Monday, October 18, 2010

Tennis and Hand Pain

High level tennis players place a great deal of stress on their hands:

Photo by splitmilk

In an earlier entry, we looked at the shape of the hamate, which has a hook (blue arrow):

In sports where an instrument is swung, fractures of the carpal hamate bone can be due to blunt trauma or a sharp strike against the hook of the hamate. The swinging motion that accompanies golf, baseball, tennis racquet are all well-known causes of this injury. Patients present with pain localized over the ulnar aspect of the wrist and reduction in grip strength.

In this case, a 40 year-old female tennis player presented with ulnar-sided pain of two weeks duration. She had no direct trauma to hand, but developed the pain after playing tennis. Axial T2 fatsat images reveal intense bone marrow edema in the body of the hamate (yellow arrow) and a fracture of the hook of the hamate (red arrow), with accompanying bone marrow edema:

A sagittal T1 weighted image confirms the presence of the fracture:

(click on image to enlarge)

Thus, one should consider this injury when assessing an athlete with ulnar-sided hand pain.

Vic David MD