Have an Injury-Free Fourth!

Considered the official kickoff to summer, the Fourth of July is a fun-filled celebration commemorated with outdoor barbeques and festivities.  Unfortunately, too many find themselves in the emergency room over this holiday weekend as a result of firework-related accidents.

While unofficially those at highest risk for firework injuries are adolescent boys, the adult male population are a close second in the highest risk group – according to reports of ER physicians and orthopedic hand specialists….

And it is estimated that over 40 percent of firework injuries occur to the hand, wrist and elbow.

Injuries most commonly occur when an ignited firework seemingly fails to go off, though explodes when handled.  Other injuries occur as a result of the extreme heat many fireworks omit.  Even the unassuming “sparkler” can heat to over 2000 degrees, capable of causing 2nd and 3rd degree burns.

The fireworks most implicated in causing injury include small firecrackers, bottle rockets and sparklers, because they are assumed to be less dangerous.  Individuals mistakenly use less caution when handling these types of fireworks.

Some of the most common hand and upper extremity traumatic injuries resulting from firework-related accidents include:

  • Burns
  • Contusions and lacerations
  • Damage to bones, muscle, ligaments and nerves 

Medical Attention for a Traumatic Firework Injury

It is important to seek immediate attention for a traumatic firework injury, to avoid permanent damage to the hand and wrist.

The hand alone contains approximately 50 nerves, with 34 muscles moving the fingers and thumb, and over 120 known ligaments, 30 major joints, 30 bones and a myriad of connective tendons involved in carrying out our everyday activities.

Long-term hand function is dependent on not only immediate care but proper follow up.  If such injuries are not adequately addressed, permanent nerve and tendon damage can impair hand feeling and movement. And the early onset of osteoarthritis from post-traumatic bone and joint damage can further hinder hand function.

Reducing Risks of Traumatic Firework-Related Injury

While many of the tips for reducing risk of hand injury from fireworks seem common sense, they can be overlooked during the excitement.  They include:

  • Ignite all fireworks with extended lighters.
  • Remain a safe distance from ignited fireworks.
  • Allow sufficient time for fireworks to go off / explode before approaching (and handle previously ignited fireworks with an extended apparatus such as BBQ tongs).
  • Supervise young children holding sparklers, advise teens of the heat hazard of these and other small, seemingly harmless fireworks.
  • Protective glasses and gloves can also reduce risks.

 Have a happy and safe Fourth of the July!

Getting a Handle on Repetitive Stress in Cycling

Hand & Wrist Conditions Cyclists Can Avoid

As cyclists across Texas ready for the upcoming BP MS 150, a two-day bike ride from Houston to Austin, we thought we’d talk about some of the most common overuse, or repetitive stress, hand and wrist conditions affecting cyclists and ways to avoid them to ensure a pain-free ride.hand and wrist repetitive stress in cycling

How Repetitive Stress Occurs
Nearly one-third of the overuse strains associated with avid cyclists competing year-round in weekend rides and races affect the hand and upper extremity. These types of injuries can also affect those who have not adequately trained yet embark upon a 150-mile ride between Houston and our state’s capital.

Despite the best equipment and preventative measures, the constant vibration, griped hand position for hours at a time or tense ride into the wind, up a hill and alongside Interstate traffic can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy, also known as ulnar neuropathy.  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

 Carpal Tunnel Syndrome

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  The result of irritation and swelling, CTS causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. CTS is one of the most common overuse hand and wrist conditions affecting cyclists. When the median nerve becomes irritated in this inflamed and compressed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers – causing discomfort and affecting a cyclist’s ability to even shift gears with the affected hand.  Resting periodically and stretching the hands, changing grip to reduce hyperextension and hyper flexion may help during the ride, but ongoing pain may require treatment – which is generally nonsurgical and may entail night bracing and/or injection therapy.  CTS pain remaining unresolved following nonsurgical treatment may require a minimally invasive Endoscopic Carpal Tunnel Release.

Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuritis or neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  This results when direct pressure is placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.  The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of this nerve can cause numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications generally resolves this condition.

handlebar palsy

Hyperflexed Wrist

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists as well – as the continuous vibration of the motorcycle causes the same type of conditions that long rides and regular bicycling can cause.

Ulnar neuritis in cycling

Hyperextended Wrist

Cycling Tips for Reducing Your Risks
Professional cyclists and medical experts have contributed to an array of preventative cycling gear and recommendations for reducing risks for such conditions.

These include:

  • Cycling gloves – both basic or specialized gel cycling gloves to reduce pressure on the ulnar nerve.
  • Additional handlebar padding.
  • Custom adjustments in handlebar height and overall bike fit specific to each rider.
  • Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion.
  • Frequent adjustments to grip and position on the handlebars during a ride.
  • Hand exercises between rides, such as squeezing an Iso-Ball.

Figures source:  http://www.hughston.com/hha/a_15_3_2.htm

 

Motorized Mobility Mishaps Increasing on College Campuses

The abundance and popularity of motorized vehicles, like Bird Rides and LimeBikes, on college campuses are changing transportation norms faster than the development of new safety guidelines and regulations. [1] As a result, the number of accidents and injuries related to motorized mobility scooters (MMS) are on the rise.

Students can pick up scooters wherever they’re left and head to class or meet up with friends – with bookbag and cellphone in hand, though without a helmet or operating instructions.  The scooters have no designated travel lane, and buzz alongside pedestrians, cyclists and motorists at a speed of 15 miles per hour. Additionally, the short wheel base and small wheel size of the scooter makes it more unstable than a bicycle and vulnerable to debris or uneven pavement.

And if that combination doesn’t raise the hazard flag up the pole fast enough, these young MMS operators are often distracted by their cell phone as well – continuing to text and check messages while in route…

According to a recently published study, ‘low-energy as well as high-energy crashes involving the motorized mobility scooters may result in serious injuries and sometimes death.’ The study suggests that “awareness by multidisciplinary treatment teams may help to avoid underestimation of injury severity. MMS drivers need to improve their driving skills in order to reduce the number of MMS crashes.” [2]

Orthopedic specialists are seeing an increase in hand and wrist fractures, which include distal radius fractures and boxer’s fracture as well as severe lacerations, concussions and neck injuries – resulting in some undergoing repair surgery over this past winter break before returning for spring semester. [3]

Following a study conducted by the Journal of the American Planning Association on pedestrian and cycling traffic, three specific “danger zones” involving more serious crashes and injuries were identified – campus activity hubs, campus access hubs and through traffic hubs. [4]

Recommendations to reduce risk of accident and injury for this population may also prove effective in reducing risks to the growing MMS operating population.

Students are encouraged to avoid distraction while using an MMS and recognize that its speed and instability can increase risk of injury if safety precautions are not taken.

References

  1. A Flock of electric scooters suddenly descended on Austin. Now the city is scrambling to regulate them.  Reported in the Texas Tribune (May 1, 2018).  Located online:https://www.texastribune.org/2018/05/01/flock-electric-scooters-suddenly-descended-austin-now-city-scrambling-/.
  2. Leijdesdorff HA, van Dijck JT, Krijnen P, Schipper I. Accidents involving a motorized mobility scooter: a growing problem. Ned Tijdschr Geneeskd. 2014;158:A7858.
  3. That electric scooter might be fun. It also might be deadly.  Reported on CNN online (October 1, 2018).  Located online: https://www.cnn.com/2018/09/29/health/scooter-injuries/index.html.
  4. Loukaitou-Sideris A, Medury A, Fink C, Grembek O, Shafizadeh K, Wong N. Crashes on and near college campuses:  A comparative analysis of pedestrian and bicyclist safety. Journal of the American Planning Association. 2014;80(3):198-217.  https://doi.org/10.1080/01944363.2014.978354.

 

 

Buddy Taping, A Helping Hand in Healing?

Buddy taping is the practice of bandaging an injured finger together with an adjacent healthy one for support.  Serving as a type of splint, the healthy finger is wrapped closely to the sprained, dislocated or fractured finger allowing both movement and a natural position conducive to injury protection.

Buddy taping an injured finger to a healthy one.

Buddy taping is used frequently in sports where finger injuries are common, such as volleyball, football and basketball.  It can serve as a temporary solution to help an athlete through a game or provide the necessary support facilitating recovery of a minor injury.  In some cases, it is also used to help prevent injuries.

As a “quick fix” post injury, buddy taping provides protection to the injured finger and keeps it out of the way so that an athlete can maintain grip and level of performance without causing further injury.

As an injury prevention measure, buddy taping may reduce risk of injury by preventing the fingers from moving past their normal range of motion during a fall or other impact [1].

Additionally, some athletes report increased grip strength when taped and practice buddy taping to provide additional grip strength as well as grip traction, in lieu of gloves, to improve performance.  Though, these perceived benefits have not been scientifically proven.

How Buddy Taping is Performed

Buddy taping is a simple process that can be performed easily with just a few items.  A piece of thin foam or padding the length of the finger is generally placed between the two fingers, a relatively stiff tape from ½ to 1 inch in thickness is placed around the fingers, leaving the joints uncovered to facilitate bending.  This may be applied directly to the fingers or over gloves (football). Depending on the thickness of the tape, one or two layers may be applied.  In some cases, a buddy tape “splint wrap” also known as “buddy loops,” a breathable foam line with a non-slip hex material that grips the skin, may be used.

 

 

Buddy taping is intended to provide “temporary” support. While it may remain on several days following an injury, all finger injuries should be assessed by a hand specialist.

Concerns about Buddy Taping

While taping digits together have become common practice, particularly in sports, some research suggests a potential for complications warranting concern and caution among those performing buddy taping to treat finger and toe injuries.

The authors of a recent study reported frequently seen complications such as necrosis of the skin, infections, loss of fixation and limited joint motion.

According to the surgeons included in the study, some of the indications for buddy taping included finger fractures, metacarpal fractures, metacarpophalangeal (MCP) joint injury, proximal interphalangeal (PIP) joint injury and carpometacarpal joint injury of the hand.

While benefit was recognized, concerns remain in low patient compliance and skin injury in the treatment of both finger and toe injuries [2].

 

References

  1. Jack Gerard. Why do football players put tape around their fingers? https://healthyliving.azcentral.com/football-players-put-tape-around-fingers-1057.html
  2. Sung Hun Won MD, Sanglim Lee MD, Chin Youb Chung MD et al. Buddy Taping: Is it a Safe Method for Treatment of Finger and Toe Injuries?  Clin Orthop Surg. 2014 Mar;6(1):26-31. doi:  4055/cios.2014.6.1.26

 

 

 

 

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.

References

 [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). https://www.medicalnewstoday.com/articles/176443.php

 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)

 

 

 

 

 

 

Digital Disabilities, Repetitive Stress & Our Mobile Devices

Too much time on smartphones and tablets can lead to a host of repetitive stress problems known today as “digital disabilities.” These conditions include; cell phone elbow, texter’s thumb, texter’s neck, iPad hand and selfie elbow.digital_device_overload

Cell phone elbow results when the bent hand holding the cell phone to the ear for prolonged periods of time causes compression of the ulnar nerve.  This is also known as cubital tunnel syndrome, which is neuropathy of the ulnar nerve or “funny bone” nerve.

Cell phone elbow may contribute to another injury called smartphone pinky, which is a condition resulting when the bent elbow (while on a cell phone) causes compression of the ulnar nerve, which also gives sensation to the small finger. Over time, the sensation of the small finger diminishes.

The repetitive movements of our thumbs while texting may lead to texter’s thumb.

Texter’s thumb is a painful inflammation of the tendons that control thumb movement and extend to the wrist.  This causes pain at the base of the thumb, which may extend to the lower arm.

The concern is not the thumb pressing down on the keys of a phone but rather the frequent passing of the thumb over the keyboard, as the thumb joint is not meant to move rapidly in this manner.

Texter’s neck comes from too much time spent on electronic devices, subsequently leading to neck and spine injuries.

Texter’s neck has become a catchphrase describing neck pain and damage from looking down at a cell phone, tablet or other wireless device too frequently and for too long.

Another modern day “digital disability,” iPad hand, causes tendonitis in the hand from having the iPad in one position for a prolonged period of time.

Many of these digital disabilities are seen in Millennials, most notably selfie elbow. In fact, according to studies from the Pew Research Center, Millennials are more likely than other generations to have posted a selfie on a social media site (spending an average of five hours a week taking selfies).

The weight of the phone is not the concern.  The repetition combined with the contortion of the elbow, held in unnatural positions while capturing the selfie shot are actually what pose the problem.

Preventing Digital Disabilities, Repetitive Stress Conditions

There are many preventative measures to prevent damage from overuse of handheld devices, such as hands-free modifications, tablet stands and attachable keyboards.

To reduce the risk of cell phone elbow, use an earpiece, a headset or Bluetooth. To avoid texter’s thumb, a keypad is great. And try taking breaks from texting. Use the audio command on your phone to just give your hands a rest.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hunting Hazards to Avoid for a Successful Season

‘Tis the peak of hunting season.

Hunters far and wide have successfully exempt themselves from Holiday gatherings to pursue their passion. treestand-1-300x300

Given this feat, we want to ensure optimal success and the best holiday hunting experience possible by helping hunters avoid some of the most common hunting mishaps identified in scientific studies, seen in emergency centers and reported among hunters in the field.

Among the most reported hunting accidents include:

  • Hunting/Tree Stand Accidents
  • Misfire/Shooting Accidents
  • Field Dressing Dangers

According to a recent study, “hunting mishaps most frequently occurred because of overexcitement, unfamiliarity with equipment, or carelessness.” The study, which reviewed the hospital records of 100 male patients between the ages of 10 and 78 showed a wide variety of injuries resulting from hunting activities.  “Almost half of the patients were injured during a 9-day gun deer hunting season.”  The study concluded that while many of the injuries were minor, serious morbidity with potential long-term disability and costs in time and money can occur [1].

Tree Stand Accidents

Tree stands situated 20-30 feet in the air present a hazard potentially as dangerous as the weapons accompanying hunters in the trek up and down.

According to Tree Stand Safety Awareness (TSSA), tree stand accidents are the number one cause of serious injury and death to deer hunters – estimating that more than one-third of hunters who use tree stands will be involved in a fall sometime in their hunting careers [2].

While broken bones are very common following a fall from a stand (arm fractures, hip fractures, as well as injuries to the head, neck and spine), others less frequently discussed involve jewelry/accessories.

A potentially limb and life-threatening injury that is completely avoidable among hunters involves jewelry/accessories – watches and rings in particular.  During a slip or fall from a stand, these objects can catch on parts of the stand, as well as nails and tree branches causing serious damage to the affected limb.  The catch/pull/hanging of the watch or ring during a fall, traumatically impacts the soft tissue of the impacted region.  This can result in a severe wrist fracture for watch wearers and traumatic ring avulsion for ring wearers, which can strip tendons and nerves from the bones of the finger.

The severity of either injury is long lasting – surgery and rehabilitation required in both cases. Additionally, hunters are often located in remote areas, and treatment of such a severe injury is delayed – impacting outcome.

Hunters are urged to ensure tree stand safety by wearing a full body harness and leaving watches and rings at home.  A system of communication with fellow hunters is also encouraged should a mishap occur.

Misfire/Shooting Accidents

Many of the injuries seen during hunting season involve a shooting accident.  These accidents often occur when hunters are overly eager and fail to adhere to a basic safety protocol – proper attire, weapon check and communication.  Shooting accidents also occur when drowsy hunters fall from their stands with weapon in hand.  These accidents can cause self-inflicted injuries as well as injury to nearby hunters.

According to the International Hunter Education Association (IHEA), approximately 1000 people in the US and Canada are accidentally shot by hunters every year – just under a hundred of those accidents are fatalities.  Hunter safety courses are strongly encouraged and required in some cases before hunt participation.

Field Dressing Dangers

Another opportunity for injury occurs during the process of field dressing.  Not only is the rapid cleaning of hunted game essential to prevent bacteria from growing on the surface of the carcass (at initial wound site or while gutting) and contaminating the meat, but also to reduce risk of dangerous infection if cut during the process.

Field dressing must be done as soon as possible to ensure rapid body heat loss. Bacteria grow most rapidly in the range of temperatures between 40°F and 140°F, in some cases doubling in number every 20 minutes. This range of temperature is often called the “temperature danger zone [3].” Hunters in warmer climates should be particularly vigilant.

Too often most of the hunting preparation is focused on the kill and not enough on safely field dressing the game.  Dull knives and dirty prep areas can result in lacerations prone to infection. These types of infected wounds can be difficult to treat.  Additionally, many types of popular game are infected with Brucellosis, an infectious disease caused by bacteria.  Hunters merely handling the blood and organs of an infected animal while field dressing can become infected.  The infection may remain dormant up to a month after exposure and can cause severe illness requiring antibiotics. Symptoms include fever, chills, headache, fatigue, muscle and joint pain [4].

Field dressing preparation should include:

  • Clean, sharp knife
  • Resealable plastic storage bags
  • Whetstone or steel for sharpening
  • Cooler full of ice/snow
  • Rope or nylon cord
  • Disposable plastic gloves
  • Clean wipes or paper towels
  • Clean drinking water

Be safe and Happy Hunting!

References

  1. Huiras CM, Cogbill TH, Strutt PJ. Hunting-related injuries. Wis Med J. 1990 Oct;89(10):573-6.
  2. Bailey C. Here are the Five Most Common Hunting Injuries. Wide Open Spaces. 2017 March 29. http://www.wideopenspaces.com/these-are-the-5-most-common-hunting-injuries/
  3. PennState Extension. Proper Field Dressing and Handling of Wild Game and Fish. 2017. https://extension.psu.edu/proper-field-dressing-and-handling-of-wild-game-and-fish
  4. Centers for Disease Control and Prevention (CDC). Hunters: Protect Yourself from Brucellosis. https://www.cdc.gov/features/huntersbrucellosis/index.html

 Dr. Korsh Jafarnia is a Houston based board-certified, fellowship trained orthopedic surgeon specializing in the hand, wrist and elbow. He is recognized locally and nationally as a “top doctor” in his field and highly sought for his level of expertise in hand and upper extremity orthopedic care.

Staying Healthy Post Hurricane Harvey

As Texans begin to restore and rebuild following one of the most devastating storms in US history, we thought it would be a good time to talk about some of the health concerns that exist in this post flood environment and precautions everyone can take to stay healthy.

Harmful Elements in Flood Waters                                     Healthy Post Hurricane Harvey

Flood waters contain a variety of potentially harmful elements, many of which linger even after water begins to recede.  Aside from sheets of fire ants, snakes and other potential harmful critters, sharp metal bits, nails and glass shards are often prevalent and linger in debris.

In a recent interview with the Washington Post, Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, explained that sewage systems merge with flooding rain, introducing infectious human waste to streets and into flooded homes. What remains as sludge and a dirty film permeates everything it once washed over.  While the waters recede, the infectious elements remain and must be treated with caution (1).

And while it is not easy to predict which microbes will cause the greatest problems, the Centers for Disease Control and Prevention (CDC) reported 30 cases of MRSA, an antibiotic-resistant staphylococcus bacterium, in a group of New Orleans evacuees following Hurricane Katrina in September 2005. “Vibrio” pathogens, also known as “flesh-eating” bacteria, sickened two dozen people and killed six – in addition to reports of heat and infection-related skin rashes and red marks associated with biting mites (2).

Other Post Storm Concerns                                                                                             

The harmful material contained in flood waters and the contaminated and dangerous debris left in its wake are common concerns following a flooding storm (3), but there are also other lesser known concerns and areas of caution.  These include:

Scientific research is increasingly reporting the significant role that stress plays in our overall health – from a weakened immune system predisposing us to a host of illnesses, to increased risk of musculoskeletal injuries and conditions traditionally associated with physical stress only.  The type of stress that can come with the anticipation of such a storm, its duration and damaging aftermath is capable of threatening the health of an individual in ways many may not realize.  Referred to as “psychosocial” factors (frustration, dissatisfaction, depression and despair), the resulting stress has shown to induce physiological responses that can contribute to the development of musculoskeletal disorders (4).

Additionally, food and water quality that is compromised during power outages can challenge the healthiest among us if not approached with caution (5). Upper respiratory disorders associated with the rapidly growing mold following a Texas flood are a big concern.  Exposure to mold spores can prompt a rise in asthma and other respiratory illnesses.  The close proximity of individuals housed in shelters or working shoulder to shoulder in cleanup efforts can perpetuate respiratory illnesses and other communicable diseases.

Cuts and lacerations resulting from and/or exposed to flooded debris are particularly concerning to physicians.  The skin is the largest organ of the human body and should be protected as such.  Any opening creates vulnerability to not only the affected area but the entire body, particularly when exposed to potentially harmful microbes often found in flood water and debris as described earlier.

Reducing Risks and Staying Healthy Post Hurricane Harvey

There are several precautions that flood victims and those helping in their recovery should do to ensure everyone stays healthy post Hurricane Harvey.  These include:

 

  • Tetanus booster shots – Texas health officials urge people post Hurricane Harvey to get a tetanus booster shot to protect themselves against disease potentially entering the body through cuts/lacerations, unless one is current with their tetanus immunization (within 10 years). Even seemingly insignificant damage to a nail bed or cuticle should be treated as any other cut.
  • Proper garments and supplies – Clothing protecting arms and legs from flood sludge and lingering debris is strongly encouraged, along with rugged gloves for debris removal, rubber gloves for cleaning affected areas/items and face masks to minimize inhalation of potentially harmful elements.
  • Proper care of cuts/lacerations/skin rash – It is extremely important when working in flood environments to properly protect existing cuts and quickly clean and care for those occurring during cleanup. Risk of skin rashes resulting from the combination of sewage, chemicals and Houston heat can be reduced with the proper garments.
  • Adequate rest, relaxation – While it is difficult for those working to rebuild their homes and quickly reclaim their lives to contemplate taking time for themselves, it is a critical part of maintaining health and well-being. The rebuilding process for many will be a lengthy one requiring strong, healthy individuals.  Adequate rest, break from exposure to irritants and moments of relaxation/destressing can reduce risk of fatigue-related accidents/injuries, optimize mental outlook and maximize physical endurance.

 

When an injury is sustained or a respiratory or gastrointestinal irritation seems to linger, it is important to see a physician.  Postponing care can in some cases complicate an otherwise simple treatment or solution – and delay all recovery efforts.
Our health is truly one of our greatest assets. Let’s protect it!

 

 

References:

  1. The Health Dangers from Hurricane Harvey’s Floods and Houston’s Chemical Plants. Washington Post, September 1 2017.
  2. Infectious Disease and Dermatologic Conditions in Evacuees and Rescue Workers after Hurricane Katrina – Multiple States. Centers for Disease Control and Prevention (CDC). August – September, 2005.
  3. Stay Out of Flood Water, Texas Health Officials Urge. NPR – Houston Public Media News. August 28, 2017.
  4. Musculoskeletal Disorders – Psychosocial Factors. Canadian Centre for Occupational Health and Safety (CCOHS). Last updated August 13, 2012.
  5. Food and Water Safety during Power Outages and Floods. U.S. Department of Health and Human Services. FDA U.S. Food and Drug Administration. Last updated August 25, 2017.

 

Other Educational Links

 

 

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

 

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.

 

References

  • Canadian Centre for Occupational Health and Safety (CCOHS), cchos.ca , https://www.ccohs.ca/oshanswers/psychosocial/musculoskeletal.html .
  • 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.