Nice overview of the more common wrist injuries. I see a number of these types of injuries weekly in my practice and you’ve pretty much nailed it. Usually nothing serious if it’s just a sprain/strain, though, as you pointed out, those can hang around for weeks or months. Anyway, just thought I’d offer my take on a well-written post. I’m definitely not an orthopedic surgeon, but have always been interested in orthopedics; especially sports medicine. Good job on the xrays, too. Go Cards! and hurry back DeRosa!

Much like 2006 was The Year of the Oblique (which, before then, I had never heard of).

Great article by the way. Let’s hope that Ryan, DeRo and Mather all come back healthy.

but this is the Cards medical staff who’s handling all these injuries. i don’t trust one damn thing they do. they’ve burned us way too many times before. i wouldn’t be shocked at all if DeRo ends up coming back too soon, then requiring surgery to fix whatever is wrong with his wrist. it’s happened before & it will happen again till the FO cleans house & gets some real Dr’s in who know what they are doing.

as we have talked about before, a strain s/a DeRosa’s is graded on severity from mild(grade1) to moderate(grade 2) to severe(grade 3). The severity is based on the damage done to the structure and thus the time frame for return is affected by the severity of the injury. Grade 1 type injuries typically result in minimal to no lost time. Grade 2’s can be anywhere from 5 days to a couple weeks. Grade 3’s can require anywhere from 3 to 12 weeks or even longer (These are general numbers, time frames for different areas of the body could be different).

Wrist injuries s/a these we are dealing with are typically dealt with as we have seen- rest, ice, and anti-inflammatory drugs s/a ibuprofen. If this approach doesn’t work, the next step is corticosteriod injections with immobilization. And the final step, if all else fails, is surgery.

Where we (Physical Therapists) come in for these types of inflammation is in strengthening the surrounding musculature and helping to eliminate the inflammation. Also, figuring out why Boog (and DeRo is his is recurring) is having a repetitive injury and correcting the impairment is a key in preventing further damage. There are steps that could be taken, beyond just icing, that would help decrease the swelling and hopefully decrease these athletes time away from the game.

Aside- I concur that corticosteroids do not typically heal the pathology. But, that is not the goal of corticosteroids. They are administered to eliminate the inflammation and allow the natural healing process to do its thing. Part of the problem in Boog’s situation is the amount of time required for the condition to resolve after the injection is administered. He should be immobilized for a couple of weeks, not a few days. So, even if the injection is eliminating the inflammation in the joint, he is going right back to doing the activity that is causing the inflammation. Get it? Its a vicious cycle.

Hazel, how far along toward becoming an MD are you? I’m less than a year away from my DPT.

Those of you who warn against becoming a primary care physician- keep on the lookout for Direct Access to physical therapy. If it ever fully comes, you can skip going to a Dr and being diagnosed with “knee pain” and go straight to a PT who can actually help you. I would suggest that you contact your congressman about this, but, there are site rules against such things ;)

DeRo has taped his left wrist since his days with the Braves. (IIRC, at one time he did both, but now just does the left.) I don’t think it has anything to do with a wrist injury while swinging the bat (he says this is the first time it has ever happened to him). It is more likely just protection against grounders taking bad hops and hitting him in the wrist. Either that, or he just wants a remnant of his football days. :-)

isn’t a fractured scaphoid the most common wrist fracture (not the distal forearm)? I only know this because I did mine playing volleyball a few years ago…

since last time I have graduated medical school and am now a bonefide orthopedic surgery resident. I can weigh in on more of this later but quick hits as follows:

- our health care system certainly has lots of issues and tons of stuff gets done simply to cover yourself liability-wise in our fine litiginous society

- distal forearm fractures (radius, ulna, “Colles”, etc) really are not difficult to heal/fix or rehab from compared to “wrist” (carpal bones) or ligamentous injury… can be way worse

- scaphoid (one of the carpals and a comparable to Mather’s hamate) is classically a really hard one to get over because the blood supply to the bone is very tenuous. for the bone to heal it needs good nutrition, flow, etc, and if you’re unlucky enough to break it at this “watershed” area than you’re faced with some hard decisions.

- If you decide to treat it “conservatively” you immobilize the joint for a prolonged period and get serial radiology exams and you keep your fingers crossed that things start fusing back together. This healing process can either go to “union” (hooray – good as new), “malunion” (didn’t heal in the right position), or “nonunion” (didn’t heal, isn’t going to heal. This typically means you’ve got at minimum a layer almost of dead or devitalized bone abutting another dead or devitalized layer… causing persistent pain/dysfunction/disability).

- Sometimes a player will opt for foregoing the “maybe this will heal on it’s own” phase and go straight to the OR where they will try to roughen up the edges and oppose them more precisely, helping generate better blood flow and then often fixing them back together with a screw that (hopefully) can remain. When Hazel talked about having to remove part of the bone that could either be that that bony portion is dead (infection risk, arthritis risk) or it could have failed either conservative therapy or an initial surgery. sometimes they heal but the screw causes too much discomfort or biomechanical dysruption on its own. One would not have to remove the bone to restore blood to the surrounding area though.

- ligamentous injuries are scary in the wrist. count me as being very concerned regarding our guys trying to play through these injuries. one swing can undo a lot of healing time.

This is not coming out in any sort of coherent progression. I’ll try to weigh in on specific questions later.

I’m shocked at all the medical personnel that showed up for this thread. I had no idea the number and qualifications in the VEB readership. I’m probably among the least qualified of anyone here to write about this, so thanks everyone.

P.S. Anyone want to write me a Med School recommendation letter?

Paletta did not examine DeRosa immediately after the initial injury, which the player said included a "pop" within the wrist. The Cardinals scheduled Monday’s follow-up exam while the team was in Cincinnati last weekend.

http://www.stltoday.com/blogzone/commishs-hot-stove/commishs-hot-stove/cardinal-beat-updates/2009/07/mo-derosa-dl-move-precautionary/

Instead, Paletta followed his usual procedure of having a monkey examine the player and come up with a diagnosis and treatment plan.

I was at Fenway last night. It was Nomar Garciaparra’s first trip back to Fenway since being traded in 2004.

Nomar had a Hall of Fame start to his career, but got sidelined by chronic wrist problems after getting hit by a pitch in 1999. Early in the 2001 season, he underwent surgery for a split wrist tendon. The results of the surgery were not great, and he’s been on and off the DL since then, mostly with problems related to said wrist. His power also decreased over time (some may point to possible PED usage, but the chronic wrist injury also played a big role).

There are six synovial sheaths on the back side of the wrist. The reason we have these are to reduce friction for the extensor tendons as they travel down to their respective attachment locations. It is not uncommon for synovial cysts to form around the extensor sheaths, and can even “communicate” with them. These cysts are usually no big deal and have absolutely nothing to do with what DeRo has going on. I’ve looked for about an hour for further information on injuries to the sheaths and I cant find anything of value that would relate to what DeRosa has going on.

After listening to DeRosa’s pregame interview, I heard him say “tear” in the “sheath” that “holds ligaments together”

There are a number of sheaths labeled, but the common sheath is the large one that starts just below the transverse carpal ligament and extends under it and into the hand. He could also be referring to the transverse carpal ligament itself. Just speculating now- deep structures of the hand are well out of my area of expertise.