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Boutonnière and Pulley Rupture in Elite Baseball Players
B o u t o n n i e` re a n d Pu l l e y R u p t u re i n E l i t e B a s e b a l l Pl a y e r s
Andrew J. Weiland, MD
PULLEY RUPTURE
BOUTONNIE`RE INJURIES
Pulley ruptures are not uncommon finger injuries in baseball pitchers and rock climbers. The long finger of the dominant hand is usually involved in baseball pitchers. The ring finger on either hand can be involved in rock climbers. The treatment of these injuries is the same for professional and amateur athletes. Treatment involves splinting and nonsteroidal antiinflammatory agents in the immediate postinjury phase. Operative treatment, in my experience, has never been indicated. Nonsteroidal antiinflammatory agents decrease inflammation, and the splint is used for the initial 4 to 10 days after the injury. The injuries are usually documented on magnetic resonance imaging and are distinguished from vincular tears, which cause bleeding in the flexor tendon sheath. Once pain and swelling has decreased, range-of-motion exercises are carried out without forestall gripping. I think steroid injections are contraindicated because they decrease the potential healing of the ruptured pulley. Pitchers can usually return to throwing in 4 to 6 weeks. I try to caution climbers to take at least 2 months off from vigorous rock climbing.
Traumatic boutonnie`re injuries are commonly seen in almost every sport, but basketball seems to be the primary culprit, followed by volleyball. For acute injuries, the preferred treatment is splinting of the proximal interphalangeal joint in extension for 5 to 6 weeks. While splinting is carried out, the therapist instructs the patients on flexion of the distal interphalangeal joints, so that extension contracture with tightening of the oblique retinacular ligaments does not occur. Return to play after injury is allowed if it does not obviate use of the splint. Basketball players are usually able to continue to play at a high level as noted in the recent 2011 National Basketball Association Championship tournament, where one of the players ended up playing with a splint on the proximal interphalangeal joint of his dominant hand. For the occasional baseball player that we see with this injury, deformity does not usually interfere with hitting or throwing. If the players are not concerned about cosmetic deformity, they can usually return to active play without splinting.
hand.theclinics.com
Hand Clin 28 (2012) 447 doi:10.1016/j.hcl.2012.05.045 0749-0712/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.
Andrew J. Weiland, MD
Andrew J. Weiland, MD
PULLEY RUPTURE
BOUTONNIE`RE INJURIES
Pulley ruptures are not uncommon finger injuries in baseball pitchers and rock climbers. The long finger of the dominant hand is usually involved in baseball pitchers. The ring finger on either hand can be involved in rock climbers. The treatment of these injuries is the same for professional and amateur athletes. Treatment involves splinting and nonsteroidal antiinflammatory agents in the immediate postinjury phase. Operative treatment, in my experience, has never been indicated. Nonsteroidal antiinflammatory agents decrease inflammation, and the splint is used for the initial 4 to 10 days after the injury. The injuries are usually documented on magnetic resonance imaging and are distinguished from vincular tears, which cause bleeding in the flexor tendon sheath. Once pain and swelling has decreased, range-of-motion exercises are carried out without forestall gripping. I think steroid injections are contraindicated because they decrease the potential healing of the ruptured pulley. Pitchers can usually return to throwing in 4 to 6 weeks. I try to caution climbers to take at least 2 months off from vigorous rock climbing.
Traumatic boutonnie`re injuries are commonly seen in almost every sport, but basketball seems to be the primary culprit, followed by volleyball. For acute injuries, the preferred treatment is splinting of the proximal interphalangeal joint in extension for 5 to 6 weeks. While splinting is carried out, the therapist instructs the patients on flexion of the distal interphalangeal joints, so that extension contracture with tightening of the oblique retinacular ligaments does not occur. Return to play after injury is allowed if it does not obviate use of the splint. Basketball players are usually able to continue to play at a high level as noted in the recent 2011 National Basketball Association Championship tournament, where one of the players ended up playing with a splint on the proximal interphalangeal joint of his dominant hand. For the occasional baseball player that we see with this injury, deformity does not usually interfere with hitting or throwing. If the players are not concerned about cosmetic deformity, they can usually return to active play without splinting.
hand.theclinics.com
Hand Clin 28 (2012) 447 doi:10.1016/j.hcl.2012.05.045 0749-0712/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.
Andrew J. Weiland, MD