Hand and upper extremity tendon and ligament injuries

If your child has injured their hand or arm but nothing seems broken and their pain persists, it could indicate a tendon or ligament injury.

About hand and upper extremity tendon and ligament injuries

We tend to think first of our bones and muscles, but ligaments and tendons — fibrous bands of connective tissue — play an important role in supporting our everyday movements. Ligaments connect our bones to other bones at the joints, and tendons bind muscles to bones. Types of tendon and ligament injuries include:

• Sprains – Overstretching or tearing the ligaments
• Strains – Pulling or tearing a muscle or tendon

These injuries can be acute (due to a sudden event) or chronic (from overuse or repetitive stress on the affected area). Common ligament and tendon injuries in the hand and upper extremity include:

Thumb/finger sprain – Also known as jammed fingers or jammed thumb, these injuries to the ligaments occur through sudden force or when a finger is pulled the wrong way.

Triangular fibrocartilage complex (TFCC) tear – The TFCC is made up of the ligaments, tendons and cartilage that support the wrist. The TFCC can tear during a fall or in sports that require repetitive wrist movement, such as tennis, gymnastics and football.

Elbow sprain or strain – Younger children are at risk for what’s known as “nursemaid’s elbow” or “pulled elbow,” when the ligament slips out of its normal position. It often happens when a child under age 5 is pulled up by one arm or when kids of any age fall.

Shoulder sprain or strain – A shoulder sprain occurs after the stretching or tearing of the acromioclavicular (AC) ligament, where the shoulder meets the collar bone. A shoulder strain can involve the rotator cuff muscle or a tear in the labrum, the soft tissue that lines the shoulder joint. Shoulder injuries can develop after high-impact sports, such as rugby, football or wrestling, or during activities that require overhead motion, such as swimming or tennis. More severe injuries can lead to a shoulder dislocation.

Experts in hand and upper extremity tendon and ligament injuries

As the only comprehensive pediatric hand and upper extremity program in the state, Children’s Wisconsin provides expert care to kids and teens with a wide range of common and rare conditions affecting the shoulder, arm, elbow, wrist and hand. With our team’s specialized training, vast experience and deep knowledge of the unique challenges of children’s growing bodies, we can ensure the best possible outcomes for your child’s recovery after a tendon or ligament injury. Our child-centered environment and wraparound services are designed to support the whole family and provide comfort when your child is stressed and in pain. If your child has already been diagnosed at another center, we invite you to get a second opinion at Children’s Wisconsin.

What causes tendon and ligament injuries in the hand and upper extremity?

These soft tissues are vulnerable to over stretching or tearing if they’re suddenly wrenched, twisted or overused. Muscle fatigue can make young athletes more prone to sprains and strains. Regular warmups, stretching and gradual strength-training can reduce the likelihood of sprains and strains.

Why are hand and upper extremity tendon and ligament injuries a concern?

These painful injuries can make it difficult for your child to do everyday tasks, in addition to playing their favorite sports. Without proper treatment, ligaments and tendons might not heal properly, causing joint instability, reducing range of motion, and increasing your child’s risk of repeat injuries or chronic pain.

What are the symptoms of tendon and ligament injuries?

Signs of a tendon or ligament injury may include:

• Mild or severe pain immediately after the injury
• Swelling
• Difficulty using or moving the injured area
• Warmth, bruising or redness in the affected area

Even if you think it’s just a sprain, it’s a good idea to see a doctor to have the injury assessed and rule out a broken bone.

How are hand and upper extremity tendon and ligament injuries diagnosed?

The physician will evaluate your child’s injury through a physical examination and imaging. At Children’s Wisconsin, we use imaging procedures that ensure your child is exposed to the smallest amount of radiation possible. Imaging procedures may include:

X-rays – Uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film

Magnetic resonance imaging (MRI) – Uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body

Computed tomography scan (CT scan) – Uses a combination of X-rays and computer technology to produce detailed, cross-sectional images of the body, including the bones, muscles, fat and organs

Treatment for hand and upper extremity tendon and ligament injuries

Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate pain and swelling. The “RICE” approach is usually recommended for the first day or two after a sprain or strain:

Rest – Your child should try not to use the injured area for 48 hours.

Ice – Apply ice to the injury for 20 minutes at a time four to eight times a day.

Compress – Use a splint, cast or bandage to compress the sprained or strained area. Ask your child’s doctor which one is best and how tight it should be.

Elevate – Rest the injured area on a pillow, and keep it elevated above the heart as much as possible.

After two days, gently exercising the sprained or strained area can help increase strength and prevent stiffness. Your child’s doctor can tell you when it’s safe for your child to return to usual activities.

For more severe injuries, your child’s doctor might also recommend:

Surgical repair – In rare cases, surgery might be required to repair a badly torn ligament or tendon. Our highly skilled pediatric orthopedic surgeon will surgically repair tendons and soft tissue in a precise and delicate manner to preserve your child’s movement and function in the future.

Hand therapy – Hand therapy is a critical part of the postsurgical and nonsurgical process to promote healing, increase range of motion and maximize functional use of your child’s hand/arm. Our certified hand therapist offers serial casting, custom splinting, paraffin wax treatments, scar massage and more.

Long-term outlook for hand and upper extremity tendon and ligament injuries

Most sprains and strains get better after a few weeks as long as your child adheres to activity restrictions and follows the other recommended treatments. More severe tears and injuries that require surgery will take much longer to heal. A previous sprain can make a child more susceptible to future injuries in the same area.