Sports Injuries
Pronator Syndrome
Definition
Compressive neuropathy (dysfunction) of the median nerve at the level of the elbow that creates paresthesia (pins-and-needles) in the thumb, index, middle finger, and radial half (thumb side) of the ring finger.
Symptoms
- Aching pain over the proximal volar aspect (inside or palm side) of the forearm.
- Includes sensory symptoms into the palm of the hand.
- Symptoms increase with repetitive pronosupination (rotation) of the forearm.
- Unlike carpal tunnel syndrome, symptoms are typically not present at night.
Pathology
- Compressive entrapment of the medial nerve at one or more of five potential sites.
- Commonly associated with medial epicondylitis, a form of tendonitis known as golfer’s elbow.
Treatment
Non-surgical
- Rest, activity modifications, removable splint, ice and NSAIDs (ibuprofen).
- Removable splint should avoid forearm rotation.
Surgical
- Indicated when non-operative treatment fails.
- Surgical decompression of the median nerve at all 5 possible sites of compression.
Mallet Finger
Definition
Extensor tendon disruption/rupture with or without an associated small dorsal (top of finger) fracture of the base the distal phalanx (last bone of each finger).
Symptoms
- Pain and swelling at the very distal (top) joint of the finger.
- Extension lag (drooping) of the finger with the inability to fully straighten.
Pathology
- Traumatic in nature (caused by a direct blow to tip of finger or laceration to top of finger).
- Common in athletic activity when a ball strikes the tip of the finger.
- Tear/avulsion of the extensor tendon with or without an associated fracture.
Treatment
Non-surgical
- Strict immobilization/splinting in full extension for at least 6-8 weeks.
- An additional 4-6 weeks of nighttime splinting.
Surgical
- Indicated when non-operative treatment fails.
- Mallet fingers that involve a phalanx fracture of more than 50% of the joint surface.