Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Digit Fractures and Dislocations

Finger fractures and dislocations can range from minor, self-treated simple proximal interphalangeal joint (PIP) dislocations to some of the most complex and difficult problems in orthopedics. They are some of the most common injuries in various sports, from football to cycling. Athletes’ significant reliance on their hands for diverse purposes leads to unique challenges in the treatment and rehabilitation of these injuries. Fundamentally, digit fractures and…

Tendon Injuries in the Hand

Although not every team physician needs to be a “hand surgeon,” the frequency of hand and wrist injuries caused by sporting activity requires expertise in the diagnosis and evaluation of these injuries. Regardless of the sport, an athlete with a hand injury intuitively appreciates the effect that a hand injury has on function and competitive ability. The injuries often sustained in each individual sport generally have…

Disorders of the Distal Radioulnar Joint

Disorders of the distal radioulnar joint (DRUJ) include those associated with pain or instability or both. In addition, one should consider pathology of degenerative or traumatic etiology. Injury to the triangular fibrocartilage complex can result in pain or instability or both, and may be traumatic or degenerative. Athletes, particularly those engaged in activities with repetitive axial loading, radial or ulnar deviation, and forearm rotation may especially…

Wrist Tendinopathies

Tendinopathies are extremely common in athletes. Any sport that requires a repetitive motion, such as a tennis serve or volley, a basketball free throw, or “turning the wrists over,” as in the completion of a golf or baseball swing, puts an athlete at risk for tendon inflammation, instability, degeneration, or even rupture. Even recreational rock climbing, which is well known for its association with flexor pulley…

Carpal Injuries

Carpal injuries represent 3% to 9% of all sports-related ailments, with carpal fractures comprising 8% to 19% of hand injuries. Carpal fractures, ligament injury, and instability can occur as a result of acute injury or overuse. Contact sports, such as football, have the highest incidence of carpal injury. These injuries are also frequently seen in gymnasts, mixed martial artists, and boxers, although any participant in sport…

Wrist Arthroscopy

Arthroscopy has revolutionized the practice of orthopedics by providing the technical capacity to examine and treat intra-articular abnormalities under magnified and brightened conditions. The development of wrist arthroscopy was a natural progression in the successful application of arthroscopy to other larger joints. The wrist itself is a labyrinth of eight carpal bones, multiple articular surfaces, intrinsic and extrinsic ligaments, and a triangular fibrocartilage complex (TFCC), all…

Imaging of the Wrist and Hand

Imaging evaluation of hand and wrist injuries in the athlete should always begin with conventional radiographs. Radiographs are excellent for detecting osseous injuries or malalignment in osseous structures as a result of ligament disruption. A standard wrist series includes posteroanterior (PA), lateral, and oblique views ( Fig. 68.1 ). Open full size image Fig. 68.1 Conventional radiographs of the wrist. (A) Posteroanterior view. (B) Lateral view.…

Hand and Wrist Diagnosis and Decision-Making

Overview Athletic participation frequently places the hand and wrist at risk of injury, which may lead to sprains, fractures, and dislocations. Reports in the literature suggest that 3% to 25% of all athletic injuries involve the hand and wrist. Additionally, overuse in competition and training may lead to tendinopathy and tendon rupture. Certain injuries are more common in particular sports and various playing positions. For instance,…

Anatomy and Biomechanics of the Hand and Wrist

Hand The human hand is the athlete's tactile connection to his or her sport. Our hands are virtually linked to every sport via a handle, a stick, a glove, or even the bare fingers. Athletes may be said to have good hand-eye coordination, good ball-handling skills, or even quick hands, but in each case the relationship between the sport and the athlete's hands is obvious. Hand…

Loss of Elbow Motion

Acute and chronic disorders of the elbow are frequently observed in both recreational and professional athletes, particularly athletes who participate in sports that involve throwing. Although clinicians most frequently evaluate athletes in throwing-related sports who have elbow pathology related to overuse injuries, including ulnar collateral ligament insufficiency, valgus extension overload syndrome, and epicondylitis, acute elbow trauma may affect athletes in all sports. These acute injuries most…

Elbow Throwing Injuries

Elbow injuries in the throwing athlete are often the result of high valgus and extension forces that act on the elbow during the throwing motion. These forces place tensile stress on medial structures, compression stress on lateral structures, and shear stress posteromedially. Identification of the disorder and provision of appropriate treatment requires an accurate history, a thorough physical examination, and adequate ancillary testing. Common diagnoses in…

Entrapment Neuropathies of the Arm, Elbow, and Forearm

Entrapment Neuropathies Entrapment neuropathy is a condition wherein compression, or external pressure applied to a nerve, alters function. Multiple potential etiologies exist, including a space-occupying lesion, inflammatory processes, edema, or compression via anatomic structures. Lesions can present as either acute or chronic conditions. If untreated, the sequelae of prolonged compression can result in permanent compromise of function. The median nerve at the wrist is the most…

Distal Biceps and Triceps Tendon Ruptures

Distal Biceps Tendon Rupture In 1941, Dobbie was the first to report the results of surgical reattachment of the distal biceps tendon. He recommended routine tenodesis of the biceps to the brachialis because of the risks associated with anatomic repair from the surrounding neurovascular structures within the antecubital fossa. Improved surgical techniques and a better understanding of the anatomy and biomechanics of the distal biceps tendon…

Elbow Tendinopathies and Bursitis

Lateral and medial epicondylitis are common elbow tendinopathies involving tendon origins that most commonly present in middle age. These are typically self-limited, with a multitude of conservative and operative options described. In contrast, biceps and triceps tendinitis are insertional tendinopathies. Finally, olecranon bursitis is an inflammation of the dorsal bursa at the elbow. This chapter will evaluate the literature and current evidence about diagnostic maneuvers and…

Elbow Arthroscopy

Arthroscopic and endoscopic techniques were first introduced in the early 1920s and have since revolutionized medical treatments, especially in the field of orthopedic surgery. Widespread application of arthroscopic techniques has been demonstrated in the shoulder and knee; however, its utility in the elbow has been slowly adopted. The elbow joint itself presents unique challenges because of its highly constrained nature and close proximity of neurovascular structures.…

Elbow Imaging

The elbow is a complex joint affected by a variety of pathologic conditions. Advanced imaging of the elbow with computed tomography (CT), magnetic resonance imaging (MRI), MR arthrography, and ultrasound (US) provide powerful tools for diagnosis; however, an understanding of the utility and limitations is required to select the optimal modality to answer each clinical question. Despite the availability of advanced imaging, conventional radiographs remain central…

Elbow Diagnosis and Decision-Making

Overview of Pathologies The key to diagnosing elbow injuries involves performing a thorough history and physical examination of the elbow. Additionally, to rule out referred pain, the surrounding areas such as the cervical spine, shoulder, wrist, and hand should also be examined. This chapter discusses the elements of a complete elbow history and physical examination, which would include inspection, palpation, range of motion (ROM), strength, neurologic…

Elbow Anatomy and Biomechanics

Elbow anatomy is complex, but knowledge of its intricate structural makeup is crucial to understanding athletic injuries in this area. Those who provide care for athletes, particularly athletes who participate in overhead-throwing sports, must have the ability to accurately diagnose and treat all forms of elbow injury and pathology. Accurate diagnosis and treatment require a thorough understanding of the interplay between the anatomy and function of…

Injury to the Acromioclavicular and Sternoclavicular Joints

Injuries to the acromioclavicular (AC) joint are common occurrences in the athletic patient population, with approximately 9% of all shoulder injuries involving the AC joint. Injuries to the sternoclavicular (SC) joint are less common, accounting for up to 3% of all shoulder girdle injuries. Damage to either of these joints can lead to significant limitations and pain; therefore it is critical for the orthopedic surgeon to…

Vascular Problems and Thoracic Outlet Syndrome

Vascular problems involving the shoulder are relatively uncommon, but they can result in pain, a profound deleterious effect on an athlete's performance, and, in rare cases, a potentially limb-threatening situation. Acute sports-related vascular injuries are most common in contact sports and can occur as a result of blunt or penetrating trauma. The possibility of penetration of a bone fragment in fractures underscores the need for the…