Falling down, motorcycle accidents, and falling off a ladder were the mechanisms of injury correlated with proximal humerus fractures, shoulder dislocations, and broken scapulas, respectively. Conclusion: the incidence of injury, trauma mechanism, and characteristics of the population was verified and further improvements in protocols for specific disorders and prevention can be made.

Risk factors for nonvertebral fracture in obese older women.

CONTEXT: A high prevalence of obesity has recently been reported in postmenopausal women with low trauma fracture, suggesting that higher bone mineral density (BMD) in obese individuals may not be protective against fracture. OBJECTIVE: The aim of this study was to compare BMD and other risk factors for nonvertebral fracture in 1377 obese postmenopausal women. DESIGN: Characteristics of obese women with and without incident nonvertebral fracture were investigated among the prospective cohort in the Study of Osteoporotic Fractures. SETTING: The Study of Osteoporotic Fractures is a multicenter study of 9704 women (>99% Caucasian) aged 65 yr and over who were recruited between September 1986 and October 1988 from population-based listings at four U.S. clinical centers. MAIN OUTCOME MEASURE: The main outcome measure was nonvertebral fracture. RESULTS: BMD T-scores in the spine, femoral neck, and total hip were significantly lower in obese women who experienced fractures than in obese women without fracture: mean differences, -0.56 [95% confidence interval (CI) = -0.73 to -0.39], -0.46 (95% CI = -0.57 to -0.36), and -0.51 (95% CI = -0.62 to -0.39), respectively (P < 0.0001 for all). A previous history of fracture [odds ratio = 1.69 (95% CI = 1.33-2.14); P < 0.0001] and femoral neck BMD [1.62 (95% CI = 1.42-1.85) per sd decrease in BMD; P < 0.0001] were independently associated with incident nonvertebral fracture. CONCLUSIONS: Obese postmenopausal women who sustain nonvertebral fractures have significantly lower BMD on average than obese women without fracture and are more likely to have a past history of fracture. Fractures in obese postmenopausal women thus exhibit some characteristics of fragility fractures.

[Hand injuries in workers on the eastern shore of Marcaibo Lake in the state of Zulia, Venezuela, 1986-1993]. / Accidentes de la mano en trabajadores de la costa oriental del lago de Maracaibo del Estado Zulia, Venezuela, 1986-1993.

In order to analyze the frequency, injury rate and cause of on site accidents to the hands of workers on the east coast of lake of Maracaibo in Zulia State, data was obtained from the accident reports registered with the Venezuelan Institute of Social Security. An occupational hand injury was defined as a traumatic injury to the hands, fingers or wrists that occurred while the employee was at work; that resulted from a single exposure to a hazardous agent. The following variables were analyzed: age, severity, economic activity, material agent, mechanic cause, type of injury, type of accident and unsafe action. The frequency rate was used to analyze the annual accident rate. During the period under study 2.456 injuries to the hand were registered, representing 36% of the total injuries reported; 95% were light injuries, 5% incapacitating and two cases resulted in the death of the worker. 72% of the injuries were located in the fingers, 22% in the hands and 6% in the wrists. The greatest frequency of injuries were found in the economic activity in mines and quarries with a rate of 123.1 per thousand. The age group most affected was of 20-29 years (42%), Wounds or contusions and crushings were the injuries most commonly reported, in 39% and 36% of the cases respectively. The main type of injuries were caused by run over, running into or blow from objects. The principal agents causing injuries were materials, substances and radiations in 45% of the cases. It is concluded that the hand injury rate is very high in the exploitation of mines and quarries and represents the main cause of worker's disability.

Morbilidad quiríurgica en el Servicio de Ortopedia y Traumatología / Surgical morbidity in orthopedics and traumatology service

Se realizó un estudio sobre la morbilidad quirúrgica en el servicio de Ortopedia y Traumatología durante el período comprendido entre diciembre de 1991 y junio de 1993. Las lesiones de cade ra fueron más comunes en nuestro medio, y las reducciones y osteosíntesis, el procedimiento quirúrgico más utilizado (AU)

Morbilidad quiriurgica en el Servicio de Ortopedia y Traumatologia / Surgical morbidity in orthopedics and traumatology service

Se realizo un estudio sobre la morbilidad quirurgica en el servicio de Ortopedia y Traumatologia durante el periodo comprendido entre diciembre de 1991 y junio de 1993. Las lesiones de cade ra fueron mas comunes en nuestro medio, y las reducciones y osteosintesis, el procedimiento quirurgico mas utilizado

Incidencia y prevalencia del síndrome de impactación del carpo en boxeadores

Se realiza una encuesta a 400 boxeadores de alto rendimiento durante el Torneo Nacional de Boxeo "Playa Girón 85". Se determinó una incidencia del Síndrome de Impactación del Carpo del 11,2

Incidencia y prevalencia del síndrome de impactación del carpo en boxeadores

Se realiza una encuesta a 400 boxeadores de alto rendimiento durante el Torneo Nacional de Boxeo "Playa Girón 85". Se determinó una incidencia del Síndrome de Impactación del Carpo del 11,2