An elite Muay Thai fighter came with a swollen and painful thumb after hurting his thumb when he accidentally hit the side the head of his opponent during a professional bout. Treated it aggressively with RICE therapy, electrotherapy and rehabilitation exercises and he returned to fight again in 2 weeks duration. He had a protective taping for the fight and managed well.
A junior rubgy player came after competition with a painful Rt 5th finger. He had pain at the side of the Metacarpo-phalangeal joint after feeling a sharp pain and loss of power after 'losing grip' of an opponent's shirt.
He suffered from torn collateral ligament and would benefit from buddy taping or splinting over the next 4 to 6 weeks.
This is the photo of a basketball player who dislocated left 5th finger. The finger was immediately rediced easily by the coach. He subsequently used RICE treatment which reduced the symptoms. He taped the finger to prevent a recurrence but refused further examination.
A gentleman came in this morning clutching his wrist with a profusely bleeding left middle finger. His finger was hit by a falling panel which dislodged his wedding ring and cut his finger while deforming it instantly.
The left middle finger had a swan neck deformity and a gaping laceration across the middle phalanx oozing out with blood. There was crepitus (indicating a fracture) and he could not extend his distal phalanx suggesting a ruptured long extensor tendon.
I quickly cleaned his wound with Povidone iodine, applied a pressure bandage to stop bleeding, did a buddy taping with a finger splint running across the hand on both sides. He was referred to an Orthopaedic surgeon for further evaluation and treatment. If he was an athlete who had to use his upper limb, he should be out of training for at least 4 weeks.
Here's a badminton athlete who was found to be able to hyperextend his fingers without any discomfort. He does not seem to have hyperlaxity in other joints although he is flat footed.
This sub-elite athlete suffered from an old punching injury to his 3rd metacarpal phalangeal joint a year ago during competition. The initial swelling and pain had subsided with treatment but he still has movement restriction. He should be able to continue training with taping but he will need an X-ray to find out the extent of damage. If the X-ray is normal, physiotherapy with finger exercises would help him regain full range of motion. 
This sub-elite athlete suffered from an Index finger injury 6 months ago. His proximal interphalangeal (PIP) joint is still swollen although the pain has mostly subsided. He wanted to fight in another competition and was advised to tape his PIP joint. He should also obtain an X-ray of the PIP joint to rule out more serious injury.
Here's a video of a female martial arts exponent who dislocated her left thumb 2 years ago after receiving a kick during competition. I did a test to evaluate the hypermobility of her joint. She is also having some hypermobility of her right thumb but it was less mobile.
Interesting Links:
Dislocation of the Thumb MP Joint
Ms N is a 4 years old girl who had a fall on her palm two weeks ago was brought by her father showing a small pea-like swelling on the palmar surface of the proximal phalanx of her right little finger.
The swelling was only painful upon palpation. She otherwise had full function and power of her right little finger. It was difficult to tell whether she had the swelling previously as children do not usually complain until there is pain. I suggested an ultrasound of the swelling which should demonstrate a cystic (fluid-filled sac)swelling with some inflammation. I referred her to a Hand Orthopaedic Surgeon for further evaluation and treatment.
Ganglion cysts are the most common lesion of the hand and wrist, accounting for 50% to 70% of all masses identified. The majority of ganglion cysts can be treated nonoperatively but when surgery is performed a low recurrence rate can be anticipated. Giant cell tumor of the tendon sheath hand epidermoid cysts are also common hand lesions that require surgical excision in most instances. Of the three, giant cell tumor of tendon sheath have the most notable recurrence rates. (Nahra etal, 2004)
Usually Ganglion cysts may be treated non-surgically. If it becomes painful or restricts normal function, cyst aspiration and corticosteroid injection may help. Surgical excision usually has low recurrence rate.
Ahmed is a recreational volleyball and soccer goalkeeper at the club level. He accidentally hit the ball trying to save it yesterday and the injury caused severe pain and swelling of the distal part of his thumb.
He came with his painful swollen thumb (despite RICE treatment the previous day) and it was really tender and bruised at the tip and base of distal phalanx. There was a small hematoma in the finger pulp. His thumb movements were still intact. 
His plain X-rays showed a minute fracture fragment of the base of the distal phalanx and a non-displaced fracture of the tip. An ultrasound of his finger tendons may be required if he had a suspected extensor tendon rupture. I placed his finger in a splint and advised him to return in 2 weeks.
Posts
All Comments
