“Hockey Wrist” – The Forgotten Ligament Injury

 

MRI displaying a “Hockey Wrist” injury


Q: Dr. Hockey, my 14-year-old son, Eric, injured his right wrist last week at hockey camp during an intense day of shooting on the ice followed by an off-ice regimen of rigorous weightlifting. He’s a left-handed shot and he gets pain on the outside of his right wrist whenever he shoots now. What do you think is going on? When is Eric going to get the power back on his shot? 

– Jennifer E 

A: Jennifer, despite the use of protective hockey gloves, injuries to the hand and wrist remain common at all levels of ice hockey. Unfortunately, these injuries can be quite debilitating. Grip strength is critical for successful shooting, passing, and stickhandling. During a wrist shot, the top hand on the hockey stick is at a mechanical disadvantage. For Eric, this is his right wrist because he is a left-handed shooter. There is a ligament on the outside of the wrist, the dorsal ulnotriquetral ligament (DUTL), and the position of the right wrist during left-handed shooting makes this ligament vulnerable to injury. Repetitive shooting can overwhelm and stress this ligament, causing an overuse-type injury. This injury occurs so frequently in hockey players that it is commonly referred to as “Hockey Wrist.” Hockey camp is exactly the kind of environment where this condition typically develops because of the intensity of the practices that, of course, involve repetitive shooting.

The good news is that I would expect Eric to do very well with a one-week course of therapy that includes anti-inflammatory medications, wrist stabilization, and taking a short break from shooting. I recommend administering anti-inflammatories, such as Aleve (naproxen) around-the-clock for seven days and not “as needed.” His injured wrist should be stabilized in a removeable wrist splint, and he should take this week off from shooting to allow the inflammation in the ligament to subside. I would expect the power on his shot to return in about two weeks. 

A wrist splint can be purchased over the counter and is recommended to help with “Hockey Wrist” injuries.

If Eric does not experience relief of his pain after following this regimen for a full week, I would advise you to seek evaluation by a sports-medicine trained physician. At that point, he would likely need imaging studies, possibly an MRI, to evaluate the injury further. The MRI would provide information about the extent of damage; if the trauma is more significant than simple “Hockey Wrist,” consultation by a hand specialist may be indicated. 

 

Charles A. Popkin, MD is a team physician for USA Hockey and is a member of the Safety and Protective Equipment Committee. He is an Associate Professor of Orthopedic Surgery at the Center for Shoulder, Elbow and Sports Medicine at Columbia University in New York City. 

Issue: 
2023-10

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