Category Archives: Wrist/Hand

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Chimezie Metu Wrist Fracture

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Sant Antonio Spurs player Chimezie Metu fractured his left wrist when he fell onto it while playing during the Las Vegas Summer League on July 8, 2018.

The most common wrist bones to fracture are the scaphoid (one of 8 small bones that act like ball bearings) and the distal (towards the hand, away from the body) part of the radius bone (the seat of the wrist).  Media reports did not state which bone was broken.

If the bones are out of place, surgery using metal fasteners (e.g. a screw or plate and screws) might be considered to hold the bones in place. The scaphoid bone is sometimes secured with a screw even if it is not out of place, in part because it is notorious for healing problems.  

Media reports indicate that Chimezie Metu’s fracture will be treated without surgery.  His wrist is casted. Fractures are usually ready for full sports (80-90% strength) after about 3 months. Complete healing takes a year.  He is expected to play this fall during training camp.

This blog was written by Ramla Kiyar and David Ring.

All Blogs, Basketball, Wrist/Hand

Lebron James Right Hand Bone Contusion

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Following Game 4 of the NBA Finals, LeBron James revealed he had suffered what was described as “a deep bone contusion” on his right hand right after Game 1 when he punched a black board in the locker room.

Punching usually injures the metacarpal bone of the small finger. The head (end) of the metacarpal forms your knuckle when you make a fist.

An MRI was done, which suggests that radiographs were normal. Two MRIs were done with the explanation that the contusion was only visible when some of the swelling went down. Swelling should not affect diagnosis of fracture on an MRI so it is unclear why two exams were ordered.  For most people a normal radiograph would be sufficient. One non-concerning MRI would be more than enough. A contusion that is difficult to see on MRI is quite minor. A bone contusion means that the bone is injured, but remains structurally sound.

The body heals a bone bruise without immobilization or projection.  It’s better to keep the hand moving to limit stiffness and swelling.

Bone bruises are painful. The bone may be a little weaker due to microscopic damage, but only for a month or two. It’s safe to play.

This blog was written by Paul Bonilla and David Ring.

All Blogs, Wrist/Hand

David Price Carpal Tunnel Syndrome

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David Price, pitcher for the Red Sox, had not been as effective as usual early this year. He is reportedly experiencing numbness in this throwing hand and is being evaluated for carpal tunnel syndrome. David Price was out from May 3rd until May 12 when he started, threw effectively and won in Toronto.
Current best evidence suggests that some of us are born with narrower wrist (carpal) tunnels where the tendons and nerves pass into the hand. This tunnel is like the ring on a fishing rod—holding the tendons and nerves in place. If you are born with a narrower tunnel, eventually you may start to have problems with the nerve that passes through the tunnel. The role of activity in causing or worsening carpal tunnel syndrome is highly debatable (Lozano-Calderón, S., Anthony, S., & Ring, D.).
Media reports have emphasized David’s love of video gaming and suggested that it might be contributing to the carpal tunnel syndrome. Although he rightly questions this association as not based on scientific evidence, he will be giving up his favorite game for the time being in order to limit this distraction.
Carpal tunnel is a result of compression on the median nerve as it passes into the hand. This nerve runs along the palm side of your hand—referred to as the carpal tunnel. This nerve allows for feeling in the thumb, pointer finger, and parts of the ring finger. When compressed, this affects the ability to feel causing numbness. Swelling of the wrist causes this compression leading to numbness, tingling, and weakness. Pain may occur with extreme pressure.
Price hopes to avoid surgery and is opting for an “acupuncture-like procedure”. This is outside of best scientific evidence. Splints that keep the wrist from bending can limit night-time numbness (the classic symptom of carpal tunnel syndrome). There are no other proved palliative (symptom relieving) treatments. The only treatment that can prevent progression of the disease (carpal tunnel syndrome can cause permanent nerve damage) is surgery to release the transverse carpal ligament.

This Article was made by Alexa Ryder and Dr. David Ring.
Citations:
Lozano-Calderón, S., Anthony, S., & Ring, D. (2008). The Quality and Strength of Evidence for Etiology: Example of Carpal Tunnel Syndrome. The Journal of Hand Surgery, 33(4), 525-538. doi:10.1016/j.jhsa.2008.01.004