Trauma & Sports

Traumatic and sports injuries treated by Dr. Desai.

The distal radius bone runs along the forearm on the thumb-side, connecting to the bones of the wrist. It is one of the most fractured bones in the body, with injuries typically due to falling. When the fall is broken by an outstretched hand, the impact is often absorbed by the distal radius bone.

Hand Treatment Options

Our treatment options depend on the severity of the fracture and the patient’s expected activity level. In general, the options are a cast or surgery. Casts are used frequently and are normally worn for six weeks. When the cast is removed, hand therapy can begin.

Hand Surgery

If surgery is necessary, an internal, external or pin fixation device may be used to set the bone. Fixation devices require a different sort of therapy with a different timeline. A splint may be required for only a few days before therapy commences. Unless told otherwise by a doctor, you should try to keep your fingers, elbow and shoulder moving so that post-procedure and post-treatment use of the arm remains normal.

An estimated 30 million Americans ride horses each year. The risk of injury is highest in competitive sports such as polo and equestrian events or in circumstances where beginners are poorly supervised. According to the U.S. Consumer Product Safety Commission, more than 205,000 people were treated for horseback riding related injuries in 2004. On average, the chances of being injured while horseback riding are 20 times greater than when riding a motorcycle.

The most common injuries are sprains, contusions and fractures of the wrist, elbow, shoulder or collar bone. The primary cause of injury is falling from the horse. Other common causes involve faulty ropes, reins and other equipment or improper use of that equipment. Nearly 20% of all related injuries occur during horse-handling activities.

Treatment and Prevention

Beginners are well advised to seek lessons from a qualified professional. Proper technique and safe horse handling should be emphasized at all levels. A rider’s experience, size and skills should always be evaluated before selecting a horse.

Generally, we treat horseback riding injuries with rest as well as by icing and elevating the affected area. In more serious cases, however, especially of bone injuries, the bones and joints may require surgical repair. Immediate medical assistance should be sought as improper or incomplete treatment may prevent the body from healing correctly. This can leave the affected area vulnerable to debilitating conditions such as diseases of the joint or bone and osteoarthritis.

Fishing injuries are usually the result of overuse of a particular joint. Pain symptoms in the upper body, back, hand, wrist, elbow and shoulder are common and tendon conditions or arthritis can develop. The joints affected and the severity of pain depend on a variety of factors including frequency of participation, grip and casting style as well as the type of equipment used.

Fishing in salt water or deep sea conditions requires greater strength and effort. Not surprisingly, enthusiasts of this type of fishing report the most problems. Fly-fishing, a variant of fishing which is generally of a lower impact but involves repetitive motion, can cause all of the aforementioned conditions due to the style and mechanics of casting.

Another concern for anglers is infections of the hand. In the Chesapeake Bay or other brackish water, an organism called Mycobacterium Marinum can enter the tissues of the hand and cause a smoldering infection. Another organism that can be very serious is the Vibrio vulnificus bacteria. It is typically spread when an open area of the skin comes in contact with contaminated water. Sudden onset of redness, pain and swelling are the main manifestations.


Conditions involving overuse of the joints can be prevented by using proper equipment and casting techniques, particularly in the case of fly-fishing which requires repetitive motions. Warming up and stretching, often neglected by anglers, are also important. Rest is important for treatment while serious conditions may require surgery to alleviate pain and restore function to the joint.

Infections of the hand are often not recognized as an infection initially and these conditions can be advanced before the sufferer seeks medical assistance. Rapid medical treatment with antibiotics and surgical removal of infected tissue is essential.

A golf swing requires movement of nearly every part of the body. Joints twist, bend and rotate, exerting force and causing pressure throughout the body’s bones, tendons and ligaments. Accordingly, sprains and strains are the most common injuries.

A condition known as golfer’s elbow can cause pain on the inside of the elbow as a result of a torn tendon attachment to the bone. Golfer’s elbow is generally associated with pain when gripping. A less common injury is a fracture of the hand which happens when the force of the swing is directed back through the club when striking the ground during an errant swing.

Prevention and Treatment

Appropriately sized clubs are important for prevention and serious golfers are well-advised to have their swing evaluated for proper mechanics. Rest is important for both prevention and recovery. When prevention is no longer an option, our main treatments are ice, anti-inflammatories, stretching and steroid injections. In severe cases, surgery may be necessary to remedy pain and allow the golfer to get back to the course.

Fractures of the hand bones are among the most common hand injuries we see in our Richmond, VA office. The hand is a delicate network of bones that serves as a point of attachment for the muscles, tendons and ligaments responsible for lower arm movement.

Hand fractures may be hard to distinguish from other, less serious finger or hand injuries. Aside from the obvious pain and swelling, other indicators include a deformity of the finger or knuckle, a shortened or misaligned finger or loss of movement in the hand.

Treatment and Hand Surgery

You must seek medical help if you believe that you have suffered trauma. While a broken bone may be obvious other serious injuries may not be as evident.

Treatment varies depending on the type and severity of the injury. Some injuries may only require ice to reduce swelling and pain while others may require surgery. Always seek medical attention after sustaining a traumatic injury.

Richmond’s Best Hand Surgeon

We treat relatively minor fractures with a cast or a splint. More serious hand fractures such as those involving crushed or fragmented bones require hand surgery to stabilize the hand and ensure proper healing. Screws, plates and wires may be inserted to support the bones. Depending on the procedure and the severity of the case, the implants may be removed or left in the hand permanently. If you would like more information about hand injuries or treatment, please make an appointment with Dr. Desai today. We serve patients not only in the Richmond area, but also throughout Virginia and the mid-Atlantic region.

Injuries resulting from the use of firearms go far beyond the obvious dangers. Repetitive use of shotguns, rifles and other firearms commonly result in thumb and elbow injuries. When the grip of the gun is held incorrectly, the impact caused by recoil can be absorbed by the thumb. This is seen most frequently in target shooting or sporting clays enthusiasts.

If the gun is shouldered improperly, recoil impact normally absorbed by the shoulder is transferred to the elbow. The damage can include blunt trauma, but most often results in a chronic or degenerative condition. Afflictions can include arthritis, bursitis, tendinitis as well as dislocation. It is of utmost importance to make sure that the proper precautions are taken. Another serious cause of injury, though less common, involves accidents with tree stands. A variety of fractures, sprains and dislocations can result if both the hunter and the stand are not properly secured to the tree.

Prevention and Treatment

Firearm instruction is vital for proper form as well as for safe gun handling. Correct mechanics will ensure not only a healthier thumb and elbow, but a more accurate shot. Many outdoor sporting manufacturers sell shirts, jackets, braces and other gear with special protection designed to prevent injury.

While we may be able to treat some of these problems with general medical care, surgery may be necessary if the injury is too severe or if the joint has degenerated to a point where no other viable options remain.

People who practice high-impact martial arts disciplines are susceptible to a variety of orthopedic injuries. The injury rate is comparable to contact sports such as football and rugby. Sprains and strains are common, as are fractures and contusions of soft tissue and bone.

The most common martial arts injury of the hand, boxer’s fracture, is a fracture of one of the long bones that runs across the top of the hand. Also common are fractures and strains of the wrist which are often seen with beginners who aren’t used to the impact of punching an opponent or a heavy training bag.

Similar injuries include tendinitis, the result of repetitive punching motions, and jammed joints, mainly fingers, from punching improperly or having your strike blocked by an opponent. In judo and wrestling, sprains and hyperextensions can occur during joint manipulation or lock holds.

Treatment and Prevention

Improper technique is often the cause of martial arts injuries. When striking opponents, punching bags, pads or boards with force the entire body must be in alignment, especially the arm. This means connecting with the correct part of the hand, keeping the wrist straight and the elbow close so the force of the impact is absorbed by the body.

We treat soft tissue injures with rest, ice and by elevating the affected area. Injuries to bone surface areas may not display any of the usual visual symptoms, such as discoloration or swelling, but noticeable pain may be the result of small fractures in the bone’s outer layers.

These injuries, as well as serious injuries to soft tissue, may require weeks of treatment to heal and medical advice should be sought immediately. If small fractures or seemingly minor injuries are not treated quickly and appropriately, the possibility exists in later life of developing osteoarthritis or other bone and joint diseases that could lead to severe disability.

The scaphoid is a commonly-fractured bone in the wrist. Because of its unique blood supply, it can be very slow in healing. Some of these fractures can be treated with a cast. Some, however, require surgery in order for the bone to heal. Surgery can be done using minimally invasive techniques to allow an early return to activity.

Skiing is a high speed activity that can be very dangerous. In addition to skier’s thumb, a variety of injuries due to trauma, such as bone fractures and various sprains are common in an activity that involves the levels of speed and motion required in skiing. Skier’s thumb is the name given to a ligament injury in the middle joint at the base of the thumb. This condition results from trauma that occurs during a fall to the skier’s outstretched hand, while still holding the ski pole.

Snowboarders have both feet strapped to the board, making it difficult to recover their balance. Accordingly, falls are the leading cause of snowboarding injuries, which generally involve the upper extremities. Most injuries occur during a snowboarder’s first year of experience, often during the first day.


Professional instruction is important for beginners. Obtaining equipment that is properly fitted, adjusted and designed for the skiier’s or snowboarder’s size and skill level will decrease the chance of falling, therefore decreasing the risk of injury. Inexperienced and young skiers must be realistic when choosing equipment with regard to skill level. All skiers and snowboarders and particularly those who are inexperienced should rest often on their first day on the slopes and whenever they become fatigued.

Initial treatment of skiing-related sprains involves rest, ice, compression and elevation. We monitor minor sprains to determine if they require further treatment. Serious sprains are braced and usually require physical therapy to regain range of motion and strength. Activities are gradually resumed. In the most serious cases in which non-invasive options are inadequate, surgical procedures can be performed to repair the damage. An orthopedic surgeon can discuss treatment options.

When treating skiier’s thumb, serious tears require weeks of casting or bracing support and surgery may be necessary. When not properly treated, thumb strength is decreased permanently. This injury can be prevented by not wrapping the pole straps around your thumbs, so that they do not become entangled when falling.

Unsurprisingly, tennis, as an activity requiring both speed and power, can lead to a number of debilitating injuries for frequent participants. Commonly reported injuries associated with tennis include tendinitis, tennis elbow and wrist strains. The various grips and arm motions required to play tennis exert stresses on every part of the arm. Overuse, use of excessive force, incorrect grip position on the racquet and poor mechanics are common causes of injuries.

Treatment Techniques

A change in technique to ensure correct mechanics and diligent stretching can prevent most of these injuries. Lessons from a tennis professional can teach correct stance, grip and swing actions. Injuries can also be prevented by selecting the appropriate racquet and grip size. Injuries are often treated with rest and by icing the elbow. In cases in which this proves to be insufficient, we may recommend an elbow brace or surgery.