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Golfing Injuries

Golfers Elbow Treatment Manhattan | Golfers Elbow Treatment New York CityFor most golfers, the hand and/or wrist is the 3rd most common body region injured, after the back and elbow. The wrist is injured 3 times more frequently than the hand. In golf, the action of the wrist is important for the "snap" of the shot in long shots, and the precision "feel" in short shots. Golfers who lack strength in their forearms are more prone to wrist and hand injuries. The leading wrist/hand(left side for right-handed players, right side for lefties) is most at risk. Injuries result either gradually from overuse, or from a traumatic blow (hitting a root or a rock, or hitting a fat shot off hardpan) causing sprains (ligament injuries) or fractures("broken bones").

The most common wrist/hand complaint is due to tendonitis (tendoninflammation) of any of the tendons that cross the wrist. Treatment usually consists of rest, splinting, ice, and non-steroidal anti-inflammatory medicines. If these initial treatments fail, cortisone injections may be used at the discretion of your doctor.

Another distinctive golf injury is fracture of the hook of the hamate, one of the smallbones of the wrist. The hook is the particular part of that bone that protrudes toward your palm, and is vulnerable to injury from the club on a hard hit to the ground as the handle crosses right over the bony hook when gripping the club(see Figure 1, 1A). Hook of the hamate fractures may cause pain in the heel of the little finger side of the palm. If it irritates the adjacent ulnar nerve, it may cause numbness and tingling in the ring and little fingers. The tendons that bend the ring and little fingers are also adjacent to the hook, and movement of these fingers maybe painful and give a sensation of "catching" or "clicking" if these tendons are rubbing on the fractured bone. Left untreated, the tendons can even gradually fray and rupture. In addition to physical examination, your doctor may obtain x-rays,but the fracture is often difficult to see on plain X-rays because of the overlap of the other small bones in the wrist. A special study called a CT scan is often used to visualize the area of the hamate hook in greater detail when a fracture is suspected (see Figure 2).Treatment may consist of splinting or casting if the fracture is seen very early after injury. If seen late and there is continued pain,numbness and tingling, or tendon irritation, surgery is usually performed to remove the broken bone fragment.

Golfers Elbow Treatment Manhattan | Golfers Elbow Treatment New York CityThe elbow may be affected with "golfer’s elbow", which is a painful tendonitis on the inner aspect of the elbow at the origin of the "flexor/pronator" muscles. They originate off of a bony prominence of the humerus (arm bone) called the medialepicondyle, and so this condition is also called "medial epicondylitis" (see Figure 3). It can be caused by repeated swinging stress to the elbow, and may result from many other non-golfing activities, such as heavy lifting and hammering. Lateral epicondylitis, on the outer side of the elbow, is also commonly seen in golfers from repeated strain to the lead arm, similar to hitting backhands in tennis (see brochure/web page on tennis elbow/lateral epicondylitis). Both these conditions are usually first treated with rest, a physical therapy program of muscle stretching and strengthening, and non-steroidal anti-inflammatory medicines. If these initial treatments fail, cortisone injections may be used at the discretion of your doctor. In a small percentage of patients, non-operative treatment is unsuccessful, and your doctor may recommend a surgical procedure that entails removal of the degenerated part of the tendon and possible tendon repair.

Another potential cause of injury when golfing is the unsafe use of golf carts. Golf cart accidents with fall-outs and tip-overs may cause very serious injury such as fractures to the wrist, forearm, elbow, arm, shoulder, tibia (shin bone), and ankle,among others Proper care and caution must be exercised when driving golf carts.

Non-upper extremity injuries worthy of mention include sprains and strains of the back, especially the lower back called the lumbar spine. Proper warm-up and stretching is important to decrease the chances of injury. Gradual increase in length and intensity of play should be exercised as the season progresses.

Click here for a full PDF brochure on Golfing Injuries

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Hand Fractures

What is a fracture?

The hand is made up of many bones that form its supporting framework. This frame acts as a point of attachment for the muscles that make the wrist and fingers move. A fracture occurs when enough force is applied to a bone to break it. When this happens, there is pain, swelling, and decreased use of the injured part. Many people think that a fracture is different from a break, but they are the same (see Figure 1). Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable and the bone fragments tend to displace or shift. Some fractures occur in the shaft (main body) of the bone, others break the joint surface. Comminuted fractures (bone is shattered into many pieces) usually occur from a high energy force and are often unstable. An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.

How does it affect the hand?

Fractures often take place in the hand. A fracture may cause pain, stiffness, and loss of movement. Some fractures will cause an obvious deformity, such as a crooked finger, but many fractures do not. Because of the close relationship of bones to ligaments and tendons, the hand may be stiff and weak after the fracture heals. Fractures that involve joint surfaces may lead to early arthritis in those involved joints.

How are they treated?

Medical evaluation and x-rays are usually needed so that your doctor can tell if there is a fracture and to help determine the treatment. Depending upon the type of fracture, your hand surgeon may recommend one of several treatment methods.

A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Some displaced fractures may need to be set and then held in place with wires or pins without making an incision. This is called closed reduction and internal fixation.

Other fractures may need surgery to set the bone (open reduction). Once the bone fragments are set, they are held together with pins, plates, or screws (see Figure 2). Fractures that disrupt the joint surface (articular fractures) usually need to be set more precisely to restore the joint surface as smooth as possible. On occasion, bone may be missing or be so severely crushed that it cannot be repaired. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body to help provide more stability.

Fractures that have been set may be held in place by an "external fixator," a set of metal bars outside the body attached to pins which are placed in the bone above and below the fracture site, in effect keeping it in traction until the bone heals.

Once the fracture has enough stability, motion exercises may be started to try to avoid stiffness. Your hand surgeon may determine when the fracture is sufficiently stable.

What types of results can I expect?

Perfect alignment of the bone on x-ray is not always necessary to get good function. A bony lump may appear at the fracture site as the bone heals and is known as a "fracture callus." This functions as a "spot weld." This is a normal healing process and the lump usually gets smaller over time. Problems with fracture healing include stiffness, shift in position, infection, slow healing, or complete failure to heal. Smoking has been shown to slow fracture healing. Fractures in children occasionally affect future growth of that bone. You can lessen the chances of complication by carefully following your hand surgeon’s advice during the healing process and before returning to work or sports activities. A hand therapy program with splints and exercises may be recommended by your physician to speed and improve the recovery process.

Hand Fracture Treatment Manhattan | Hand Fracture Treatment New York City

Click here for a full PDF brochure on Hand Fractures

*All information provided by American Society for Surgery of the Hand
www.assh.org

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