Virginia Research Day 2022

Medical Resident Research Case Reports

07 Rapid Evalution And Treatment Of Wrist Pain In A Division I College Football Athlete

Stephen Despins, DO; Mark Rogers, DO; Micah Jones, DO, Brett Brodsky, OMS IV; Grayson Daffron, OMS II, Brett Griesemer, LAT, ATC; Miguel Silva, LAT, ATC Corresponding author: sdespins@vcom.vt.edu

Virginia Polytechnic Institute and State University VCOM Virginia

History: A student athlete (SA) presented to the sports clinic with left wrist pain after a football scrimmage. He reported falling backwards onto his outstretched hand followed by immediate wrist pain. He went over to the athletic training staff, on the sideline, for evaluation. When attempting to remove his glove, on the sideline, the SA reported feeling a "pop" and immediately felt better. After a few more plays, he started to feel the same type of wrist pain. He started to pull on his wrist and again felt a big "pop" with some relief. After the scrimmage, his wrist still bothered him, so he reported to the sports clinic for further evaluation. Wrist pain was on the medial, dorsal, and volar side of his left wrist. Pain was dull and achy. Pain did not radiate. Pain was worse with any type of wrist movement, including gripping. He denied numbness or tingling in the hand, wrist, or forearm. Physical Examination: Some swelling to the wrist but no erythema or obvious wrist deformities. There was tenderness at the anatomic snuffbox as well as along the dorsal part of the wrist. There was mild tenderness at the distal ulnar styloid and triangular fibrocartilage complex (TFFC). In addition, he

had tenderness to palpation of the mid-carpal and lunate areas. He was able to fully pronate but had limited supination with a loss about 10 degrees. Wrist extension and flexion were severely limited secondary to pain. He had a positive piano key sign. He was neurovascular intact. Tests & Results: Radiographic images demonstrated a volar displaced lunate on lateral view. An MRA would be taken two days later, post-reduction, which demonstrated a significant amount of contrast in the dorsal extensor compartment, no obvious full thickness rupture of the scapholunate ligament, a TFCC tear in the central articular disc, degenerative changes in the lunotriquetral ligament, minimal tendinopathy in the extensor carpo-ulnaris tendon and abnormal non- contrast fluid in the volar flexor compartment. Final Diagnosis: Volar lunate dislocation with concurrent injuries to the triangular fibrocartilage complex and peri-lunate ligaments. Outcome: Noting the volarly displaced lunate on radiographic imaging, the team physician reduced the lunate bone at bedside. Post-

radiographic images confirmed reduction of the carpal bone. Discussion: This was an interesting case of a perilunate dislocation in a division I football athlete. This case demonstrates the importance of combining both radiographic imaging and physical exam to accurately diagnose and treat a dislocation quickly and effectively. Perilunate dislocations are often underdiagnosed and can lead to poor outcomes when missed, including complete loss of wrist function. By initially evaluating the SA on the field and quickly transitioning to the sports clinic, the sports medicine staff were able to quickly develop a plan for the division I athlete without him losing any playtime. Return to Activity and Follow-Up: The SA received weekly radiographs of his left wrist to monitor for worsening instability and avascular necrosis. His left wrist was casted daily for practice and for games. He received reconstructive surgery at the end of the football season by a hand surgeon.

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