It’s No Fish Tale – These Uncommon Hand & Upper Extremity Fishing Injuries Can Really Happen!

Located on the Gulf of Mexico and home to hundreds of lakes, it’s no wonder that the Texas coast is the playground to fishing enthusiasts far and wide.

Barracuda

unhook stingray2But even the seasoned sportsman can fall victim to some unlikely fishing injuries affecting the hand and upper extremity. In fact, fishermen (and women) put themselves in danger every time they come into contact with marine life – unpredictable behavior/aggressive and often forceful nature of a catch, prevalence of less commonly treated bacteria, unsanitary tools/equipment, poor wound care – all contributing to some common and not so common injuries that hand specialists see in a region like the Texas Gulf Coast.

Some common fishing injuries and conditions with which a Texas hand surgeon is all too familiar include:

fillet_2Many of these common injuries and conditions are treated non surgically and follow the same treatment protocol as any other patient with the same diagnosis – regardless of the cause.

Uncommon Hand & Upper Extremity Fishing Injuries and Conditions

Though there is very little that surprises a hand specialist practicing in “sportsman’s paradise,” an unusual injury associated with fishing will occasionally make its way to a Texas medical clinic.

Some of these uncommon injuries and conditions include:

  • Sting Ray Laceration
  • Fish Bite / Impalement
  • Fish Handler’s Disease / Bacterial Infection
  • Lodged Fish Bones, Fin Spine 

Unlike other injuries that break the skin, these types of fishing injuries are particularly concerning.  Fish and other marine life carry bacterial infections within their bodies, as well as on their skin, which can affect humans if certain precautions are not taken immediately. Some types of bacteria found in marine life are not commonly seen and do not respond to conventional antibiotics frequently used for infections.

Additionally, some marine life such as the Sting Ray utilize defense mechanisms that require special attention when used against a fisherman.

Sting Ray Laceration
While many sting ray injuries involve an inadvertent encounter between a foot or other lower extremity and a sting ray’s barb, some have occurred to the hand or wrist while trying to remove a sting ray from a fishing net or line.

These types of lacerations require more than bandaging.  Not only do sting ray barbs pierce like a weapon, all sting rays are armed with at least one serrated venomous spine at the base of their whip-like tail.  Short-tail sting rays have two tail spines: a slender spike in front of a large, jagged bayonet (1).

In addition to possible damage to muscle, tendons and nerves that can occur from the physical impalement of a sting ray barb, its venom is comprised of many different substances that can cause tissue to break down and die.
Some of the symptoms that Sting Ray venom can cause include:

 

  • Immediate and severe pain radiating up the affected limb
  • Bleeding and swelling in the affected area
  • Sweating
  • Faintness, dizziness and weakness
  • Low blood pressure
  • Salivation, nausea, vomiting, diarrhea
  • Headache
  • Shortness of breath (2)

 

Medical attention is recommended for all sting ray injuries.  Minimally, the wound will be cleaned with warm water to remove the venom and a tetanus booster given if it has been more than five years since the last tetanus booster. Tetanus prevention is required if the patient has never had a tetanus vaccination.  Antibiotics may also be required, and depending on the severity of the injury and amount of damage sustained (often the result of the delay in seeking treatment), surgical intervention to repair soft tissue damage and/or a period of rehabilitation may be required to restore strength to the injured limb (2).

Fish Bite and Impalement
While not every fish injury comes with a venomous double blow, the high risk of bacterial infection and soft tissue damage can be just as serious.  Many fish have sharp teeth, tails and pointed features that can easily break the skin.  Wrestling the unwilling catch onto the boat or beach can leave some sportsmen a bit worse for the wear.

 

Aside from the bacterial concerns that come with marine life, the forceful impact from a sharp feature of the fish can result in soft tissue damage that may require surgical repair and/or months of rehabilitation to restore hand and upper extremity function – as the hand alone is comprised of approximately 34 muscles, 120 known ligaments, and 50 nerves!

 

These types of deep puncture wounds or lacerations in the hand are also at high risk of infection and should be monitored closely.  A delay in the appropriate treatment can lead to complicated tenosynovitis and horseshoe abscess.  Additionally, marine life bacterial infections resulting from Mycobacterium marinum (M. marinum) do not respond to some conventional antibiotic treatment such as amoxicillin (3).

Fish Handler’s Disease
Not every fishing-related Mycobacterium marinum infection is the result of an obvious injury/wound.  A condition known as Fish Handler’s Disease can impact those frequently handling fish and generally affects the hands.  Any inconspicuous cut or small opening on the skin can allow the bacteria to enter the body.  The bacteria’s inability to proliferate in the warm body confines it to the affected area.

 

Common symptoms include swelling, tenderness, and bluish-purple spots. Fish Handler’s Disease is treated with special antibiotics used specifically for this type of bacterial infection.  Recovery can take months.

Lodged Fish Bones, Fin Spine
Occasionally in the handling of fish a fish bone or fin spine can lodge in the hand. Though this may not be painful or immediately worrisome to the injured party, these types of injuries are concerning.  Such injuries often leave residual fragments of foreign organic matter in the soft tissue, which can cause secondary infections such as Staphylococci and Streptococci (4).

 

Typically, x-rays are used first to try and identify a foreign body in the tissue, though are not always successful in doing so.  An MRI may be indicated to identify fine fin spines and tiny bones lodged in the body’s tissue. The surgical removal of the foreign body is important.  Failure to seek and remove the foreign body may lead to persistence of infection (4). Multiple surgical procedures may be required, and the patient is put on antibiotics to prevent infection. Physical therapy may be required after surgery to regain mobility of the hand.

 

If this type of injury goes untreated it can result in permanent disability and hospitalization for infection. Though the area may look as if it has healed, but is still tender, swollen, discolored, or abnormal in any way, individuals are urged to see a hand specialist.

 

Prevention and Precaution
Understanding the unique aspects of the marine life occupying the waters you’re sporting and utilizing protective gloves and garments while fishing can go a long way in injury prevention.  As the largest organ of the human body, our skin serves as a protective barrier.  When any area is compromised, our entire body is compromised. Individuals with other health conditions, such as diabetes or immune deficiency disorders should be particularly cautious and consult a hand specialist for proper wound care.

If not addressed properly, even seemingly minor fishing injuries can result in serious infection, lingering weakness or permanent disability – inhibiting participation in the sport you love.

 

References

 

Hoverboard Hazards

The exciting new phenomena of “hoverboarding” has made hoverboards one of the most popular technological “toys” on the market today.  Intended for agile adolescents, its appeal has also drawn parents and other adults nostalgic for those days gone by.

The technology of the hoverboard, known as a smartboard or balance board as well, doesn’t actually create a hover but rather a forward and backward motion on a sideways skateboard of sorts, with either a large single center wheel or two smaller ones at each end.  It is automated, can reach a formidable speed of 16 mph and relies on body movement for navigation. It is basically a hands free, self-balancing electric scooter.

Concern over hoverboard safety grows amid increase in injuries.

Concern over hoverboard safety grows amid increase in injuries.

They have become the vehicle of choice for students travelling around campus and preteens maneuvering around the house and down the street to visit friends.  They light up, are stealth quiet, move as fast as one’s imagination …. and leave hands free for any other activity desired on the fly.

Unfortunately, while the mainstream hoverboard never actually leaves the ground, its ability to send riders airborne is causing increasing concern.

In fact, the Consumer Product Safety Commission has reported receiving dozens of hoverboard-related injuries from across the United States.  Houston hospitals have also reported in a recent Associated Press article seeing a sharp increase in the number of hoverboard accidents sending adult and young riders alike to the ER and urgent care clinics.

Colleges are not only restricting their use on campus, as a result of the injury risk (to the user and passers by) but also the fire hazard their electrical system poses.  The hoverboard fire hazard is covered extensively in other hoverboard reports.

Among the most common musculoskeletal injuries seen from hoverboard use include concussions, fractures, contusions and abrasions.

Concussions

While most frequently seen in sports such as football and soccer, concussions are increasingly reported in hoverboard accidents.  With no recommended safety wear, the speed and maneuverability of the device is resulting in high impact falls and collisions – resulting in concussions. The primary symptoms of a concussion include:

  • Headache
  • Trouble concentrating, feeling “foggy”
  • Nausea
  • Delayed reaction times
  • Dizziness, lightheadedness
  • Sensitivity with bright lights or loud sounds
  • Irritability

 If a concussion is suspected, an evaluation should be conducted by a physician and hoverboard and other balancing activities should be avoided.

Fractures

Wrist fractures are among the most common types of fractures seen in hoverboard accidents – distal radius fractures among the most common type of wrist fracture.  This is often the result of breaking a fall or harsh impact with an outstretched arm. Other hoverboard fractures and dislocations have been seen in the fingers. Symptoms of a fracture or dislocation can be evident with extreme pain, swelling and slight disfigurement or subtle with only slight swelling and pain.

Most wrist fractures and finger fractures and dislocations can be treated nonsurgically, depending on the severity of the fracture or dislocation.  A splint or other bracing may be indicated, along with anti-inflammatory medication and rest/refrain from extracurricular activity.

Contusions and Abrasions

Collisions causing contusions and abrasions are frequently reported on hoverboards in the absence of safety gear. While most are minor cuts and scraps, some may result in open wounds requiring stiches, while potentially damaging nerves and other soft tissue.  Swollen, discolored injuries lasting more than a month should be further evaluated by a physician.

Preventing Hoverboard Injuries

The lack of safety standards and recommended safety gear/wear is a concern among hoverboard retailers and healthcare providers alike.  But, parents do not have to wait until such recommendations are established.  If a hoverboard is in your family’s future, take the proper precautions. As with any sport, safety gear recommended or not, will provide a bit of assurance.

Cyclists travelling at much less speeds not only have both hands and legs navigating a two-wheeled structure designed for the road, but also helmets, gloves, shoes and other gear designed for safety and the sport. This is also true of rollerbladers and skateboarders. Invest in the safety of your hoverboard rider and purchase protective safety gear.

Help young riders understand the potential risks for injury and encourage that they err on the side of caution to avoid the ER.

Have fun and be safe!

Read a hoverboard article from a young contributing writer.

 

Baseball Fit – Preventive Exercises for a Winning Season

As weather warms and winter sports wind down, attention turns to the promise of a new baseball season and the championships ahead.

Now is the time to begin preparing.High School baseball

At the core of a successful team are strong players – physically strong, well rested and well conditioned.

Baseball is one of the few sports played almost daily throughout the entire season.  For young players beginning in little league, this amounts to a lot of plays by high school.  The frequency of repetitive stress injuries in youth baseball have increased over the years, particularly with the rise in special “elite” teams and extended seasons. This is most evident in young pitchers, on which much research has focused and for which Pitch Count guidelines have been developed.

Although baseball is not considered a contact sport, injuries can result from contact with the ball and other players, as well as poor form/technique, or an awkward movement during a play.

Some of the most common baseball injuries include:

  • Injuries in the shoulder and elbow (Little Leaguer’s Shoulder, Little Leaguer’s Elbow)
  • Knee injuries
  • Muscle pulls
  • Ligament injuries
  • Fractures (Finger, Distal Radius/Wrist)
  • Concussions 

While some injuries resulting from collision with another player are getting hit by the ball cannot be avoided, exercise can aid in reducing risks or preventing many repetitive stress related injuries.

Repetitive injuries are the result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones and joints), which are not given adequate time for proper healing. They are sometimes called cumulative trauma, repetitive stress or overuse injuries.

To avoid such repetitive stress conditions and muscle fatigue, players should have a dedicated fitness program – ideally one that is also specific to the position they play.  This should include overall strengthening and endurance, along with specific exercises to equally strengthen the muscles of the limb(s) most used. Such fitness programs should also include stretching and rest between play.

Exercise programs should also be age appropriate. Young, developing players are encouraged to build strength through resistance rather than weights. Involvement in other seasonal sports such as swimming and running can also provide excellent overall strengthening and endurance.

Strength and Conditioning Exercises – Upper Body

As a throwing sport, exercises for baseball concentrate heavily on the upper body – arms and shoulder. Core strength is also essential for pitching velocity, hitting power and running speed.

The key to any exercise program is the balanced/equal strengthening of muscle groups. For the upper body, this includes triceps/biceps, trapezius, rotator group, and deltoids.

Some Effective Arm, Shoulder and Core Exercises Include:

  • Resistance bands – These can be effective in building arm and shoulder strength. (View video on how these bands are used in exercise programs.)
  • Push ups – Traditional push ups are very effective in building upper body strength (arms, shoulders, back and core/abdominal muscles).
  • Pull ups – Using your own body weight/strength these work on the biceps, upper shoulder and back, upper abdominals and obliques.
  • The Plank – strengthens the core, lower back and oblique muscles. (View video demonstration of the Plank.)

Exercises to Improve Leg Strength

Lower body strength and conditioning is as important as upper body training for young athletes. Leg strength impacts throwing velocity, bat speed/force and running speed.

Squats, lunges and running are among the most effective ways to strengthen the lower body.

Stretching

Stretching is a very important part of an exercise program for athletes in any sport. During exercise and play muscles contract. When muscles contract, they produce tension at the point where the muscle is connected to the tendon. Stretching helps lengthen, relax and restore muscles to their natural state.

Stretching following activity is as important as stretching while warming up before practice and play.

Some easy, yet effective stretches include:

  • Elbow Pulls – Raise the right arm as though asking a question and drop the forearm behind the head though leaving the elbow in the air. Pull the elbow to the left with the left arm until you feel the stretch, hold briefly then repeat several times. Do the same on the opposite side.
  • Cross Body Arm Pulls – Straighten your right arm and pull it across the front of your body, cradling the forearm and elbow with the left hand, pull the arm towards the left across the body until you feel the stretch. Hold the stretch briefly, then repeat on the opposite side.
  • Shoulder Stretch – Lay face down on a floor mat and stretch arms overhead to form a “Y,” with palms facing down on the floor. With forehead on the ground, retract shoulder blades while lifting arms off the ground (still outstretched). Hold for a couple of seconds while squeezing the shoulder blades together. Be careful not to “shrug” the shoulders up. Return to starting position and perform several sets of 10 repetitions. To work the back a little differently, perform this same exercise with the arms straight out to your sides, forming the shape of a “T.”
  • Runner’s Lunge – Position into a deep lunge on your right leg, drop the knee of your left leg and lean forward over the right quad until you feel the stretch, hold for several seconds. Repeat on opposite leg.
  • Hamstring Stretch – Stand flat on the floor with feet a little less than hip width apart. Lean forward and place palm of your hands flat on the floor just in front of your feet, hold for several seconds.

TOP PREVENTION TIP

Resting is as important as any of the components in a successful training program.

Protecting Fingers in Fall Sports

Behind the catches, interceptions, tips, tackles and returns are some of the most commonly reported sports injuries in football, as well as other fall and winter sports – finger injuries.Football Finger Injuries

Finger injuries actually represent one of the most common body injuries in sports in general and include sprains, dislocations, tendon damage and fractures. They are very common in football, basketball and volleyball.

Rarely does a finger injury go unnoticed.  They can be very painful and more challenging to heal, as our hands are constantly in use in everyday activity.Basketball Finger Injuries

Some of the most common causes of a finger sports injury include:

  • Struggle to maintain (as well as strip) a football
  • Clashes with teammates and opponents
  • Awkward and sudden impact with a ball
  • Catching or pulling on a jersey
  • Falls onto a hard surface

Sprains and DislocationsVolley Ball Finger Injuries

Finger sprains generally represent damage to the collateral ligaments, which are band-like structures that stabilize the finger and prevent side to side movement. It most frequently occurs in the mid finger. The little finger, middle finger and thumb are the fingers most affected in such injuries.

A finger sprain can vary in severity and is graded on a scale of 1-3. Grade 1 represents the mildest type of sprain, a stretched ligament.  Grade 2 is a partially torn ligament, and Grade 3 represents one that is completely torn.  When a Grade 3 finger sprain is sustained and bones are also out of place, altering joint surface contact, it is diagnosed as a finger dislocation.

A finger dislocation may be identified as an MCP (metacarpophalangeal), DIP (distal interphalangeal) or PIP (proximal interphalangeal) dislocation depending on the finger joint and bone it affects.

Finger sprains are also often referred to as a “jammed finger.”

Depending on the severity of a “jammed finger,” symptoms may include:

Finger Anatomy

 

  • Pain and immediate swelling
  • Bruising and pain during activity
  • Impaired function
  • Deformity
  • Stiffness and difficulty during gripping activity

Tendon Injuries

Tendons in the hand are tissues connecting muscle to bone, which when contracted pull on bones causing fingers to move. These muscles moving the fingers and thumb are located in the forearm – long tendons extending through the wrist and attaching to the small bones of the fingers and thumb.

The tendons on the top of the hand straighten the fingers and are known as extensor tendons. Those on the palm side bend the fingers and are known as the flexor tendons.

When fingers are bent or straightened, the flexor tendons slide through snug tunnels, called tendon sheaths, keeping the tendons in place next to the bones.  A tendon rupture disrupts this natural flow.

A relatively common tendon injury of the hand diagnosed in fall sports is a tendon rupture, also called a “Jersey Finger.”  This occurs in a “tear-away” type of activity, such as grasping a jersey with finger(s) in a flexed position – and then forced straight as the player quickly moves in another direction.  The result is loss of flexion at the DIP joint because of damage to the flexor tendon.

An injury to the tip of the finger may result in extensor tendon damage, which is also known as a “Mallet Finger.”

Symptoms of a flexor or extensor tendon rupture may include:

Flexor

  • An inability to bend one or more joints of your finger
  • Pain when your finger is bent
  • Tenderness along your finger on the palm side of your hand
  • Swelling of the finger

Extensor

  • Inability to open or extend the hand or fingers
  • Pain
  • Swelling or weakness of the finger
  • Cut to the back of the hand or fingers

Finger Fractures

Among the more severe finger injuries occurring in sports are finger fractures.  This is a break in one of the small bones of the finger.  Finger fractures may be stable or unstable.  Among the most common finger fractures include; distal phalanx (also known as a Tuft Fracture and associated with “crush” injuries), mallet, flexor digitorum profundus avulsion, and middle and proximal phalanx fractures (non-displaced, unstable, or displaced – which are usually more complex fractures to treat).

The correct diagnoses and treatment of a finger fracture, which can often mimic a finger sprain or dislocation in pain and symptoms, is imperative in ensuring optimal long-term function.

DIAGNOSIS

While many finger injuries can be diagnosed with a physical examination, an x-ray is indicated to more thoroughly assess the injured area or possible fracture – and severity of the injury. A CT scan may also be used to evaluate complex fractures. An MRI is often used when the soft tissues are involved (such as with tendon ruptures).

TREATMENT

Treatment for most finger injuries is nonsurgical, conservative approach that may involve RICE (rest, ice, compression, elevation), splinting, anti inflammatory medications for swelling/pain, and rehabilitation exercises.  Reduction may be performed on some simple fractures and supported with splinting or “buddy taping” (practice of taping the injured finger to a nearby uninjured finger to limit mobility and provide splint-like support).

More serious injuries and those unresponsive to conservative treatment may require surgical repair and an aggressive post-surgical hand and upper extremity therapy program.

PREVENTING INJURY

Injury prevention is always preferable for athletes wanting to give it their all during the sports season.  There are some things you can do to reduce risk of injury during sports this fall and the seasons to come:

  • Avoid wearing rings or other jewelry when playing.
  • Opt for closed fist rather than open hand approaches in volleyball and blocking in football.
  • Buddy taping (as mentioned above) can also be effective in preventing finger injury in a number of different sports.
  • Finger bracing should be worn in both practice and games until symptoms of a mildly injured/painful finger resolves, to avoid more serious injury/damage.
  • Finger and hand strengthening exercises can be beneficial.