WRIST INJURY - FOOTBALL

Abstract

HISTORY A 21-year-old intercollegiate football player at a Division III institution sustained a right wrist injury while engaged in a blocking drill at practice. During the drill the athlete's hand was in contact with an opposing player's shoulder-pads when a forceful unsuspecting blow was delivered to the player's wrist from another participant's helmet. During the blow the athlete's hand remained engaged with the shoulder-pads, and his wrist was forced into supination. The athlete felt multiple pops and developed an abrupt onset of pain over the distal radioulnar joint (DRUJ). A prominence of the distal ulna was noticed by the athlete (approximately 3cm). After noticing the deformity the player grasped the distal ulna with his left hand, squeezed forcefully, and the bone shifted into normal position. Following the play the athlete reported the injury to the athletic training staff. PHYSICAL EXAMINATION Initial evaluation by an athletic trainer revealed no deformity, moderate point tenderness over the distal ulna, and diminished wrist range-of-motion and strength. Because the athlete was scheduled to start in a football game in two days, immediate referral to an urgent care facility was initiated. The athlete was evaluated by a general practitioner, who obtained x-rays, and immediately consulted an orthopedic surgeon for an additional assessment. Further evaluation by the orthopedic surgeon revealed point tenderness, mild swelling over the volar and dorsal aspects of the wrist, and palmar laxity (which reproduced symptoms) surrounding the DRUJ. Wrist motion was also limited and painful. DIFFERENTIAL DIAGNOSIS Fracture of distal ulna. Wrist sprain and/or strain. Dislocation of DRUJ. TESTS AND RESULTS Wrist anterior-posterior and lateral radiographs were negative. FINAL/WORKING DIAGNOSIS Distal radioulnar joint dislocation. TREATMENT AND OUTCOMES Fitted with a Muenster long arm cast, which was padded for participation. Practiced the next day and played in a game 2 days post injury. Practiced and played with the padded cast for 4 weeks. Fitted with a Muenster-type orthosis 4 weeks post injury. Orthosis worn fulltime (except to shower) for the next two weeks. Six weeks post injury the orthosis was used on a limited basis (practice and games). Wrist mobilization and light resistance exercises were initiated and continued for 4 weeks. Brace was discontinued 10 weeks post injury, the athlete progressed through the rehab process and completed the season without further complications.