Friday, July 5, 2013

A Sports Injury

I went into see a teen-ager who had suffered an acute injury at school.  Amanda was a patient I was familiar with, she was very sports orientated, usually ending up playing at least two sports per school year.  She was known as the best volleyball spiker on her team and during the spring season she was involved in cross country running.  I could well imagine her bedroom wall.  It was most likely decorated with all of the local, regional and state awards she had won from her sports endeavors.  She was very smart, tall and lanky.  She was the type of teen-ager that any parent would be proud of, responsible, mature and focused on her school studies. 
“Hey, Amanda, what’s going on?”
“Sharon, I was getting ready to spike the volleyball last night during our tournament when I hit the ball the wrong way and all of the sudden I had this intense pain in my hand and wrist.  I tried to shake it off, but that didn’t work.  So I had my coach take me out of the game for the rest of the period and sat on the sidelines with an ice pack on it.  That helped, I also iced it last night at home.  But it still hurts today and I can’t make a fist with my hand without pain here in my arm.”
“Okay, well let me take a look at your arm.  You’re right handed aren’t you?”
“Yeah."
“Okay, well then let’s start with your showing me whether you can rotate your right arm back and forth.”
“I can do that, it hurts a little bit over my lower arm though.”
“Okay, well now can you fully extend your hand and then make a fist out of it?”
“I can extend my fingers, but I can’t make a fist, my third finger doesn’t want to cooperate.  It really hurts over the top part of my hand when I do that and it causes pain down my lower arm up to my elbow when I do it.”
“Okay, then try bending your hand back and forth.  Does that hurt?”
“Yeah, when I try to bend my hand in towards my wrist.  The same areas hurt.”
“Okay, when I tug on your third finger does that hurt?”
“Yeah, that hurts all the way down to my elbow.”
“Okay, well it looks as though you have tendonitis, you have sprained the tendon that serves your third finger.  I think it happened when you went for the ball and the ball forced your thrid finger backwards.  Your tendon to the third finger goes from the tip through your wrist and onto the elbow where it hooks into your radial bone.  It’s going to take about four weeks for your tendon to heal.  So if there is any more tournaments to be played with your volleyball team, I think that’s off the table.  I’m going to put your hand, wrist and lower arm into an ace wrap to help support it.  I want you to keep putting ice on your hand/wrist, 15 minutes on, 15 minutes off until tomorrow.  Then you can start applying heat, 15 minutes on, 15 minutes off.  You’ll find that if you keep your hand/wrist in the ace wrap it will help with the discomfort and prevent you from moving your finger.  I want you to take some motrin every day, try taking two over the counter strength tablets three times a day for the pain.  I also want you to slowly extend and flex your right hand several times a day to help slowly stretch out the tendon, which will help loosen it up.   It should take about four weeks before the tendon is totally healed, afterwhich you should be able to go back to your regular activities.  If it’s not healed by then, please come back in and be seen.  Any questions?”
“No, I don’t think so.   Although, how am I supposed to write in school?”
“Hmm, I think you’ll have to ask your teachers how they want to handle that.  It’s going to be cumbersome at best.   By the way how did your team do last night?”
“We won.  So we’re going onto the district tournament next weekend.”
“Oh, dear , they’re going to be playing next weekend without their best spiker.  Sorry about that.”
“Yeah, I know, bummers!”
“Alright, well there’s always next year, Amanda.  Do well, come back and see me if your arm doesn’t feel totally normal in about a month, okay?”
“Alright.”

I didn’t hear back from Amanda again through the rest of her school year.  She came in during the summer for her sports physical and told me that her tendonitis had healed up nicely and she was able to use her arm without any pain after about 3 weeks.  She had just finished school for the year and told me she had won the state cross country championship. 

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