3 minute read
Polodoc: The Polo Hand
by Edit
Dr.med. Andreas Krüger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013
Protective gear, such as carbon-enforced gloves, are available
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Photograph by The Art of Polo
The Polo Hand
Fracture, rupture, degeneration
Photography by Polodoc Typical polyarthritis x-ray in proximal and distal finger joints
The player’s hand is one of the most exposed and fragile parts of the body. At the same time it’s also the most important part of the body for handling the stick and steering the horse. Riding as the cause of hand injuries is overall third place after ball sports and cycling. A little impact is enough to change function in regard to grip strength and the free range of motion. But not only external impact can be detrimental. Bones can experience wear and tear at the joints, which can make our joints painful and inflamed. This is what we call degenerative changes (osteoarthritis). These changes can occur from years of use, or can come on a little earlier if you have had a previous injury that alters the way your joints might move. The other structures in the body that can deteriorate over time are our ligaments. This is commonly seen in the wrist with people who have been involved in lots of manual heavy work over years. If the ligaments deteriorate they are often not then doing a great job at supporting your joints, and this can cause significant pain. Common places for degenerative changes to occur for horse riders are the thumb and index finger. Getting thorough assessment is the first place to start, to work out the cause of your pain and plan a solution to get you back to pain free use.
Diagnostics
Deep, clinical analysis of the impaired function of the hand by a medical professional (orthopaedic or hand surgeon) is crucial. Little injuries from a pull by the reins or impact by ball or stick can leave their marks. An overview can be achieved with a hand X-ray performed from at least two directions. Fractures can be precisely diagnosed using Computer tomography (CT), where thin slices of different directions of the bone can be generated. Soft tissue pathologies or injuries (ligaments, cartilage, deposit diseases) can better be detected in MRI (magnet resonance imaging) or high resolution ultra-sound (functional analysis).
Local infiltration for tendon problems Ultrasound Guided Infiltration
Sometimes even a medical work up with lab test for deposit diseases and rheumatoid changes are needed to find hidden underlying causes for pain. Symptoms like pain, tenderness, stiffness, redness, warmth and decreased range of motion in the affected joint needs to be checked.
Treatment
Little local impacts with only bruising or haematoma can be treated by local elastic taping or the use of silicon or neoprene bandages. Acute trauma with partial lesion of ligaments or pulleys can be facilitated with the use of PRP (platelet rich plasma). Instable joints and bow stringing of tendons as well as displaced fractures mostly tend to need surgery. Deposit diseases like gout or CPDD (calcium pyrophosphate deposition) or rheumatoid diseases need special examination based pharmaceutical treatment.
Outlook
Hand pathologies and hand trauma are common in polo players. These impairments can stop one from playing. Modern handheld diagnostic devices can already provide pitch-side help to find the correct diagnosis. Awareness is increasing and protective gear, such as carbonenforced gloves, are available.
For more information on Polodoc contact Andreas Krüger at drmedkrueger@gmail.com or www.polodoc.ch
Splints can be used to support finger injuries
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