Wrist fractures vs. wrist sprains: Knowing the difference could save your career

2015-07-02 11:19:59 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

The Miami Marlins will be without Giancarlo Stanton, the team's undisputed best player, for the next four to six weeks as he recovers from a hamate bone fracture in his left hand. The Miami Marlins will be without Giancarlo Stanton, the team's undisputed best player, for the next four to six weeks as he recovers from a hamate bone fracture in his left hand.

It's tough to keep up with all the young stars in baseball, but one in particular is quickly rising to the top - Miami Marlins' Giancarlo Stanton. Unfortunately, he broke his hamat bone in his wrist over the weekend and will be out for 4 to 6 weeks.

It's a fairly common injury, even for high school and college athletes. It's caused by repeated pressure or rubbing from a bat, club or racket.

The good news is the recovery time is short and shouldn't have long-term affects on a player's career.

This week, I spoke with 1590 WAKR morning show host Ray Horner about this injury. We also discussed a much more serious wrist fracture involving the navicular bone. If left untreated, it doesn't heal and can be career threatening due to a loss in range of motion.

Below is an audio file and transcript of our discussion.



HORNER: In our studio, Dr. Joe Congeni, Sports Medicine Center, Akron Children's Hospital. Joe, you wanted to talk about a baseball injury.

DR. CONGENI: Well, you know, the superstar of baseball. I've gotta admit, and I try to keep up with sports, hard to keep up with some of the young stars. But, everybody knows Giancarlo Stanton (Miami Marlins), right?

HORNER: He's something, huh?

DR. CONGENI: This is the guy, man.

HORNER: He can hit a ball a country mile.

DR. CONGENI: He's got all the tools.

Dr. Joe Congeni Dr. Joe Congeni

HORNER: Yep.

DR. CONGENI: ... And, he has the long ball and all that kind of stuff. They paid him a ton, a ton of money. And unfortunately, he's on the shelf with an injury. Of course, we know in Cleveland sports, worrying about injuries, , what do they mean?

This wrist fracture that he has is not a bad one to have, but it's also not that uncommon, so I wanted to mention it. It happens not just in baseball, but in golf, tennis, any sport where you're holding a racket or stick in your hand.

In the fleshy part of the hand, on the little finger side, there's a bone called the hamate bone, and it has a little funny hook to it. And when that hook gets jammed repeatedly over and over again ...

HORNER: So, where is it here?

DR. CONGENI: So, right on the palm of your hand ... on the little finger side, there's a bump sticking out.

HORNER: Yes.

DR. CONGENI: And, if you press really hard and that's exactly where the person hurts, you have to get an X-ray. But even with that, the medicine's not easy.

If you get just a typical hand X-ray, you will miss it. There's a particular X-ray that we get a tunnel view actually, a carpal tunnel view, and you'll see this hook and if it's broken off, it just continues to cause pain. Some people continue to play with it.

I'll never forget, uh, Jim Thome in one of our great runs in '95 or '97 had a hook of the hamate fracture. People wear a little pad on it, but it hurts every time you swing, swing and a miss, particularly. And you saw Stanton kinda bent over in pain when he had that. So, you go in and have that little bone taken off.

The good news is 4 to 6 weeks. It heals very well. No long-term problems with hook of the hamate fractures, but they do happen even in high-school kids and in college kids.

It's a, you know, pain in the wrist that just is not getting better; not a typical sprain where the entire wrist with movement. It's in one very localized spot in the fleshy part of the palm of the hand on the little finger side.

HORNER: So, you actually get hit there to break it? It's not like a wear-and-tear ?

DR. CONGENI: No. Kinda the bat or the golf club or the tennis racket continues to sheer over that over and over again, and if there's one particular time that it sheers and people feel kind of a pop or pain in that area and they're real local about where the pain is, . It's only in one particular spot. Not really in the joints, so it's not bugging their range of motion or anything.

It is the 2nd or 3rd most common wrist fracture that we see. It's not that unusual. It's an easy one for the surgeons. They take that out and do the surgery very easily.

It's 4 to 6 weeks, so that's not the end of the road. We will see Stanton again this year. And, it has no affect on the long-term of his career. So overall, it's not a terrible thing.

But, we see them in our office being missed for 3 weeks, 4 weeks, 6 weeks because people think it's just a wrist sprain that'll continue to get better.

HORNER: Yeah.

DR. CONGENI: They try to tape it and pad it and do other things, and it just isn't getting better. In that kind of a scenario, get the person in particularly to a sports medicine doc or an orthopedist who knows to get that special view. Because if you don't get that special view, you can't see the little hook, and if you don't see the little hook, you can miss the fracture.

HORNER: With all these things going on, you mentioned the clubs and the swinging and everything, is it a common injury?

DR. CONGENI: ... Yeah, it is fairly common. In a sports medicine practice, we see it a couple of times a year and so it's not that uncommon.

People when they heard about it with Giancarlo Stanton were really surprised about it and some of them had never heard of it before, but it's just a wrist fracture that is relatively not a big deal.

On the other side of the wrist, there's a wrist fracture that's a real big deal. It's a fall on an outstretched hand. There's a bone called the navicular bone and this bone is kinda canoe-shaped. It has a bad blood flow.

If it's missed for a month, 6 weeks, 8 weeks, it doesn't heal. It needs a pin put in it. It's a real big deal. It can be really career threatening because what happens athletes is they lose their range of motion.

So, knowing the difference between a navicular fracture with a fall on an outstretched hand versus this much more ... benign kind of fracture called the hook of the hamate is .

And, here's I guess the greatest baseball player of our time and a big money guy, he's gonna miss some of the meat of the season, but he'll be back if this team makes a play-off run.

HORNER: So with that being said, maybe educate us here, how do we know the difference between a wrist sprain and one of these bones being broken? Is it the healing time? ...

DR. CONGENI: I think the biggest thing is if it's all the way across the entire wrist versus very local ; if it's in one spot. I keep saying focal or local. We use that term. One pinpoint spot probably should be looked at.

No. 2, I'm okay with giving a wrist injury a week, 10 days, even 2 weeks where you're taping it and things. should be getting better with a wrist sprain; should definitely be improving.

If it's not improving over that period of time, don't wait a month or 2 or 3, get that person in for the appropriate X-ray sooner so that we can pick up a couple of these fractures that do occur in sports.

HORNER: With this bone right here. The one you were talking ... what's it called again?

DR. CONGENI: Hamate. Hook of the hamate.

HORNER: Is there any preventative thing we can do to cut down on that wear and tear on that bone?

DR. CONGENI: Well, a lot of people, kinda the way they hold the bat or the club sheers right across that bone. You can feel the bump right there. And so, sometimes you can do some mechanical things to take pressure off, um, but there's not really anything else.

People don't for preventative reasons wear a pad or anything like that. Sometimes after they've had an injury to it they'll wear a pad because it hurts and they know right where it is. So, they'll wear a pad for a while and try to get through a season and get it fixed at the end of the season.

That's what Thome did. In one of the years we made a big run, I think it was '97, he wore a pad on it and as soon as the season ended, he had the piece, uh, taken out.

HORNER: Uh, 330-370-1590 if you'd like to talk with, uh, Dr. Joe if you've had some wrist type of injuries and such. Now, you mentioned the other side of the wrist, that's the worst one, right?

DR. CONGENI: Yeah, that's the bad one, but it's usually a very specific type of injury. We call it a FOOSH: Fall On OutStretched Hand. So, they fall directly on the wrist.

HORNER: I see.

DR. CONGENI: It's the most specific area. Again, very local, one spot. This bone has a bad blood flow to it. So, it's one thing that we teach residents and things that come through our place or emergency rooms, have a high index of suspicion if they're sore right there.

And then one other thing to make that tough is initially the X-ray can be normal and then after 2 weeks you might see the X-ray. If you are really not sure, you sometimes have to use advanced imaging like a bone scan or an MRI to make the diagnosis of a navicular fracture.

HORNER: With us is Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital. I was thinking of you the other day, and I always think of this, Grady Sizemore gets the home run against us the other day ...

DR. CONGENI: Yeah, yeah.

HORNER: and I remember to the point, guys, Dr. Joe was in the studio when Grady had that initial injury to the knee, I believe.

DR. CONGENI: Mmhmm.

HORNER: You said, where that knee is with the blood flow, said, I don't think he'll ever be the same ball player again. And, I always think of that because you were dead on with that.

To many of us, we're going, knee injury? He'll be okay. People recover from this all the time, but you knew where that particular injury was that this was going to be real difficult for him.

DR. CONGENI: Yeah, you know ... it's all a matter of what type of injury and whether it has long-term consequences, uh, related to it.

For Grady, you know, we all kinda could have predicted that he was gonna break up that perfect game with a home run. I mean, that's just the way it goes in Cleveland sports for sure.

HORNER:

DR. CONGENI: He'd been somewhere on the shelf, in the back pages for weeks and months and years, and then he comes out and he plays one game, 3 for 5, and then he comes up against us, breaks up a perfect game.

But Grady's big injury, too, was he had a bad sports hernia then ... followed by . That's one of those injuries that we kinda call unraveling, he was getting different things.

Like for instance, going back to the Cavs play-off run, I feel really good about Kyrie's injury. That's not one that has long-term implications. It has a very good chance a pretty complete healing versus other types of injuries that just go on for a long time.

Remember, Grady's was a microfracture.

HORNER: Yeah.

DR. CONGENI: ... And, microfracture is one of those that means we're kinda running out of options, last resort. So you kinda read in from the outside as to what kind of injury .

When he was having a microfracture as early in his career as he did, . And again, Grady is the kinda guy, he tried to play through all those injuries, which is a reason we ought to embrace him.

The enduring fans of Cleveland outta look back on Grady . He had some phenomenal years in the mid-2000s, '05, '06, '07. He had great years with, uh, home runs and averages and stolen bases.

HORNER: Oh yeah.

DR. CONGENI: He was a great player. But, he started to try to play through injuries in '07, '08 and he was unraveling by '08, '09. He has never been the same player.

I'm really surprised and it's just a tribute to him wanting . Here he is he's kicking around in 2015 and we'll watch and see what he does with Tampa, but his career trajectory just dropped off the table.

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