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DISABLEMENT MODEL CASE STUDY 

 

9 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018 
 

Acute Management of an Abductor Digiti Minimi Strain in a Collegiate 
Baseball Player: A Patient-Centered Case Study 
S. Andrew Cage, MEd, LAT, ATC1,2, Diana M. Gallegos, MS, LAT, ATC1, Brandon J. Warner, MEd, LAT, 
ATC2,3 

1The University of Texas at Tyler, Tyler, TX; 2The University of North Carolina Greensboro, Greensboro, NC , 3Grand Canyon 
University, Phoenix, AZ 

 

 
ABSTRACT 

The purpose of this disablement model case study was to 
describe the case of a collegiate baseball player suffering 
from an isolated abductor digiti minimi strain. Despite an 
initial decrease in function, the treating sports medicine staff 
was able to provide the necessary care to allow the patient 
to participate in the final games of his career. While the 
anatomy and function of abductor digiti minimi are well 
described in the literature, there is no documentation of 
isolated abductor digiti minimi injuries. In this case, the patient 
injured the medial aspect of his hand when hitting a baseball. 
The patient experienced immediate pain along with the 
sensation of “tightening” throughout the hypothenar 
eminence. The following day the patient reported difficulty 
with sleeping and daily activities due to pain. Although 
fracture tests were negative, the patient exhibited significant 
weakness and pain with fifth finger abduction and flexion 
leading to physician referral. The team physician noted pain 
with active ulnar deviation in addition to previous symptoms. 
At this time, the patient was diagnosed with an abductor 
digiti minimi strain. The patient stated that he was in his final 
season of competition and wished to continue participating 
with his team. The patient consented to a treatment plan 
involving local injection of lidocaine and bupivacaine along 
with compression via Kinesiology Tape®. Using these 
methods, the patient was able to participate in the final two 
games of his career. Following the cessation of baseball 
activities, the patient noted that he had no recurrent 
symptoms or complications from his injury. When prescribing 
treatment for patients in a competitive setting, it is paramount 
that clinicians take into account patient centered values. If 
there is no risk of significant, long term injury, clinicians should 
attempt to provide patients with the means to participate in 
activities if they should desire. 
 
Key Phrases 
Abductor digiti minimi, college and university patient 
population, functional testing 
 
Correspondence 
S. Andrew Cage, The University of Texas Tyler, 11325 
Preakness Dr., Flint, TX 75762. 
E-mail: sacage@uncg.edu 
 
 
 

Full Citation 
Cage SA, Gallegos DM, Warner BJ. Acute Management of 
an Abductor Digiti Minimi Strain in a Collegiate Baseball 
Player: A Case Study. Clin Pract Athl Train. 2018;1(2):9-13. 
https://doi.org/10.31622/2018/0002.3.  
 
Submitted: August 16, 2018  Accepted: October 1, 2018 

 

INTRODUCTION 

The abductor digiti minimi is a small muscle that 
makes up a portion of the hypothenar eminence. 
Originating from the pisiform, pisohamate 
ligament, and flexor retinaculum, the abductor 
inserts on the proximal phalanx of the fifth digit 
as well as the sesamoid bone when present. 
Primarily, this muscle is responsible for the 
abduction of the fifth digit.1 The muscle receives 
its neurological innervation from the deep branch 
of the ulnar nerve and vascular supply from the 
ulnar artery.2 Apart from its role in fifth digit 
abduction, no other functions have been described 
for the abductor digiti minimi.   

The abductor digiti minimi has been implicated in 
approximately a quarter of the cases of 
Dupuytren’s contracture of the hand.3 In some 
cases, this compression of the ulnar nerve can be 
caused by the presence of an accessory abductor 
digiti minimi muscle.4 In spite of the abductor digiti 
minimi’s involvement in ulnar nerve pathologies, 
there is no peer reviewed literature describing an 
isolated injury to the abductor digiti minimi.3,4 
Furthermore, without a body of literature, it is 
difficult to create an evidence based approach to 
treating these injuries and the subsequent 
dysfunctions that occur. Thus, it is the purpose of 
this case study to describe an isolated abductor 
digiti minimi in a collegiate baseball player. This 
case will describe the mechanism of injury, 

https://doi.org/10.31622/2018/0002.3


Acute Management of an Abductor Digiti Minimi Strain in a Collegiate  
Baseball Player: A Patient-Centered Case Study 

 

 

10 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

diagnosis, treatment, patient reported 
disablements, and outcomes. 

Patient Information 

The patient described in this case is a right 22-
year-old collegiate baseball player who fielded 
the shortstop position. When playing, the patient 
would throw right-handed and bat left-handed. 
The patient had a previous history of surgical 
excision of the hook of the hamate in his right 
hand from the previous year, but was otherwise 
healthy and fully functional. After hitting a 
baseball during competition, the patient 
reported immediate pain along the medial 
aspect of his right hand. Initial evaluation 
revealed moderate pain, but full strength and 
range of motion with all wrist and digit motions. 
For the remainder of the game, the patient was 
able to participate at full capacity, but was 
instructed to report to the athletic training staff 
the following day. 

Differential Diagnosis and Evaluation 

The following day, the patient reported to the 
athletic training clinic complaining of increased 
pain. The patient stated that the pain had 
disrupted his sleep, made it difficult to turn the 
steering wheel of his car while driving to the 
clinic, and was significantly worse than the 
previous day. The patient’s hand was diffusely 
tender to palpation along the medial aspect of 
the hypothenar eminence. While all fracture tests 
were negative, the patient presented with 
enough pain and weakness with fifth digit 
abduction and grip strength that physician 
referral was warranted. At this time, the 
differential diagnosis included: TFCC injury, 
Wrist Sprain, Wrist Strain, Subluxing Extensor 
Carpi Ulnaris. 

Two days after the initial injury during the team 
physician’s evaluation, it was also noted that the 
patient was experiencing pain with ulnar 
deviation. However, the most explicit pain and 
weakness was elicited with resisted fifth digit 

abduction. Following a comprehensive exam, the 
patient was diagnosed with an abductor digiti 
minimi strain. It was at this time that the patient 
expressed his concern regarding his ability to 
participate in the upcoming tournament. His 
concern were compounded by the fact that he 
was in his last year of eligibility, and the 
upcoming tournament represented his last 
opportunity to participate in collegiate baseball. 

With the patient’s desires and values in mind, 
treatment options were discussed, and the 
patient was educated on the potential outcomes 
of all of them. Given that other conservative 
treatment options would have resulted in a 
significant delay in returning to competition, the 
decision was ultimately made to perform local 
injections of lidocaine and bupivacaine at the 
insertion of the abductor digiti minimi prior to the 
upcoming competitions in addition to being 
taped to provide as much compression as 
possible without inhibiting function (Figure 1). 
Kinesiology Tape® was chosen to allow the 
patient the most range of motion possible at the 
wrist while also providing compression. A first 
strip of tape was cut and then applied over the 
medial aspect of the hypothenar eminence with 
50 % tension. A second strip of tape was split 
half way, with the anchor covering the ulnar 
styloid. Once the anchor was affixed, the split 
ends of the tape were then wrapped around the 
wrist medial to lateral in an effort to provide as 
much compression as possible without occluding 
neurovascular structures.   

Body Structure and Function 

Given that the injury was muscular in nature, the 
primary diagnostic tools utilized were strength 
and range of motion tests. At the initial time of 
injury, the patient presented with full range of 
motion and adequate wrist and digit strength 
with only mild pain. However, by the following 
day, the patient’s strength with fifth digit 
abduction had decreased to a 4/5. The patient 
was still able to perform ulnar deviation with full  



Acute Management of an Abductor Digiti Minimi Strain in a Collegiate  
Baseball Player: A Patient-Centered Case Study 

 

 

11 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

Figure 1: Compression tape for digiti mini strain.  

strength, but noted increased pain from the 
previous day. Additionally, the patient could no 
longer perform the motion without experiencing 
significant pain. 

Activity and Participation 

In order to determine if the patient would be 
able to participate in the upcoming games, 
functional testing was performed consisting of 
hitting and throwing drills prior to the initiation of 
interventions. With the decrease in strength and 
increase in pain, the patient began to experience 
difficulty gripping his bat and throwing with both 
accuracy and velocity. If the patient decreased 
his velocity he could throw more accurately, but 
he expressed concern that this may affect his 
ability to remain competitive at his position. The 
patient stated that he believed that he would be 
able to improve both the accuracy and velocity 
of his throws if his pain levels were decreased. 

Environmental and Personal Factors 

Outside of baseball related activities, the patient 
stated that the pain he was experiencing in his 
hand was affecting his daily activities. 
Specifically, the patient stated that the intensity 
of pain inhibited his ability to obtain quality 
sleep and drive his motor vehicle. Other activities 
that the patient’s hand pain affected included 
being able to type on his computer. The patient 

reported having to change his typing form in 
order to mitigate the intensity of pain he was 
experiencing. This change in form resulted in the 
patient’s homework assignment taking 
significantly longer than it would have otherwise. 
Given the inconveniences created for the 
patient’s in his collegiate activities and in his 
daily life, he wished for his injury to be healed 
as quickly as possible 

INTERVENTIONS 

Three days post injury, the patient was seen in 
the athletic training room prior to his first 
postseason competition. The patient’s skin was 
prepped using an alcohol prep pad, and a 
mixture of lidocaine and bupivacaine was 
injected near the proximal aspect of the 
hypothenar eminence. Two strips of Kinesiology 
Tape® were then used to provide as much 
compression as possible without impeding wrist 
or hand motion. While this technique had not 
necessarily been described in the current 
literature, the clinician used knowledge of the 
structures being taped and the principles behind 
compression tape to approximate the best tape 
job possible for the goals in mind. Follow up 
evaluation revealed that the patient did not 
experience any further pain at rest, or with 
motion, and demonstrated full strength with fifth 
digit abduction and grip strength. The patient 
was then taken to the field to ensure that he 
would be able to grip and swing a bat, and grip 
and throw a baseball. After demonstrating the 
ability to swing a bat without pain, the patient 
then hit off of a tee to provide resistance to his 
swing. Once the patient had passed this sport-
specific testing, the patient was cleared to 
participate in the day’s competition. 

OUTCOMES 

Body Structure and Function 

The patient was able to regain fifth finger 
abduction, wrist ulnar deviation, and grip 



Acute Management of an Abductor Digiti Minimi Strain in a Collegiate  
Baseball Player: A Patient-Centered Case Study 

 

 

12 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

strength after the application of lidocaine and 
bupivacaine injections in combination with 
compression taping at the proximal aspect of the 
hypothenar eminence. Along with the recovered 
strength, the patient noted that there was little to 
no pain for roughly three hours post injection. 
However, after the three hour time frame had 
elapsed, his pain gradually increased again. 
When asked, the patient said this period of 
relatively pain-free activity was enough to allow 
him to comfortably and effectively participate in 
his competitions at full function. 

Activity and Participation 

Through the use of the proposed treatment plan, 
the patient was able to participate in the final 
two contests of his career. While participating, 
the patient was able to perform at a high level 
and maintain the standard of performance he 
had throughout the season. The patient noted 
that if any of the competitions had gone longer 
than their regulation length, he may have had 
increased difficulty in completing in them, but 
had no severe issues completing a standard 
game. 

Aside from baseball, both sleeping and activities 
of daily living that required gripping or fifth 
digit abduction continued to bother him. If the 
injury had taken place during the regular season, 
the patient may have required considerations 
from his instructors regarding completion of 
course work that required a large amount of 
typing or writing. Fortunately, the academic year 
had concluded by this point in the season, and 
the patient was not required to perform 
extensive writing or typing that might have 
exacerbated the symptoms of his injury. Within a 
week of completing his final season, the patient 
reported significant decreases in pain following 
relative rest combined with regular icing and 
NSAID usage, and was pain free by the two-
week mark. 

Environmental and Personal Factors 

Given the patient’s expressed desire to 
participate in the final competitions of his 
playing career, he remained stringently adherent 
to all appointments and measures taken to allow 
him to participate. While the patient reported a 
slight increase in pain from baseline following 
each of the two competitions, he stated that is 
was well within tolerable limits if it meant he was 
allowed to continue to play. Furthermore, the 
patient was not allergic to lidocaine, 
bupivacaine, or the adhesive from the 
Kinesiology Tape®. As such, the patient suffered 
from no adverse effects from the chosen 
treatment course. 

DISCUSSION 

This case describes the diagnosis and 
management of a patient suffering from an 
isolated abductor digiti minimi strain. While the 
abductor digiti minimi’s involvement in other 
pathologies has been described, there is no 
documentation detailing strains to the muscle and 
the treatment thereof.3,4 Fortunately, this case 
resulted in a positive outcome for the patient 
which allowed him to achieve his goals. However, 
the short timeframe did not allow for a 
measurement of progression of the injury while 
continuing participation in baseball. Had this 
injury occurred at a different phase of the 
season, the clinician would have been able to 
attempt other conservative treatments and chart 
the progression of the patient’s outcomes in order 
to determine the best possible course of 
treatment in future instances. This means that the 
case presented may not be generalizable for 
clinicians seeking to care for a patient with a 
similar injury over a longer course of time. 
Further research is required to determine the 
best practices for managing an acutely strained 
abductor digiti minimi in a patient who requires 
above average dexterity to complete their daily 
activities. 

Overall, the choice of intervention (i.e. local 
anesthetic injection and compression taping) was 



Acute Management of an Abductor Digiti Minimi Strain in a Collegiate  
Baseball Player: A Patient-Centered Case Study 

 

 

13 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                         Volume 1 – Issue 2 – October 2018  

chosen due to the short timeframe in which the 
patient had to recover from his injury. Had the 
patient had prospects of playing past the current 
season, there may have been other 
considerations when determining the course of 
treatment. Additionally, if the patient had been 
required to continue typing for his academic 
work there may have been a need for other 
interventions, including discussions with instructors 
of alternate methods for the patient to complete 
his assignments. Ultimately, the patient’s 
symptoms were able to resolve with cessation of 
activity, and no adverse outcomes were 
reported. 

CLINICAL BOTTOM LINE 

Within the scope of clinical practice, it is entirely 
possible for clinicians to encounter injuries and 
conditions that are not well described in the 
literature. In these instances, clinicians must rely 
on their expertise along with patient-reported 
measures and values. When relying on these 
facets of clinical care, evaluation and re-
evaluation of the clinician’s treatment and 
rehabilitation plan are crucial to achieving 
optimal patient outcomes. When prescribing a 
course of treatment for patients in a competitive 
setting, it is paramount that clinicians take into 
account patient-centered values. While the goal 
of clinicians should be to provide patient-
centered care, they must also incorporate patient 
education as much as possible. By providing a 
patient with as much information as possible 
regarding potential outcomes of a chosen 
treatment program, the clinician can hopefully 
mitigate at least some of the potential conflicts of 
interest that may occur in such a scenario. If there 
is no risk of significant, long-term injury, clinicians 
should attempt to provide patients with the 
means to participate in activities if they should 
desire. 

 

 

REFERENCES: 

1. Schmidt UL. Surgical Anatomy of the Hand. 
1st ed. New York, NY: Thieme Medical 
Publishers, Inc; 2003. 

2. Usyal AC, Alagoz MS, Tuccar E, Sensoz O, 
Tekdemir I. The vascular anatomy of the 
abductor digiti minimi and the flexor 
digitorum brevis muscles. J Hand Surg Am. 
2005;30(1):172-176. 
https://doi.org/10.1016/j.jhsa.2004.06.00
1  

3. Meathrel KE, Thoma A. Abductor digiti minimi 
involvement in Dupuytren’s contracture of the 
small finger. J Hand Surg Am. 
2004;29(3):510-513. 
https://doi.org/10.1016/j.jhsa.2004.01.01
6 

4. Al-Qattan MM. Ulnar nerve compression at 
the wrist by the accessory abductor digiti 
minimi muscle: wrist trauma as a precipitating 
factor. J Hand Surg. 2004;9(1):79-82. 
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https://doi.org/10.1016/j.jhsa.2004.06.001
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https://doi.org/10.1142/S0218810404001899

	INTRODUCTION

