Dr. Mark Cohen on Wrist and Hand Injuries in Athletes

Dr. Mark Cohen, Director of the Hand and Wrist Section at Midwest Orthopaedics at Rush and team physician for the Chicago White Sox, recently appeared as a guest on the NYU Langone orthopedic program on Sirius XM radio to discuss hand and wrist injuries in athletes. The conversation ranged from ligament anatomy to high-profile baseball injuries to practical advice for weekend warriors — and offered a clear window into why wrist injuries are among the most complex in sports medicine.

Why the Wrist Is So Vulnerable

Dr. Cohen opened by drawing a distinction that trips up many patients: the difference between tendons and ligaments. Tendons connect muscle to bone and drive movement; ligaments connect bone to bone and provide stability. In the wrist, that distinction matters enormously, because the joint is made up of eight small carpal bones, each held in place by its own set of ligaments — all of which absorb force directly.

The most frequently seen injury is a tear of the scapholunate ligament — the connection between the scaphoid and lunate bones — typically caused by a fall on an outstretched hand. It's a mechanism that's simple, sudden, and surprisingly consequential.

The Roman Anthony Injury: A Rare and Unusual Case

When Boston Globe reporters reached out to Dr. Cohen about Red Sox prospect Roman Anthony's persistent CMC (carpometacarpal) ring finger injury, his answer was striking: he had never seen or read about this specific injury before.

Dr. Cohen was careful to note he hadn't examined Anthony or reviewed his imaging — and wasn't dismissing the injury. CMC joint trauma is real and takes many forms: bone bruises, hairline fractures, non-displaced fractures, and dislocations. His point was that the ring finger CMC sits naturally protected between two adjacent joints, making a true isolated ligament tear there exceptionally unusual. His best clinical read: some combination of soft tissue and bone trauma, with a recovery timeline of 8–12 weeks for collagen healing and 6–8 weeks for bone.

Elite Athletes and the Demands of Recovery

Anthony's prolonged absence from the lineup is a reminder of something Dr. Cohen sees regularly with the White Sox: high-level athletes often need more time than expected — not because of weakness, but because of the extraordinary demands of their sport.

Conservative management — anti-inflammatory medication, cortisone injections, taping, and therapy — is often the first line of treatment, but returning to play at the elite level requires a standard of joint function that everyday patients simply don't need to meet.

Hook of the Hamate: The Classic Baseball (and Golf) Injury

One of the most recognizable hand injuries in baseball is the hook of the hamate fracture — and Dr. Cohen can spot it on television. When a batter swings and immediately grabs the base of his palm, the diagnosis is rarely in doubt. The butt of the bat contacts the hook of the hamate directly, and a ballistic force goes straight into that tiny structure.

The same mechanism occurs in golf — not from the swing itself, but from hitting the ground too hard. A fat shot, a chunk of turf, and the force travels up the club into the palm.

Because the hamate hook is so small and so poorly supplied with blood, it almost never heals on its own once fractured and displaced.

Excision of the hook is the standard of care, with no meaningful functional loss and a recovery that simply requires the palm incision to heal. Equipment innovation is also helping on the prevention side: padded batting gloves and the axe-handle bat — which eliminates the traditional knob at the base — are designed to reduce the traumatic load to that area of the hand.

When to Seek Care: Don't Wait It Out

One theme Dr. Cohen returned to throughout the conversation is that hand and wrist injuries are consistently undertreated by patients who assume that if a finger moves, it isn't broken. That assumption is wrong, and delay can lead to poor outcomes in terms of alignment, rotation, and long-term function.

Whether that evaluation happens with an orthopedic specialist, at an urgent care, or in an emergency room matters less than getting it done. Dr. Cohen noted that patients often apologize for coming in when their X-rays are normal — and his response is always the same: please, always come in.

An Underrated Treatment Tool: The Nighttime Brace

For patients dealing with chronic wrist pain from yoga, pushups, or general overuse, Dr. Cohen's most counterintuitive recommendation is also one of his most effective. While most patients assume braces are for daytime use, the wrist actually undergoes significant stress during sleep — bent into hyperflexion or awkward positions for hours at a time.

Keeping the wrist in a neutral position overnight gives soft tissue a consistent window to recover, particularly for patients whose symptoms flare with weight-bearing in extension. It's a low-cost, low-effort intervention — and one that Dr. Cohen says makes a measurable difference.