Aug. 30, 2004

Heath C. Thornton, M.D.
Team Physician
Wake Forest University Sports Medicine

One of the unique features of human beings that separate them from so many other living creatures is the human hand. Our ability to utilize the hand and fingers to manipulate and control has allowed us to create, invent, refine, and...play!

One of many sports that require the fine and firm control of hand and fingers is field hockey. At the same time, due to the nature of the sport, the hand is a relatively common part of the body exposed to injury. Be it the opponent's stick, the game ball, a teammates shoe or the turf played on, all are culprits to various injuries to the hands of field hockey players.

The hand and fingers have many bones, joints, ligaments and tendons which equates to many different types of possible injuries. A study published in 2001 found that the majority of fractures reported by field hockey players were in the hand and fingers. While fractures also topped the list of hand and finger injuries, there were various injuries reported.

While it is not possible to discuss all the possible injuries in this article, some general categories are important to address as proper recognition and treatment will maximized speed of return to play and long term function.

Finger fractures
Most finger fractures are relatively stable and minor. They require little more than buddy-taping, splinting, and protecting from re-injury. These types of fractures are sometimes referred to as hairline fractures, small avulsion fractures, and non-displaced fractures.

Not infrequently, however, fractures can be more severe and unstable, and at increased risk of becoming worse. Fractures that involve the finger joints, that have the two fractured pieces significantly separated, and that are considered "open" (skin is cut open to expose the fracture) are all considered unstable and more severe.

If the fracture falls in the second category, evaluation by a physician trained in fracture care is important. These fractures many times require surgical treatment.

The consequences of improper treatment are loss of full movement of finger joints, loss of fine control of finger, decreased grip strength, and chronic pain. Therefore, it's very important to properly identify these injuries. These injuries may not seem important at first but think of all the time we use our fingers in our everyday lives.

Hand fractures
While finger fractures are relatively easy to see due to the separation of the fingers and mostly being composed of bones, it can be challenging to diagnose hand fractures since the bones are surrounded by soft tissue (muscle, tendons, ligaments, and fat) and are grouped together within the hand. The hand contains 8 small bones (Carpals) connecting the wrist to the hand and 5 "long" bones (Metacarpals) which connect the hand to the fingers.

Due to the exposure to sticks and the hockey ball, the long bones are more commonly fractured. A fall on an outstretched hand is the most common way carpal bones are injured. Just as with the fingers, a metacarpal or carpal fracture can be stable and minor or unstable and severe. The same principles of treatment apply to both.

However, casting the hand and wrist for hand fractures is commonly used to maximize stabilization and, thus, healing of the fractures. This is especially true of carpal fractures since several of the carpal bones have limited blood supplies and are at risk of irreversible damage if not treated appropriately. Any "sprained" or "bruised" wrist or hand that is not improving over one week should be carefully evaluated by a physician.

Finger tendon and ligament injuries
Tendons (which connect muscle to bone) and ligaments (which connect bone to bone) serve as the primary stabilizers and functional control of the fingers and hand. As such, they are at risk for various injuries including sprains, strains, and complete tears or ruptures. Ice, anti-inflammatory medication, and buddy-taping are the treatments of choice for most sprains and strains, commonly known as "jammed fingers".

Additional treatment, however, is required in unstable sprains and strains and in complete tears of ligaments or ruptures of tendons. The results of not properly treating these more severe injuries include loss of strength, loss of function, contractures leading to malformations of the fingers, and increased risk of recurrent injuries.

If diagnosed early, most of these severe injuries can be treated with non-surgical techniques, including splinting. Longer treatment duration is required than for minor injuries. Inconsistent compliance with recommended treatment tends to lead to even longer recovery and poorer outcomes. If conservative treatment fails, surgery may be needed.

Evaluation by a certified athletic trainer and/or physician should be sought if: (1) an injury to a finger is worsening or not improving over a 2 week period; (2) the finger has loss of motion or strength; (3) there is a change in normal position of finger. These are all possible signs of a more serious injury.

Finally, a quick note on prevention of hand and finger injuries. You may have noticed that field hockey is one of the few "stick and ball" sports which do not require protective hand gear. The International Hockey Federation's Rules of Hockey states:

"Field players are permitted to wear gloves for protection which do not increase the natural size of the hands significantly."

The NCAA rules do not change this "permission" and thus do not require the use of gloves.

At the 2004 Annual Meeting of the American Medical Society of Sports Medicine, Dr. Brian J. Sennet presented an ongoing study at the University of Pennsylvania related to hand and wrist injuries in field hockey. Initial information suggested that significant participation time was lost due to injuries to the wrist, hand and fingers. A significant decrease in injuries with use of protective hand gear was also seen.

While there are many questions still unanswered concerning the effectiveness and consequences of this type of protective equipment, field hockey players of all ages should consider protective gloves as a means to potentially reducing the risk of serious injury to hands and fingers.