FROM OUR GUEST EDITOR
I am honoured to be the guest editor of this topic issue on Wrist & Hand of the Aspetar Sports Medicine Journal and most grateful for all experienced contributors giving their “top-of-the-notch” knowledge in the following articles.
Wrist and hand injuries among athletes, such as tennis players, golfers, handball players, rugby players, basketball players, and other contact sports athletes, are common.
Rigid fixation of different fractures, such as phalanx- and metacarpal fractures, with a possibility of quick return to play, is strongly recommended among athletes.
According to ongoing research projects, only 1 % of the total injuries among professional football players affect the hand, wrist and forearm.
But approximately 50% of those injuries affect the goalkeepers.
Outfield players can often return to training and matches in spite of an upper extremity injury. For example, wrist sprains and ligament-injuries, are therefore often underestimated in the acute phase, but the players can unfortunately experience severe problems, later on.
The human hand is a masterpiece – capable of both power grip as well as coordinated precision movements. Much of our personality also lay in the gestures and movements of the hand as well as communication with the surrounding world.
The body surface and muscles are not equally represented in the somatosensory (i.e. the palm of the hand represents 1 % of the total skin area) and motor cortex area in the brain. Instead the hand and face are represented in the somato-sensory and motor cortex by very large areas (the hand; perhaps as much as 20%), reflecting the large number of nerve cells needed for fine motor control and somato-sensory processing in these body parts, compared with for example the lower limbs or the torso.
Adolescents can nowadays earn thousands of USD competing in Gran Turismo and Fortnight, and addiction to gambling is unfortunately an increasing problem.
Nobody knows how the current increasing use of computers, smartphones and participating in eSports, will affect the hand and the brain among youngsters. Will we see increasing numbers of thumb base degenerative arthritis and trigger fingers – especially synovitis of the flexor pollicis tendon – in the future, due to overuse of smartphones, PlayStation, Nintendo and X-box?
We are looking forward to providing the region with our skills and knowledge and are aiming on having repeated courses for advanced training of surgeons in terms of injuries from the fingertip to the elbow at Aspetar, in the future.
This issue of Aspetar Sports Medicine Journal will display a vast area of knowledge about the wrist and hand, such as:
· Wrist arthroscopy, wrist ligament injuries and thumb base arthroscopy,
· Ligament injuries to the thumb,
· Thumb base fractures,
· Finger injuries among athletes,
· Scaphoid fractures,
· Proprioceptive neuro-muscular training of the wrist and hand,
· Hand rehabilitation after different injuries, and
· Flexor tendon injuries, written by my mentor dr Arvid Ejeskär.
Some take home messages:
· A negative result from MRI is unable to rule out the possibility of a clinically relevant wrist ligament injury (see the articles about wrist arthroscopy, scapholunate (SL) ligament injury and injury to the triangular fibrocartilage complex – TFCC). The current gold standard – wrist arthroscopy – remains the preferred diagnostic technique with sufficient conclusive properties when it comes to wrist ligament injuries. Wrist arthroscopy is a safe method (4.5% complication, mainly minor) and is the only method that can dynamically evaluate instability and healing capacity.
· 90% of the scaphoid waist fractures heal within 6 weeks of immobilization in a cast. CT is the preferred method of choice to evaluate healing.
· Anatomical reduction of intraarticular fractures, such as i.e. Bennett fractures of the base of thumb is mandatory, to reduce the risk of secondary degenerative arthritis.
· Do not forget the importance of what professor emeritus Göran Lundborg says in his books about the hand & brain; the hand is needed for full experience of our surroundings and development of our brain skills, as well as our emotions.
· Further information of the hand & brain can be found in the article about hand rehabilitation.
Enjoy this Targeted Topic issue of the Aspetar Sports Medicine Journal on Wrist & Hand!
Jonny K Andersson MD PhD
Senior Consultant Hand Surgery
Aspetar Orthopedic and Sports Medicine Hospital