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Common injuries in volleyball. Mechanisms of injury, prevention and rehabilitation.

Volleyball has become an extremely popular participation sport worldwide. Fortunately, the incidence of serious injury is relatively low. The sport-specific activity most commonly associated with injury is blocking. Ankle sprains are the most common acute injury. Recurrent sprains may be less likely to occur if an ankle orthosis is worn. Patellar tendinitis represents the most common overuse injury, although shoulder tendinitis secondary to the overhead activities of spiking and serving is also commonly seen. An unusual shoulder injury involving the distal branch of the suprascapular nerve which innervates the infraspinatus muscle has been increasingly described in volleyball players in recent years. Hand injuries, usually occurring while blocking, are the next most common group of injuries. Fortunately, severe knee ligament injuries are rare in volleyball. However, anterior crutiate ligament injury is more likely to occur in female players. Many of these injuries may be preventable with close attention to technique in sport-specific skills and some fairly simple preventive interventions.

Ankle Injuries↗

High-pressure injection injuries of the hand.

While often innocuous at presentation, high-pressure injection injuries can lead to devastating consequences. Stiffness, chronic pain, infection, and even amputation can occur, with amputation rates ranging between 16% and 48%. Early surgical decompression and debridement are the cornerstones of treatment.

Adult↗

[Flap resection and split-thickness skin transplantation as a method of flap correction of the hand].

Hand injuries involving extensive skin loss and soft-tissue destruction in depth will require flap coverage. Once successful grafting has taken place, however, the thickness of the flap often necessitates further surgical intervention for reasons of good function and cosmesis. A surgical regime is described in which the healed flap is partially removed, leaving a healthy surface upon which split-thickness grafts are applied. During the years 1991 and 1992, 21 patients have been treated according to this method in our department. The technique and results of 16 of these 21 cases are described.

Adult↗

Small joint injuries of the hand. Dynamic and functional implications.

An injury to one of the small joints of the hand may have a major impact on hand function and thus have major implications for career and avocation. Proper treatment demands a knowledge of hand anatomy and dynamic function. Proper primary treatment usually yields better results than attempted late reconstruction; however, even with the best of primary care, long-range significant disability may result.

Hand Injuries↗

Glass injuries of the hand in children.

One hundred children with glass injuries to the hand were studied with an average follow-up of twenty-two months. Fifty-two had involvement of deep structures. The treatment and results are discussed.

Child↗

A unique case of high-pressure injection injury of the hand.

A unique case of high-pressure injury to the hand is described with extension of the injectate to the elbow. Diagnosis includes the need for high levels of suspicion and evaluation by radiography. Meticulous debridement and copious saline lavage, and decompression of the carpal tunnel space, followed by split-thickness grafting, were successful in this case.

Adult↗

Pneumomediastinum after injection injury to the hand.

Pneumomediastinum as a consequence of injection injury to the hand has not been previously reported. We present a 22-year-old male who developed pneumomediastinum when a high pressure hose injected air into his hand. The anatomic continuity between peripheral ulnar neurovascular bundle and the hilar vessels provided the route for air entering the hypothenar eminence to penetrate the mediastinum. After ruling out life-threatening causes of pneumomediastinum such as esophageal perforation, his management included observation and serial radiographs. By one week there was complete resolution of the mediastinal air. This report demonstrates that pneumomediastinum may be associated with air injection injury of the hand, and that expectant management is appropriate.

Adult↗

[Primary management of flexor tendon injuries of the hand].

The repair of interrupted flexor tendons of the hand and their return to satisfactory function has been one of the most difficult and challenging tasks and problems even for the hand surgeon. Accordingly, nearly all publications have dealt with suture techniques, suture material and even the number of knots with regard to vascularization, course of sheaths and biology of healing. The aim of all surgical intentions is intrinsic healing, with as few adhesions as possible. On the one hand, this requires non-traumatic treatment of the tendon, respecting the dorsally located blood support and, on the other, early motion, jeopardizing the continuity of sutures. These diametrical requirements are the crux of flexor tendon surgery. Many authors-including-prefer a combination of Kleinerts intratendinously knotted suture with Ikuta's technique with the knot sunk below the tendon surface. Closure of the severed sheath is recommended, as is reconstruction of both tendons, provided that both are injured. The repair of partial lacerations is different, however. Kleinert's early motion treatment in the rubber-hand-protected flexion position is the postoperative management that has the most acceptance. In two consecutive follow-up studies (1974-1987 and 1988-1994) of 253 patients with 348 injured fingers, we achieved excellent and good results in 84.8% in the earlier group and in only 80.3% in the later one, which involved more surgeons with varying amounts of experience in hand surgery.

Finger Injuries↗

Left-hand dominance and hand trauma.

To investigate the relationship between hand dominance and the risk of major hand injury, the case records of 125 patients who had been treated for digital amputation were retrospectively reviewed. A second group of 116 patients treated for minor hand trauma was similarly evaluated. The incidence of left-hand dominance among the digital amputation group was 35%, and among the minor trauma group the incidence was 11%. The left-handed were more likely to have an amputating injury of their dominant hand than were the right-handed (70% compared with 51%, respectively). The most common mechanism of amputating injury was by power saw. The present data suggest that left-handed individuals have a relative risk of sustaining an amputating injury that is 4.9 times greater than the right-handed individuals, while minor hand trauma occurs at rates proportional to the distribution of left handedness within the population. Additional safety measures and the redesigning of tools, assembly lines, and workstations are recommended to help decrease the incidence of serious hand injury among left-handed individuals.

Accidents, Occupational↗

Injuries to the hand and wrist.

Because sports-related injuries to the hand and wrist are relatively frequent and lead to significant disability if misdiagnosed or improperly treated, it is important to identify the specific nature of such an injury to reach an accurate diagnosis and administer appropriate treatment. The author advocates an initial three-step process that may help the clinician to effectively diagnose and treat injuries: listen to the description of injury mechanisms; observe the site of injury; palpate the area for tenderness or instability.

Adolescent↗

[2-stage flexor tendon transplantation].

Staged flexor tendon repair utilizing temporary silastic rod implants has proved to be an effective method for restoring the grip function of severely injuried hands. Since its inauguration by CARROLL and BASSETT in 1958 this method has been successfully practiced by numerous hand surgeons. In this review the patho-physiological principles of the development of the so-called "pseudo tendon sheath" are described. The various findings as far as the formation of the new tendon sheath is concerned, are presented. The theories about incorporation of the subsequent graft and its revascularization are described. Following a detailed description of the surgical procedure our own results with 272 silastic rod implants in 184 patients are presented. Because of the kind of patients selected for the procedure, excellent results were not obtained. However, in 62% of cases results were graded "good" and in 23%, "satisfactory", while 15% were "poor". It seems to be justified to utilize two-stage flexor tendon repair for restoring grip function in severely injured hands in spite of the considerably high technical requirements, the prolonged course of rehabilitation and consequently increased cost of treatment.

Adolescent↗

The posterior interosseous reverse flap: experience with 113 flaps.

The authors have used a posterior interosseous flap for resurfacing in 113 cases of hand injury during the past 13 years. Its main indications were complex hand trauma or burn injuries with large skin loss, either acute or postprimary. Flaps survived completely in 98 patients. Twelve patients had superficial necrosis of the distal part of the flap, which did not require additional surgical procedures. Three flaps were lost and alternative coverage was used. Six patients demonstrated paralysis of the motor branch to the extensor muscles of the wrist or fingers (generally to the extensor carpi ulnaris, the extensor digiti quinti, or the extensor pollicis longus). All recovered completely within 6 months. The donor area was closed directly in 3 to 4-cm-wide flaps, leaving an inconspicuous scar. Larger flaps required skin grafting. Donor site morbidity was minimal. Major anatomic variations precluding the use of the flap were encountered twice in this series.

Adolescent↗