CEU: Hand Injuries: Anatomy, Management, & Return to Play - 206

Hey, this is Sandy. And Randy? And we're here on AT Corner. Being an Athi trainer comes with ups and downs, and we're here to showcase it all. Join us as we share our world in sports medicine. Welcome back to another episode of AT Corner. For this week's episode, we have a handy dandy See you episode. From Randy and Sandy, I had to do, I had to do that. Man, that works. Man, that was a great way to start this bad boy. So what are we talking about

today? We're going to talk about hand injuries and there's no sleight of hand here. I wish I had something to come back from that, but I I don't. Man, I didn't realize there were so many hand jokes that you can do until just now apparently. And we're just getting started. So this is ACU episode if you're interested in that. Thank you so much to Clinically Pressed and athletic training

chat. If you are listening to this as it comes out, it is a free category ACU if you if it is a little bit older, it is purchasable. And for National Athletic Training Month, all of our Cus through Clinically Pressed are 25% off using code and ATM 25 Sweet. If you're interested, the link is down below in the show notes or the description wherever you're listening to this. So for this episode, we will be talking about the anatomy relevant to hand injuries.

So of course got to talk about the anatomy of the hand. We're going to describe some of the management of some common hand injuries and then we're going to just kind of discuss some kind of return to play considerations for these kind of hand injuries. I feel like hand injuries are those ones that are so important to the person who's dealing with it, but I feel like to an out in an outside perspective, like a coach or a teammate, they're like, it's just your hand.

Oh yes, I'm never going to forget. I've had a coach before with one of my athletes having a a like a finger injury hit him with it's just a finger. No. What do you what do you use most often during the day? Yes, and then let's not forget Ronnie Lott, famous Niners safety. I can't remember what the actual injury was, but cut off part of his finger so he can return to play sooner. So I think that's where it really stems from.

That's just a finger. So this evidence based episode brings you amputation as the primary treatment. Option maybe what not to do? So what is the anatomy we're talking? About yeah, so for for injuries of the hand, it's really interesting. Like a lot of the literature really focused like on the fingers. I mean, obviously there's other stuff that can go go on in the hand. And then like it's also really hard 'cause it's like hand and wrist get kind of lumped in together.

And then again, same with the fingers, right? So we're really kind of focusing more on the fingers 'cause I feel like there's more going on there that we can kind of deal with. Like mostly the forefingers. Yeah, yeah, we're we took out the thumbs for this one. So the the first Phalangi is is not in this episode that. May be a different. Episode yes, there's. Enough going on with that appendage.

For sure. And I think too, like with like finger injuries, I feel like there's a lot more that we can kind of play with and there's a lot more considerations and maybe just truly the hand itself, because really there's like the metacarpals and it's like, what are you going to do? All right. Like if it's a fracture, like we kind of have an idea there. So I think the fingers was kind of a nice one to kind of talk about. And with the fingers, there's a lot of tendons and ligaments

that are actually around the fingers that made it very interesting. And I feel like in school, we I don't feel like we really talked about it that much about how complex the anatomy of the fingers actually are, at least from what I remember. I was just like, yeah, you. They're like my favorite was like, they're like mini knees. And I'm like, oh, but there's a lot more going on than just mini knees. That's happening. OK, but you have therapists who are literally for the just for

the hand. Yeah, and and that's why you have surgeons that specialize in the hand, right, Right. So, yeah, no, it's true. Like there's a reason why there's a special specialty because there is so much to

consider and go on that. I think it's important as athletic trainers to know that like it's OK if you don't feel like you're the expert on the hand and fingers, but it's good to have an idea of I may not be the expert and I might need a little assistance with this and know who to go to and how to help facilitate. Exactly. And that's what that's what we're here for. For sure. So of course, we're going to

talk about the phalanges, right? And of course, we kind of know the basic right that you have the proximal middle and distal failings, right? And then those bones kind of articulate to make up your proximal interphalangeal joint and then your distal interphalangeal joint. How do you remember those? For our students, the way I remember it is the DIP I. Just I just know DIP&PIP.

I could never, I would always mix them up so the DIP how I remember it is like if you dip your finger in water like. That's genius. That's the first part that that's the first joint. That's genius. You just dip your finger. So what do you dip? The DIP, it's the other one. It's the one that's not been dipped. I've heard something really good but I can't remember it. I just remember. That's that's pretty good. I just remember proximal is

proximal. Yeah. Well, you have to like think about that one. No, I like that, that dip one, that's pretty dope. And then of course, these these joints are protected by a collateral ligament. So this is where the idea comes in like, oh, they're like mini knees, which in a way they kind of are. But what was also interesting is there's kind of two sections of this collateral ligament of

these collateral ligaments. And again, I feel like this isn't like, I don't, I don't remember talking about this in school. So you have the kind of like what's referred to as the proper collateral ligament, which this is where anatomy always gets crazy because that's abbreviated PCL. Oh yeah. PCL of the finger. Yes. And this actually stabilizes more in kind of flexion, especially like kind of like like the deeper flexion you go and you'd really isolate. This is on both medial and

lateral. Yes, OK. And then you have the accessory collateral ligament or your ACL in the finger. That is so funny how that works. Yes. And this stabilizes in extension, right. So you can kind of already start to kind of think about your evaluation of the collateral ligaments as far as, again, it's like a mini LCLMCL kind of thing where you test valgus varus in extension and 30° of flexion to kind of isolate each each structure.

These joints are also protected by what's referred to as the volar plate, right? So that's more on the Palmer side. And literally it's like a kind of a sheet of tendon that kind of spans that joint on the Palmer side. And this kind of helps protect against that hyperextension. Which you can also get irritated or in the way when a dislocation occurs. Absolutely, and that's what it's trying to help prevent is those dislocations. Sometimes that doesn't happen.

Yeah, sometimes it just gets in the way. In the proximal interphalangeal joint, there is what's referred to as the central slip. This kind of supports that dorsal aspect of the joint and really prevents kind of volar subluxation and dislocation as well. All right. So that's kind of giving you that kind of dorsal protection for the joint.

And then in the distal interphalangeal joint, right, you have what's referred, which I thought was interesting because again, like I feel like when you look at anatomy text or like kind of how we like talk about like the extensor tendons, like it makes it sound like, oh, the extensor tendon just runs all the way to that distal distal phalanx and just starts pulling on it. But this is actually a whole more complex where the extensor digitorum tendon actually as it

runs down into the actual finger, it actually like breaks off into like 3 different branches. All right. Part of it comes into the central slip and then other sections of it actually go into what's referred to at these lateral bands. And all it is, is like like 2 bands, not like 2 bands going kind of lateral and like attaching to the distal failings like they almost attach like in AV kind of pattern. That's why that's where, like Boutonniere.

Yeah, and that's how you get those kind of formations from like how you get like the weird swan neck boutonniere, pseudo boutonniere is like cause of reasons like that, cause of it's not just one continuous tendon. It actually separates and kind of goes through different bands to actually get there. It was pretty. It was really interesting. That is pretty cool. Another thing that I learned from this reading, again, I learned a lot from this bad boy,

is there's actually like a system called the flexor pulley system and basically what these are just like kind of little mini retinaculums that hold the flexor tendons basically against the phalange. This is what climbers talk about all the time. Rock climbers. What I mean, yes, because this is important for this and we'll talk about it during the injuries, but I was like, I've never, I feel like I've never heard of this. You have not looked at climbing injuries.

I have not, apparently. Well, because I don't have a lot of climbers. You are a climber. I am, I am not. Doing not someone who's been injured, not someone who's injured their flexor pulleys. Yes, knock on wood, but I'm also not doing the climbs that are really going to fire this bad boy, which we'll talk about, we'll talk about injuries. But essentially they're just kind of right neck and that kind of run from basically the MCP.

And they kind of they're in different sections all the way to the DIP and you can kind of break them down into zones and that it's basically from A1 to A5 S A1 is basically on the Palmer side of the MCP joint. A 2 is on the Palmer side of the proximal phalanx. A three is on the Palmer side of the PIPA, 4 Palmer side of metal phalanx and then a 5 is that Palmer side of the DIP. All right, so those are areas where the flexor pulleys are the most common sites.

Just kind of see injuries to the flexor pulleys tend to be A2 and A4. So like right along those proximal or right along those phalanx, the Palmer side of the phalanx. Exactly. Yep. Which kind of makes sense because like at the joints it seems like it has a little bit more support. Yeah. And there's a lot more kind of going on. Obviously, there's more motion there, whereas over the face there's not necessarily motion. You're literally just rocking

with tension, right? Yeah. So now that we kind of have that kind of baseline anatomy right now, we're kind of going to the actual pathologies of the hands. And anytime you're talking about hand finger stuff, there could definitely be just countless injuries, right? Again, there's a lot of deform like like dysfunction misformations like swan necks and stuff like that, right? And it's actually kind of interesting how like the hand and wrist, you really don't think about it.

But I feel like like it does make up a lot of injuries. And some reports have shown like around 25% of all sport injuries are hand and wrist. I mean, honestly, I don't know about all sports, but I see it a lot in football. I've been seeing it a lot because of now I do have a lot more hand required sports but I've over the past few years I've seen it a lot with between volleyball and basketball. I would. I could see basketball. I haven't seen any. I don't think I've seen any in

volleyball. Maybe like 1? All all my blockers, man. Interesting. I could. I mean, I could see it. I just haven't really experienced that. But you know my stunt performers, I've had a lot of finger. Injuries. Oh, interesting. I mean, I guess I see it right hand going to the ground and just going on people. I could see that. Or like any other like fights? Yeah, true. Or if they're like passing some sort of prop back and forth to one another.

Yeah, for sure. So, so kind of for this episode, we're really kind of focusing on a little bit more of the common ones that I feel like you're going to like feel like or probably more common to see. First one was kind of Jersey finger. This is the rupture of the

flexor digitorum profundus, and this is really caused by any forced extension of a finger that's flexed, right? So the reason it's called jersey finger is like, oh, you going up against another athlete on their jersey, right? They pull away and it forces you into that extension while you're like gripping. That's basically the mechanism. And what's actually interesting is it it is divided into kind of four types. So a type 1 jersey finger is basically the tendon retracts to the palm.

Oh gosh. Normally you don't think type 1 is, so is is usually like oh, that's minor. Right. You think like grade one, but like no. No, Type 1 is just 100 real quick. Yeah. And the problem with this one is the blood supply to that tendon is obviously compromised because of how much damage has been done. All right, so the, the tendon and the blood supply is very just kind of like delicate in

this area. So when you have something that significant, right, that blood supply has been disrupted and it it could lead to it just is going to have a poor, more poor prognosis. All right, type 2, the tendon is going to retract just to the level of the PIP. What's nice about this is blood supply still pretty intact. So it has a pretty good healing potential. I love how we went from the palm to the PIP. Yes, Type 3. You kind of get an avulsion

fracture with this one. So the tendon actually is pulling a chunk of the bone off. What's kind of interesting about this one is it actually gets stuck at the A4 pulley, so it can't retract any further because it got stuck. That's where the phalanx one of the failings. Yes, that would be what would be, I think that was. The proximal. The middle, yeah, that'd be the middle failing, so it doesn't have a chance to go much

further. And then type 4, basically you get an avulsion fracture and then the tendon actually pulls away from that fracture. So it's a combination of like a Type 1 and type 3. Wow. Yeah, that's a lot of damage that happened on. That one. Seriously. So type 1 and type 4 like no go like those are. Yeah, those are bad news. They're all bad news. Yes, they're all bad those. Are definitely bad news.

So when you're evaluating this, this patient, right, you're going to probably you're going to see some swelling, there's going to be some pain, there might be some ecchymosis as well. But obviously the biggest thing that really identifies this is just that DIP flexion just dysfunction, all right? So you're not really going to see the DIP want to go into flexion because obviously there's no connection there that's pulling it anymore.

But one thing that is interesting to kind of consider is when you ask the patient so to do this, like ideally, right, you should stabilize the middle and proximal phalanx and then ask for DIP flexion. In some cases, like in a type 3, you actually might see slight flexion, right? So what they've kind of advocated for is add slight resistance to see how that kind of strength is, because if you add slight resistance with a type 3, you should just overcome

that really easily. Wait, what do you mean? Like you might see some flexion, so they might be able to flex a little bit they. Might be able to flex it a little. Bit if they have an evulsion fracture, they. Might be able to, yeah. Because of how far it because of where it got stuck, it still might be able. To create it because it gets stuck, you know? Yeah, it.

Still might create the motion. So that's why they advocate for slight resistance, because if you had resistance, they they shouldn't be able to resist you because there's no pull on that DIP, but it's the pull and the pulley that is what was creating that. OK. Yeah. So if you actually had the resistance, you'll be like way overpowering them. And then you'll know, oh, it's probably a Type 3 Jersey finger. Yeah, I guess your fingers are pretty strong.

Yeah, yeah. So if you do see that and you like you see, oh, it's slightly flex, but you're like, this is weird, add a little resistance to it and if it if they're able to resist it, you can probably feel good. It's not a Jersey finger, but if you're like Pew, probably Jerseyfinger. So the management of Jerseyfinger, it pretty much tends to be surgically managed. And a lot of stuff has advocated like surgery as soon as possible

kind of thing. But in general, some kind of guidelines that that I was noticing is like in a Type 1, like this is kind of like surgery's got to be pretty quick. So type 1 is the yeah. Oh, the one that goes all the way to the. Palm yeah, Like that has to be surgery pretty quick. But what's interesting is what I was reading is just like, oh, within seven to 10 days, which I guess for like surgery, like for most cases tends to be I guess pretty quick.

But like, for our athletes, it's probably going to be a lot sooner depending on your setting. And then the ones that I've had, they've sent for, I've sent and they've made them specific like splints or braces for. And usually they're in the slight flexion. Yes, because they want that tendon to be able to heal. Yeah, for sure, for sure. And Type 2, right surgery can kind of get put off at least within one to two weeks. Type 3 is kind of the same surgery within one to two weeks.

But some things did say you could maybe get away with three to six weeks. For an avulsion fracture, I mean, I guess that makes sense a little bit. I mean, fractures in the hand kind of heal within three weeks. Yeah, So that's really interesting. And I guess it is an avulsion fracture, but still like. Yeah, for sure. Just some thoughts. I just love how it's like, oh, well, it's stuck. It's gonna, it didn't go very far. It might. We can we can wait a little bit.

And again, that's more kind of like that get away with three to six weeks. Like some of it might be, hey, like maybe season, like at a certain point season, the physician might be OK with it. But a lot of times that three to six weeks is more like the athlete didn't say anything and didn't think it was like a big deal. Like they may not have thought like, oh, whatever, like, oh, I jammed my finger or something like that. And then they come see you at like Week 2.

All right. So it's not like the end of the world. It's almost kind of yeah. You gotta love that. Oh, the story of athletes and their fingers. And and then type 4 is again surgery within 710 days. This is an ASAP situation. Well, yeah, yeah, the tendons tearing away from the fracture too. Yeah, that's not that's no boy. No, no thanks. So next we have is mallet finger

and finally this year I broke the streak because my first like I've had two basketball seasons where I've had one athlete with a mallet figure I had 1-2 years ago, one last year. This is the first year that I didn't have a mallet. Figure what did they do? How did they get a? Mallet the ball just would hit their finger and force them into Yeah, like literally jam their finger from the ball but force

them into. Wow. Yeah, I'm lucky. And and this is basically just a rupture of basically where that kind of V from the extensor tendon joins the distal phalanx, right? You get that rupture now you don't, you can't extend that distal phalanx, all right? So you get just forced flexion against a contraction and boom. So like basically mallet finger and jersey finger are the opposite? Yes, yeah, exactly. All right, So your evaluation it, it's pretty self-explanatory.

You kind of just see a dropped distal phalanx, right? Like it's kind of weird to think about it, but like we have good tension in in our fingers. So you don't really see it. But if it's like ruptured, like you'll see like it just drops, like nothing's just holding it there and the flexor tendons are still pulling on it. Well, also like if you ask them to open their hand like you can see it pretty obviously. And I was going to say, that's the next thing, right?

Inability to extend that distal failing. So yeah, good idea, right? To just extend. Sometimes I'll hold the middle phalanx and just ask them to extend their fingers to see so I can actually truly just look at it to see if it moves. If it actually extends, you might see some dorsal swelling as well. And sometimes you can actually palpate where that tendon retracted to. You know, Dang, I've never thought about palpating to like, feel the tendon.

Sometimes you can, sometimes you can feel the bulge. Yeah, I've never thought about that. Now next time I get. That's the same with the Jersey finger too. Sometimes you can actually palpate like where the swelling's at. Sometimes you palpate there and you'll feel the like the bulge of the tendon as well. I've never. Thought to do that. Interesting. Management for this tends to be pretty conservative. You can get away with throwing them in a splint and hyperextension. OK.

Yes you can, but if they're going to be compliant. That's that is the big thing is the compliance aspect, right? They have to be in this splint for a minimum six weeks. And it's and like you can't take it off, like if you take it off, you have to keep it an extension. And I think that's that's something that my Co head wanted is a really good job of explaining with our athletes like, like hold your finger and then, you know, if you like take

the. The. Splint off, wash your hand, whatever. Wash your splint and you're holding your finger the entire time and then you put it back on because as soon as it bends, you're basically. Just you could just. Damaging that. All that work. Going right, right. And so splinting in hyperextension for those six to eight weeks, the surgical consideration IS1 non compliance possibly or, or they might just be like, well, you just you will not be able to extend that DIP

as much anymore, right, right. And what was interesting too is if there is laxity too at the PIP joint, like maybe someone who has just generalized laxity. That's how you get a swan neck deformity. I can't, I can't do a swan neck very well. Yes, you, yes, you do a good swan neck, right. So if you have laxin that PIP and you just have a chronic mallet finger, a swan neck deformity can form because it's almost like a compensation for not being able to do DIP extension.

So yeah, that's a fun fact. But surgery might be considered also if there is an avulsion fracture that is taking up a 40% or more of the articular surface of the distal failings. So they might, yeah. So that there they might be saying, hey, we need to do surgery to kind of pin stuff back. There might be some success with conservative treatment on an avulsion of 30 to 40%, right. I think that's kind of probably surgeon preference and kind of

what they've seen. But yeah, I've kind of, that's what I've kind of heard like if it's just the tendon, you're pretty good with conservative. Once you start talking about avulsion fracture, surgery tends to be in the conversation. I mean, that makes sense, especially when you're talking about fingers. Yeah. Especially when you talk. About things that like you're you, you're gripping or you're moving your hands like dominant versus non dominant. Yeah, for sure.

And then the next one is those kind of pulley tears.

And this is this is where we are going to talk about the climbing stuff, right? And like this was interesting for me because again, like I didn't really, I haven't really heard of these kind of injuries. So I think this was really kind of dope to kind of read about. I'm so surprised still, like I'm so surprised. This is like all over my feet. Oh, interesting. Apparently I'm not on climbing, but these interests are going to come from that, like kind of

that crimp grip activity. And you love the crimpy. Climbs. Those are my climbs. These are like. That they blow up my pulleys. That's probably why it's so uncomfortable for. Me they're like the like, you know, it's like if you think of sign language like the letter E like like bending in the DIP and the PIP, but extension of the I was going. To say but not the. MCP, yeah, that's kind of like your. Crimp. I do not like those climbs. We call them the fingery climbs,

yeah. I don't like the fingery climbs, but yeah, so those kind of crimp activities are or grip activities are going to be the the kind of mechanisms because they do put a lot of strain on the flexor pulley system. And again, this tends to be, and the literature even acknowledged this tends to be in climbers. But for your traditional athletes, you'll see this in pitchers, right? Because there are some pitches that do require some kind of like like kind of crimp like grip.

I could see that, yeah. I could see that. So you could get this and you're still in your traditional sports, not just like oak climbers. The problem is you're not going to get a pitcher in a finger splint. This could be very detrimental for a pitcher. Right, Right. Yeah. Especially if you don't have like activation of your fingers for sure. You know, I noticed something like when we go climbing, if I'm not properly warmed up and if I try like a climb that's too hard

before, like I warm up properly. Like I can't fully extend my fingers like like that. Like the when I'm climbing I just can't do a full like extension of my fingers. Yeah. Interesting. Oh yeah, You. Yeah. And you're like, you've seen it. Yeah, I've seen it like it's legit. You're like almost in like contracture. Exactly. Like my flexors have taken on too quickly.

So I think like, I'm thinking like in a pitcher, yeah, like, obviously that's not from injury, that's from improper warm up. But like, I'm thinking like in a pitcher, like pitchers have to be able to really control their grip. Yeah, yeah, for sure. You. Do so it really it really would change things. Yeah. So your evaluation is fairly simple with these, right? You're going to look for swelling and then you could actually see a bow string of the tendons.

All right, so this is basically the tendon kind of popping out because again, the job of the pull is hold this tendon in so you can actually get a mechanical advantage and actually like be able to grip and like all that stuff. All right, So if that's gone now you get like that bow string and that tendons going to like just pop out. So that's kind of a good sign of, hey, you probably have a pulley tear manage. What?

No thanks. Management for this is mostly non surgical and it definitely can be splinted in with like a pulley ring. Splint basically just looks like a ring over basically wherever that pulley is and it's just replacing that, right? You're basically replacing the pulley by having something that pushes the tendon back in. That's just crazy. Yeah, they did say you could tape it too or you could add tape like so to add like the little tape rings and that can help keep that kind of tendon in

as well. It's like a weight belt but for your finger. Yeah, for sure. And higher grade tears of this, So tears that kind of involve multiple structures might need surgery, but conservative tends to be pretty successful and kind of lower grade tears for. These they say like how long? Yes, we do have a little bit of timelines, right. So, and some of that is the return to play consideration as well. OK. You just want to do that for

everything, Yeah. So a lot of these pathologies do have a quick return to play even early in the recovery process, right? So it kind of depends on the sport and just how splinting can be applied, right? Like like for me, like basketball, right, A lot of basketball guys don't really like or basketball athletes, I should say, don't like a lot of things on their hands, right? It's kind of weird to shoot if your shooting hand is all taped

up, splinted, you know? I think it's also worthy to take a look at what splints you have available to you because for example, like everyone knows the, the blue foam with the metal like that's not really commonly like used in sport, you know, like, but like you could transfer to like an or like I make orthoplast splints for fingers all the time in

football. Or you could use like those, like little thumb caps, I have no idea what they're called, but like those little finger caps, like those. Are that that one's often used with like mallet finger too, Yeah. Those or you ones that we really, really like are called protective splints and they're basically just like it's a big roll and you just cut however much you need and it's like a little U shape and you can put

it underneath the finger. You can put it on top of the finger, you can put it on the side. I really, really like those. And I just like round the edges so they're not sharp. And then like put a little tape on them and then just tape them on. And they're like, yeah, pretty quick. Sometimes I cut them ahead of time and then like in a game, like I could just put it on someone real quick and then they can go in it. And those are pretty like small.

Yeah. So depending on what sport it is, it's and depending on what position or depending on what finger and what joint. Like sometimes they can just go back in pretty quickly or like a quick buddy tape with extra support. So yeah, it it definitely all those factors really determine when someone can return to play, how they're going to return to play. So like Jersey finger, right, you're looking at a full return

in about 10 to 12 weeks. Sooner is possible if it's a sport where hands aren't quite as important, right? So like, if you're a track athlete, right, you're probably going to get back pretty quickly, right? Maybe. Maybe the baton, yeah. I don't know, you might be not be on the relay, right or like a soccer athlete, right, That might be doable because there's not a lot of hand necessary, right?

Unless you're the goalie. Unless you're the goalkeeper for sure, and obviously there's the risk of falling too, right? So, so there are ways to do it, especially if you're able to protect that splint as well. So again, like again, you see this a lot with football. It tends to be like you can

really pad something right. And if they're in a position where they don't really need to use their hand right, they're probably going to be able to come back a lot sooner compared to like someone who's like receiver who's going to need his hand. You know, I, so one season I had a quarterback with a pinky. He had a pinky dislocation and a fracture. It was an avulsion fracture. And then in the in the same season I also did O line with a

pinky fracture. And I just took a picture of like the two of their splints together that I made the orthoplas splints because they were completely different. And it was just really cool to see like they both had the same injury, like both had a pinky fracture, but the management of them and like position specific was just so different. So I'll find that and I'll post that on our Instagram. So if you're interested in that, make sure you check that out

for. Sure. And really the position that they're going to be kind of splinted in, especially when they're starting to return to play is almost like a loose fist, right? So they're not going complete fist, right? It's going to be almost like 1/2 fist kind of thing, right? They're going to be kind of splinted in that position for which one Jersey finger. Oh good. Yeah, like their whole hand. Yes, it would be whole hand.

I believe that that was my interpretation of when I how I was reading it. I haven't seen a whole hand when I sent a jersey finger, but I don't know, maybe that. Did you see it? How did they splint it when you saw it? Just the single, yeah. Oh yeah, when I was reading it said loose fist. So I just took it as like, oh, whole hand because I guess maybe it was, it would be hard to I, I don't know. Maybe it depends on if it's the one that goes all the way to the. Yeah, maybe.

Possibly. Yeah, yeah, could be next. Again, mount finger, right? If it's being treated conservatively, they could be a really return to a quick return to play, especially if the splinting's tolerated. And again, it depends on the sport as well. Like for one of my basketball guys, when we had them, we had him return to play, right. Like, again, it's kind of weird to have the splint on the Palmer side because you know, if you're dribbling a ball. Can't feel it, Yeah.

Yeah, and it's going to be kind of in the way compared to everything else. And so I did a dorsal splint that held them up into a hyperextension so that that helped kind of make it a little more tolerable to play. But really, again, you're splinting for six to eight weeks and if compliance was great, everything went well, you can actually wean them off the splint around week 6 and use those final two weeks of a night splint only. So they put it on at night and then they can take it off,

right? Again, if it's surgical, that's going to be a little more complex and now you're probably looking at more closer to that three month kind of timeline. Again, I've seen that too, where, you know, sent the kid to the doctor for the mount finger and they they wanted to do surgery with them. So I've seen that too, to where he, his season of fortune was done because of a mount finger. So again, it really depends what's going on in there if it could be treated conservatively or not.

Dang, yeah. And then for your pulley, pulley tears, this one had a very just wide range of things to do like like or like what you're kind of like timeline looked it could be from six weeks to three months. Yeah, try telling that to someone who needs their fingers. And the best part is as with most things, delaying treatment could just lead to a lot worse outcomes, right? So again, it you can kind of tape and split in this timeline to maintain kind of that

activity. And if everything go is going well and there's not a lot of other structures damage, you probably don't need surgery with this. So again, it, it really kind of depends, but that's kind of your game plan and you're looking at least six weeks for stuff that's pretty minor. Anything that's a little bit more major, you could just start pushing that three months aspect. And again, a sport is going to be kind of dependent, right? Again, like a pitcher, right?

This could be pretty detrimental. Or someone who puts their entire body weight on their finger. Exactly. Right. And then, and apparently I was reading that a lot of climbers just basically tape these, those fingers, those areas of their fingers just preventatively. Yeah. And they feel like it gives them more grip. Now I want to try it. Maybe I can just start doing the group. Maybe I can start doing the fingery ones if I tape. There you go.

I should try it see if it does make a difference because it does hurt my hand. I don't like it because it hurts my hand. But you can do. It and it's maybe my pulleys, so I'm going to try it. Don't hurt your pulleys. It could take six weeks to three months to heal. Yeah. But if I tape them as classic AT how can we tape it? Yeah. So that's the hand. Well, what's your action item for this? Don't mess with the fingers, man. You never know. You just they're not just it's

just a finger injury. Now these these could be really detrimental and can affect quality of life, but also try to work with like your physicians on what does return to play look like and how can you safely get them to return to play. Yeah, that's a good point. Honestly, when I've sent finger or hand injuries, like a lot of times, like they'll get a splint and then like I will make a splint. So like they'll have a splint for like the day-to-day and then

I'll make a splint. Yeah. And then I'll make a splint for like the sports specific portion for sure. And then like, we didn't even talk about rehab, but you know, incorporating like specific rehab exercises and strengthening not just in the fingers in hand, but also the wrist and the forearm flexors and the extensors and. And a lot of this stuff because again it is going off of the tendon and for a lot of the pro surgical stuff too, tendon glides were huge in this.

And especially looking at for a lot of the surgical stuff, it was starting right around week 3 post op was when they were starting to do the how did it go? Tendon. Glides, there we go. Bend straight. Bend straight, Yeah. Like that I don't do attending. Just have to remember your thumb. Yeah, I always forget my thumb. But yeah, right around week 3 post op ish for a lot of these in general was when they started doing that. I was trying to do the glides. That's cool.

I mean, and if you're you're someone is getting surgery like you'll, you'll be able to get an idea of what the surgeon would. Like what their parameters are and what their protocol looks like for sure. Suite, again, if you're interested in this CEU, make sure you check out clinicallypressed.org and find our course on there. Randy, how many references did you use for this? So this one, this was a little bit on the lower end, I think we had right probably around 8:00. OK, nice.

If you're interested in those references, they are on our website. Again for NATM we are doing 25% off Cus with NATM 25. If you're listening to this as it comes out, it is free. If you are looking for more C us we are still working with Medbridge for $101.00 off for your subscription for a year. You can use code 80 corner. And then lastly if you guys are new, we do every episode as

either education like this. We do story episodes with stories from real life athletic trainers or we do interview episodes where we bring on someone and we talk about something really cool for athletic trainers. So make sure you check out those other episodes. If you guys have anything else, make sure to reach out to us on our Instagram at 80 Corner podcast. And I think that's all I got. Just one more action item. I apologize. It's always a good idea to have some splints on hand. It is.

It is. Get it on hand. On hand. Man, it really took us to the end of this episode to get another pun all. Right. Well, thank you for helping us showcase athlete training behind the tape. Bye.