Tennis Tournament Level Play Increases Risk of Trauma

Tennis is a physically demanding sport which, in avid players, is most often associated with hand and upper extremity overuse or repetitive stress conditions, such as tennis elbow and other tendinopathic injuries and conditions.  But for those playing competitively with tennis leagues at tournament level play, there is also risk for more serious injury.

Nearly one-third of tennis injuries are the result of a traumatic or acute event, which include:

  • Stress Fractures
  • Muscle Strains

These types of injuries are most common in those players engaged in rigorous training, competitive play and frequent tournament participation.

Stress Fractures

Stress Fractures occur when repeated stress on a limb weakens the muscle.  The overload of stress is then absorbed by the bone to the extent that a small fissure or fracture in the bone occurs. This often affects the olecranon (round bony part of the elbow) or the ulnar shaft and seen in athletes participating in throwing and swinging sports.Stress Fracture of Elbow

Additionally, young players are much more likely to sustain a stress fracture than professional playing adults, because they are training too rapidly and fatiguing the ill prepared muscles surrounding the bone.

Unlike a typical fracture that causes a clear break in the bone, a stress fracture is a slight crack that causes pain.  While most often seen in the lower extremity in runners, they also occur in the upper extremity in competitive level athletes involved in such sports as tennis, swimming and throwing activities [1].

Stress Fracture Symptoms Include:

  • Pain, weakness and or tenderness near the break
  • Slight swelling
  • Pain during activity, which is relieved at rest

Stress fractures are generally diagnosed with a physical examination and possibly an X-ray – though they can be difficult to see with this type of imaging.  A bone scan or MRI may be indicated.

Treating Stress Fractures

Most stress fractures heal with adequate rest from the sport, physical therapy and modification of technique.  If symptoms persist, arthroscopic surgery may be indicated to address bone spurs or remove loose bone fragments.

If a stress fracture is not treated despite increasing pain, it can become displaced, resulting in a more severe injury and predisposing the patient to the early onset of arthritis.

Muscle Strains

The rapid and sudden movements in tennis can result in muscle strain if players are not adequately warmed up and subjected to a rigorous training and play schedule.  A muscle strain, also referred to as a repetitive strain injury (RSI) when seen in athletes and those involved in repetitive tasks, can cause tingling in the hand or arm, loss of sensation and loss of strength [2].elbow_pain

Other symptoms of muscle strain include:

  • Tenderness in the affected muscle or joint
  • Throbbing or pulsating in the affected area

A muscle strain is generally diagnosed with a physical examination, and treatment depends on the severity of the injury.

Muscle strain treatment may include:

  • Anti-inflammatory medication
  • Heat or cold therapy
  • Splints
  • Physical therapy
  • Steroid injections (only when specifically indicated)

Preventing Injury

These types of traumatic injuries can be avoided with appropriate strength and endurance training gradually leading up to more rigorous training sessions.  Proper warm up exercises and stretching are also key to avoiding injury, as with any sport.

In young, growing athletes committed to a single, competitive level sport such as many in tennis, it is particularly important to invest in technique and strength and endurance training, as well as ensure adequate rest for muscle recovery.


 [1] Stress fractures of the upper limb. Sports Med. 1998 Dec;26(6):415-24.
[2] Repetitive strain injury (RSI) explained. Medical News Today. 2018 Jan (last updated).

 This educational information was provided by Dr. Korsh Jafarnia, one of Houston’s renowned orthopedic surgeons and board-certified hand and upper extremity specialists.  He is a member of the faculty at Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital – Memorial City/Spring Valley.

 A Side Note:

An avid tennis player himself, Dr. Jafarnia had an opportunity to check out the Astros 2018 World Series Championship trophy while attending the River Oaks Tennis Club Men’s Clay Court Championship. (Pictured with Reid Ryan, President of the Houston Astros.)

Reid Ryan (L) and Dr. Korsh Jafarnia (R)

Reid Ryan (L) and Dr. Korsh Jafarnia (R)







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.


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.




How Your “Musculoskeletal Mindset” Can Impact Injury Risk at Work

While the study of orthopedics has traditionally placed emphasis on the physical influencers impacting our bones, tendons, ligaments and other surrounding soft tissue comprising the musculoskeletal system, new research now spotlights the increasingly important role of workplace “psychosocial” factors on musculoskeletal disorders (MSD).Tired man being overloaded at work

According to the Canadian Centre for Occupational Health and Safety (CCOHS), a workplace psychosocial factor is defined as “a non-physical aspect of the workplace that is developed by the culture, policies, expectations and social attitude of the organization.” [1]

Basically, psychosocial factors umbrella the different emotional responses to the demands placed on workers while performing their job –  including frustration, dissatisfaction, depression and despair. The resulting stress induces physiological responses that can contribute to the development of musculoskeletal disorders.

New research reported by the CCOHS identifies some physiological responses to psychosocial factors, including:

  • Increased blood pressure, which in small joint spaces can increase pressure on tendons, ligaments and nerves.
  • Increased fluid pressure over a prolonged period of time can also increase pressure in joints and on surrounding soft tissue as well as the carpal tunnel.
  • Reduction of growth functions can reduce production of collagen and consequently the body’s ability to heal or recover after performing work functions.
  • Over time a decreased sensitivity to pain can prompt workers to work beyond their body’s physical capacity, predisposing it to injury.
  • Increased muscle tension can increase pressure on and around the joints and may cause excessive use of force during certain activities and movements.
  • The body’s heightened state of sensitivity may overburden the musculoskeletal system by prompting a person to lift more, work faster, etc.

It is difficult in our current healthcare environment to directly attribute “workplace psychosocial factors” as a cause of workplace MSD, because of the many other factors that contribute to such disorders/injuries (biomechanical, etc.). Increasingly, though, evidence and newly published scientific research studies are helping to spotlight the role that these factors play, and the link between “stress induced physiological changes” and musculoskeletal disorders.

Additionally, a growing number of research studies are reporting a link between emotional disorders (anxiety, depression) and medical and surgical complication rates, lower patient satisfaction scores and readmission risk in joint replacement patients. [2,3]

There will likely be much more research on these topics in the coming years.

This new information underscores the importance of identifying and addressing psychological stressors and our response to them, as they are proving to have a significant impact on not only the cardiovascular but also the musculoskeletal system – two vital contributors to overall health and well-being.



  • Canadian Centre for Occupational Health and Safety (CCOHS), , .
  • Wood TJ, Thornley P, Petruccelli D, et al. Preoperative predictors of pain catastrophizing, anxiety and depression in patients undergoing total joint arthroplasty. J Arthroplasty. 2016 Dec;31(12):2750-2756.
  • Gold HT, Slover JD, Joo L, et al. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplasty. 2016 Nov;31(11):2385-2388.





By:  Jackie Jafarnia, 10


Hoverboards might be fun, but they can also be dangerous.  For instance, I know so many people who have hurt themselves.  My friend, Ana, broke her wrist because hers wouldn’t stop.  Also if you over charge them, some of the brands catch fire or explode.  If you have one or plan on getting one, I’m telling you to be cautious.  From what I know Harvard has already banned them.  That is what I think about hoverboards.


Colleges now restricting hoverboard use on campus.

Colleges now restricting hoverboard use on campus.


Top Hand & Upper Extremity Injuries Prompting ER / Urgent Care Visits

Hand and upper extremity injuries account for over half of the orthopedic injuries seen in an ER or Urgent care center.

Fractures among most common ER/Urgent Care injuries

Fractures among most common ER/Urgent Care injuries

According to a 2012 study published in the Hand journal, the most common region injured is the finger (38.4%), and the most common upper extremity injury was a fracture (29.2%). Specific injuries with high incidence rates (all per 100,000 per year) included finger lacerations (221), wrist fractures (72), finger fractures (68), and lower arm fractures (64). [1]

While home is cited as the most common setting for an upper extremity injury, sports injuries in the field run a close second.

A few of the most common hand and upper extremity injuries include:

  • Contusions and Lacerations
  • Fractures
  • Sprains and Dislocations

Hand and Upper Extremity Contusions and Lacerations

Contusions and lacerations can result from an accident, fall or sports injury.  Both should be carefully assessed, as damage to nerves, tendons and bone may exist.


Contusions occur when a direct blow strikes part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin.

Contusions cause swelling and pain, and limit joint range of motion near the injury. Torn blood vessels may cause bluish discoloration (bruising). The injured muscle may feel weak and stiff.

Sometimes a pool of blood collects within damaged tissue, forming a lump over the injury known as a hematoma. Swelling and bleeding beneath the skin in severe cases may cause shock. If tissue damage is extensive, there may also be a broken bone, dislocated joint, sprain, torn muscle, or other injury.

Diagnostic tools used to assess the extent of the damage may include ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans.  For some injuries, testing for nerve injury may also be indicated.  Treatment will depend on the extent of the injury, though RICE (Rest, Ice, Compression, Elevation) is encouraged for contusions until a physician can be seen.

Follow up is important to thoroughly assess the scope of soft tissue damage.  Complications that can occur from contusions include compartment syndrome and myositis ossificans.


Lacerations often result from a cut with a knife, piece of glass or other sharp object. It can be difficult for patients to determine how deep and how damaging a laceration may be.

Concerns include:

  • Length and depth of cut (more than 1/4” deep with visible deep tissue)
  • Visible bone
  • Width of cut and inability to squeeze skin closed
  • Severe bleeding
  • Cleanliness of cut (item causing cut) and possible debris in the wound

An ER or Urgent Care clinic can address these types of injuries, properly cleaning the wound and bandaging and/or suturing (stitching).  Lacerations of the hand and upper extremity should be further evaluated by a specialist to determine if there is damage to surrounding nerves, tendons or other soft tissue.  If unaddressed permanent loss of sensation or range of motion can result.

Hand and Upper Extremity Sprains and Dislocations

Unlike a fracture, sprains and dislocations do not cause a break in the bone.  These types of injuries are usually the result of extreme stretching of the limb, occurring from a twist, hit or fall.  A sprain is a tear (minor or severe) in a ligament, which connects bones.  Symptoms may include pain, swelling, and bruising.

A dislocation occurs when the bones meeting at a joint are disrupted and moved out of their natural alignment.  This is a common injury to the fingers.  Symptoms may include severe pain during movement and an obvious deformity.

While initial treatment will depend on the severity of the injury, most sprains will resolve on their own with RICE (rest, ice, compression and possibly elevation).  A dislocation may require reduction (placing the joint back into proper alignment) and a brief period of immobilization with a splint.  Injuries should be assessed more thoroughly by a specialist to ensure that there is no further damage to surrounding nerves, ligaments or tendons.


Hand and Upper Extremity Fractures

Fractures are among the most commonly seen injuries in the ER or Urgent Care setting.

Fracture type can vary and are treated differently in the adolescent child and adult.

Fracture type can vary and are treated differently in the adolescent child and adult.

These types of injuries most commonly occur to the shoulder, elbow, wrist, and hand/finger as a result of a fall onto an outstretched arm or block from a harsh impact.  This is particularly true of sports injuries.

With both the frequency and intensity of youth sports participation higher than ever, understanding the significant anatomical differences between the skeletally immature patient and the skeletally mature patient is also key in properly identifying and treating the variety of musculoskeletal injuries that occur to the hand and upper extremity.

Fracture Type

There are many different types of fractures, all of which fall into one of two categories – displaced and non displaced.  A displaced fracture means that the parts of the bone at the break are not in alignment and require realignment before healing can begin.  A non displaced fracture means that the break did not disrupt the alignment of the bone.

A displaced fracture can sometimes cause the bone to pierce through the skin, which is known as an open or compound fracture.

Because the lining of the bone is thicker in children, diminishing with age, the most common fractures seen in adolescents are non displaced buckle and greenstick fractures (affecting the wrist and forearm bones).  In adults, fractures tend to be more severe – often displaced and comminuted (multiple bone fragments requiring more complicated reassembly). Common fractures seen in adults are wrist fractures (distal radius fractures and scaphoid fractures).

An x-ray will help determine the type of fracture and best treatment.  Initially, most fractures can  be safely splinted and supported with a sling, until an orthopedic specialist is seen.  Prompt followup with an orthopedic physician is important, particularly for displaced fractures.  Most ER and Urgent Care centers will provide patients with a digital copy of their x-ray for followup with a specialist.

Fracture Care

Most non displaced fractures heal well with a period of casting followed by rehabilitation exercises.  Displaced fractures first require realignment, which is known as either closed reduction (non surgical) or open reduction (surgical).  Surgical repair will also include internal fixation with plates and screws to ensure the bone pieces remain aligned while healing.

Close followup with a hand and upper extremity specialist is key for proper healing of fractures and reduced risk of future problems affecting the injured bone and nearby joints.


1.) Daan Ootes, Kaj T Lambers, David C Ring. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (NY). 2012;7(1):18-22.  Published online 2011 Dec 14. doi:  10.1007/s11552-011-9383-z

Fish Handler’s Disease

Catching more than you bargained for…..

This blog was inspired by a recent case reporting the improper handling of a stingray.  In this particular case, a man visiting Florida and unfamiliar with the local marine life sustained a hand injury from the barb of a stingray while fishing.  The injury required surgery and years of recovery.

Stingray barbs, sharp and toxic

Stingray barbs, sharp and toxic

Those familiar with stingray know to be particularly cautious.  The barb can be dangerous and wounds sustained from them vulnerable to limb threatening infection.

Though, the stingray with its venomous, razor sharp barb is not the only fish capable of inflicting harmful injury.  The dorsal fins of many frequently caught fish can contain venomous spikes and bacteria exposing open wounds to dangerous infections.

In fact, the teeth and fins of many fish are notorious breeding grounds for bacteria and fungus putting wounds inflicted by them at great risk for infection.

Too often identifying the source of infection, such as that which was found in the above case (Fusarium solani bacteria), can delay proper treatment and result in permanent damage – particularly if the medical team treating the injury is unfamiliar with the region or marine life responsible for the injury.  This patient was eventually treated with debridement and skin grafting in conjunction with ketoconazole therapy (antifungal treatment). 1 Unfortunately recovery took years.

Understanding the marine life in your area and those fish of particular concern will help reduce these types of injuries – and facilitate the healthcare team involved in your care should an injury occur.  Also knowing some first quick steps in addressing such an injury before seeking medical attention can improve outcome.

Swimming with Bacteria

Fish fins and teeth, breeding ground for bacteria

Fish fins and teeth, breeding ground for bacteria

Aquatic fungi are often considered secondary tissue invaders following traumatic injuries or infectious agents. Because many fungi grow on decaying organic matter, they are especially common in the aquatic environment, particularly in warmer waters.  A number of mycotic infections have been reported in fish. Laboratory culture and complete clinical evaluations will further the understanding of these diseases – initially for scientists and then healthcare providers treating such injuries.  The education of sportsmen can go a long way in filling the gap in between.

The prevalence of infections resulting from Mycobacterium marinum bacteria or Erysipelothrix in those handling fish and shell fish has prompted the official classification now known as Fish Handler’s Disease.  

More than an Open Wound

Whether it occurs while unhooking, filleting or tossing back to the sea, when the skin is broken by a tooth or fin (particularly among those fish identified as toxic or high bacteria carriers), the injury has a far more damaging potential than a simple, open wound.

The largest organ of the human body, skin serves a valuable protective purpose for all that lies beneath – ensuring not only that our internal network remains intact but also that nothing harmful or disruptive gets in.  When this protective barrier is breached, not only is the wounded limb affected but the entire body.  Invasive bacteria and fungal infections can spread quickly.

While addressing the initial wound, such as stopping blood loss and addressing pain, taking quick steps to reduce risk of a disseminated infection or invasive impact of a venomous/toxic encounter are key to a rapid recovery and reduction in longterm trauma.

A disseminated infection is an infection that enters at a single point and then spreads throughout the body, often affecting numerous organ systems such as that incurred by a stingray and other venomous fish. Beginning as a lesion, the injury gets progressively worse as the infection grows.  The right emergency care and ongoing treatment are key.

Immediate Action Following Toxic Exposure

Whether an open hand wound results form exposure to a known toxic barb or local Catfish fin, following these early steps will help in the ultimate healing process:

  • Bathe the wound in saltwater, removing any fragments of the spine
  • Stop the bleeding by applying pressure
  • Soak the wound in hot water until the bleeding stops, or apply a heat back. This will inactivate any venom still in the wound. Remove any pieces of the spine/fin/barb in the hand with sterilized tweezers (not advised if in the chest, abdomen, or neck).
  • Clean the wound with soap and water and dress it without taping it closed
  • Immediately go to the hospital or ER
  • Inform the medical staff of the area in which you were fishing and the type of fish you were handling

Preventing Fish Handler’s Disease and other Fishing Trauma

While not every incident during a fishing trip can be controlled, there are some things we can do to reduce risk of injuries escalating to more harmful levels.

These Include:

  • Wearing fishing gloves
  • Covering limbs with long sleeves/pants
  • Utilizing de-hooking devices while handling marine life
  • Washing hands and equipment after handling any fish, or after any exposure to open water


1.) Hiemenz JW, Kennedy B, Kwon-Chung KJ.  Invasive fusariosis associated with an injury by a singray barb.  J Med Vet Mycol. 1990;28(3):209-13.

Interesting and Informative Reading


Skier’s Thumb, Don’t Let it Slow Down Winter Fun

Winter adventures can be some of the best we’ll have all year – from a cross country hike around snowy mountains to skiing down their slopes.  And while not the worst injury that could occur, skier’s thumb is among one of the more common hand injuries associated with these winter sports.  If not properly treated it can affect pinch and grip strength, hindering overall hand function and predisposing the joint to chronic instability and osteoarthritis.

What is Skier’s Thumb

Skier’s thumb, which is also referred to as a thumb sprain or Gamekeepers thumb, is an

Ulnar collateral ligament damage

Skier's Thumb, Ulnar Collateral Ligament Damage of the Thumb's MCP Joint

injury to the ulnar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MCP) joint.  It is the result of forced abduction or hyperextension of the proximal phalanx of the thumb, caused by abnormal pulling of the thumb, such as in a fall, while affixed to the ski pole/hoop.  While this type of injury is often seen among skiers, it is also frequently seen in athletes or those sustaining a fall on an outstretched hand.

Signs of Injury to the Ulnar Collateral Ligament Include:

  • Pain at the base of the thumb between the thumb and index finger
  • Swelling of the thumb
  • Weakness pinching or grasping
  • Tenderness along the index finger side of the thumb
  • Blue or black discoloration of the skin over the thumb
  • Thumb pain that worsens with movement in any or all directions

Diagnosing Skier’s Thumb

A physical examination and patient history are used in diagnosing this condition. To determine the extent of damage to the UCL, the thumb is moved in various positions to assess stability of the thumb joint.  A stress x-ray may be recommended to confirm that there are no broken bones.

Treatment and Rehabilitation for Skiers Thumb

Treatment for Skier’s Thumb depends on the extent of the damage.  Most cases respond well to conservative, nonsurgical treatment, which may entail immobilization in a cast initially – followed by a splint for a total of six weeks.

If the UCL is completely torn, surgery may be indicated to reconnect the ligament to the bone and restore range of motion and full thumb function.  Any bone damage that occurred during the tear is also repaired during this time.  Following surgery, patients are put in a splint and undergo range of motion exercises with protected activities for four to six weeks. This is then followed by conditioning and strengthening of the thumb.

Forearm Fractures

Understanding Pediatric and Adult Forearm Fractures

Forearm fractures are common upper extremity fractures in kids and adults alike, as they compose the part of the arm which is integral in everyday activities, sports and hobbies – and frequently utilized to slow the force of an impact or fall.

Fracture of one of the forearm bones

Forearm bones and illustration of a forearm fracture.

The forearm bones are known as the ulna and the radius.  They run parallel to one another and connect the wrist joint (distal end) to the elbow joint (proximal end).

A forearm fracture can affect one or both forearm bones.  In fact, the impact one forearm bone sustains often forces it into the other causing both to break.

When a forearm fracture occurs, the type of break is carefully assessed using both a physical examination and x-rays.  It is then identified as a fracture involving either the proximal, middle or distal “shaft.”

Some of the common types of forearm fractures include:

  • Radial Head Fractures
  • Olecranon Fractures
  • Distal Radius Fractures (wrist fracture)
  • Radial Shaft Fractures,
  • Ulnar Shaft Fractures
Both bone forearm fracture in a young football player

An x-ray of a both bone forearm fracture in an adolescent football player.

The fracture is identified based on a set of criteria and the location on the bone.  If both the radius and the ulna are affected, it is known as a “both bone forearm fracture.”

If the fracture does not pierce through the skin it is considered a simple or closed fracture.  One that pierces through the skin is considered a complex or open fracture.

Forearm Fractures in Children

Forearm fractures represent nearly half of all childhood fractures – most of those occurring at the distal, or wrist end of the radius. These fractures are classified by the area of the bone affected, whether it is stable or displaced, how clean the break and whether it is partial or complete across the bone.

The classifications include:

  • Torus fracture, also known as a “buckle” fracture.  It results when the top layer of bone on one side compresses upon a harsh impact.  It is considered a stable fracture.
  • Metaphyseal fracture.  This type of fracture affects the upper or lower shaft of the bone without affecting the growth plate.
  • Greenstick fracture.  This type of fracture extends through part of the bone, causing it to bend on the other side.
  • Galeazzi fracture.  This impact is often a displaced fracture disrupting the radius and also the wrist joint where the radius and ulna come together at the wrist.
  • Monteggia fracture.  This fracture usually involves the ulna shaft and disrupts the elbow joint where the radius dislocates requiring urgent care.
  • Growth plate fracture. This type of fracture occurs across the growth plate.

(Fracture classifications source:  American Academy of Orthopaedic Surgeons)

Fractures in children are different from those in adults, because their bones are still growing.  As a result, they have more cartilage and collagen resulting in a more “pliable” bone less subject to a break – or one less severe as an adult might sustain with the same impact.  In fact, many fractures in children may be so subtle they are difficult to detect on an x-ray and require an orthopedic specialist to assess.  A fracture in a child heals rapidly.  So, it is important that it is addressed quickly and properly set before it heals in improper alignment – causing other long term problems.

Also unique in children is the impact a fracture could have on their growth plates.  Depending on the extent of a fracture, the growth and function of the child’s limb could be negatively impacted as a result.

Adult Forearm Fractures

The same fracture classifications applied to those in children, with the exception of growth plate and greenstick fractures, apply to those in adults.  The adult bone is less “pliable” than that of a child’s and has a higher tensile strength, which can result in a more serious break.

Adults suffering from osteoporosis are particularly subject to breaks from an impact or activity seemingly unlikely to inflict such damage.


Fracture treatment depends on the severity of the break and any other soft tissue damage that may have occurred as a result.  The right treatment will depend on the fracture, age and lifestyle of the patient – and may be nonsurgical or surgical with internal fixation.

All treatment includes hand therapy for the best results and most rapid return to activity.