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Isolated Fourth Carpometacarpal Joint Injury in High-Level Baseball Players: A Case Series
William P Stults1, Gary M Lourie1,2, Jeremy T Royal3
1WellStar Kennestone Hospital, Marietta, GA, USA.
Background:
We present a case series of high-level baseball players having sustained a rare, isolated injury to the fourth carpometacarpal joint of the nondominant or bottom hand during a jammed swing.
Methods:
Ten patients were evaluated for ulnar-sided wrist pain and were subsequently diagnosed with fourth carpometacarpal joint synovitis based on physical examination and magnetic resonance imaging revealing increased signal intensity within the joint.
Results:
Conservative treatment modalities including rest, nonsteroidal anti-inflammatory medications, splinting, and corticosteroid injections resulted in return to play within 4 weeks for all patients.
Conclusions:
We propose a mechanism of injury involving the bottom hand in relative pronation receiving a dorsally directed force from bat during a jammed swing resulting in isolated injury to the fourth carpometacarpal joint. This report serves to highlight this rare injury in high-level baseball players and recommend a treatment algorithm for early return to play.
