Hitting the Slopes this Holiday Season? Don’t Get Caught with Skier’s Thumb

An age-old hand injury now associated with modern day sports

This time of year the adventures that beckon include snow packed peaks and winter white trails. To ensure success on the slopes, learn how to avoid a common hand injury that could end your run and holiday fun early; “Skier’s thumb.” 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, UCL Damage of the Thumb’s MCP Joint

Skier’s thumb, which is also referred to as a thumb sprain or “Gamekeeper’s thumb,” is an 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.

The term “Gamekeeper’s thumb” was first coined in 1955 by CS Campbell, who identified UCL injuries as an occupational disease in Scottish gamekeepers. The gamekeepers strangled rabbits using their thumb and index finger, and the repeated valgus stresses resulted in UCL injury and chronic instability of the MCP joint [1]. In the present day, this lesion occurs more frequently in acute sports-related injuries like skiing.

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.

References

  1. Hung CY, Varacallo M, Chang KV. Gamekeepers Thumb. StatPearls. (Last updated Aug 11, 2021) https://www.ncbi.nlm.nih.gov/books/NBK499971/ .

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

 

 

Hunting Hazards to Avoid for a Safe Hunting Season

As hunters far and wide successfully exempt themselves from Holiday gatherings to pursue their passion, we offer some safety tips to ensure injuries do not cut adventures short.

three deer startled by headlights

 

We’ve identified some of the most common hunting mishaps featured in studies, seen in the ER, and recounted by hunters far and wide.

Among the most reported hunting accidents include:

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

According to studies, “hunting mishaps most frequently occurred because of overexcitement, unfamiliarity with equipment, or carelessness.” A study reporting on 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 the Tree Stand Safety Awareness (TSSA) foundation, 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.

 

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!

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.

 

 

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

 

Defending Against Turf Trauma

Football is now more than half way through the season, and we’ve seen our share of sprains, fractures, and concussions.  Many of these injuries have been discussed at length, so we thought we would talk about a growing concern; injuries occurring from or made worse as a result of the synthetic turf our kids are playing on today. Turf Concerns in Sports

Synthetic Turf Concerns

At the professional level, there is concern that the difference in buoyancy and other  attributes of synthetic infilled turf may contribute to increased risk of ligament injuries and overall musculoskeletal wear, resulting in prolonged fatigue and recovery between games. While studies continue to assess these concerns without conclusion, debates grow in women’s soccer and are capturing the attention of parents of young athletes playing on artificial turf across the United States [1,2].

There have also been a number of studies assessing increased risk of infection in football associated with playing on synthetic turf.  While studies are ongoing, there are currently no scientific findings to conclude that synthetic turf results in a higher number of infections than natural turf.  The abrasive nature of this artificial turf, though, has certainly resulted in an increased number of severe abrasions and lacerations of the skin, leaving players more vulnerable to infection.

The surface temperatures of synthetic turf are also significantly higher than that of natural grass turf when exposed to sunlight (Buskirk et al., 1971; Koon et al., 1971; and Kandelin et al. 1976, Devitt et al., 2007, McNitt et al., 2007).  This may contribute to increased bacteria growth.

Turf concerns have been noted as early as 2003 when Connecticut’s Department of Public Health launched an investigation into infections in a Connecticut college football team [3]. Of the 100 players studied, those with turf burns had an infection risk seven times higher than their scraped teammates. Cornerbacks and wide receivers, who frequently come into contact with other players, accounted for most cases. Improperly treated whirlpools could also have helped spread the bacteria.

When these bacteria become resistant to antibiotics they can spread and cause pneumonia, bone infections, or life-threatening infections of the bloodstream that are difficult to treat.

Reducing Risk for Turf Related Skin Infections

Each football season, we see a growing number of skin infections related to synthetic turf burns, abrasions and lacerations.  While many of these infections can be treated with antibiotics, those more resistant require special attention.  Parents and coaches are encouraged to educate their athletes on preventive practices to avoid the dangers of a serious skin infection.

Signs of a Turf-Related Skin Infection

Two of the most common skin infections associated with turf, both natural and synthetic, are Staph (staphylococcus bacteria) and MRSA (resistant staph).

Staph is one of the most common forms of infections that can develop from a turf wound.  This type of skin infection, also referred to as cellulitis, may or may not result from an open sore/wound.

Possible Symptoms of a Skin Staph Infection include: 

  • An area of tenderness, swelling, and redness
  • Inflammation — redness, warmth, swelling, and pain
  • Fever and sweats, as well as swelling in the area (if the infection has spread)

MRSA is a more serious type of staph infection resistant to many of the antibiotics used to treat staph and other common infections.  These types of infections require special antibiotic therapy.

Possible Symptoms of a MRSA Infection include:

  • General feeling of poor health (malaise)
  • Skin rash
  • Headaches
  • Muscle aches
  • Chills / Fever
  • Fatigue
  • Cough
  • Shortness of breath
  • Chest pains

Treatment of Staph and MRSA Infections

Treatment for Staph infection generally entails a course of antibiotics.  Treatment for MRSA requires a special class of antibiotics or a combination of multiple antibiotics – depending on the patient’s response and the severity of the infection.

Reducing Risks of Skin Infections

The Center for Disease Control (CDC) has outlined the five primary conditions for contracting and spreading MRSA and Staph infection.  Referred to as the Five “C’s”:

  1. Crowding
  2. Contact – frequent skin to skin
  3. Compromised Skin (cuts, scrapes, abrasions)
  4. Contaminated Items (sweaty towels, clothes, mats, synthetic turf)
  5. Cleanliness

For the prevention of skin infections, it is important that athletes:

  • Keep wounds covered and contained
  • Shower immediately after participation
  • Shower before using whirlpools
  • Wash and dry uniforms after each use
  • Report possible infections to coach, athletic trainer, school nurse, other healthcare providers, or parents

Other CDC recommendations addressing MRSA and Staph infection in sports can be found on their website: http://www.cdc.gov/mrsa/community/team-hc-providers/index.html .

References

1.) Meyers MC, Barnhill BS.  Incidence, causes and severity of high school football injuries on FieldTurf versus natural grass:  a 5-year prospective study. Am J Sports Med. 2004 Oct-Nov;32(7):1626-38.

2.) http://www.usatoday.com/story/sports/soccer/2014/10/15/alex-morgan-us-women-artificial-turf-world-cup/17295011/

3.) Begier et al. 2004. A High-Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clin Inf Dis. 2004;39:1446-53.

(Keywords:  synthetic turf, artificial turf injuries, lacerations, Staph infection, MRSA, sports injuries, skin infections)

Don’t Let Injuries Dampen Your Family’s Fourth of July Fun!

Coast to coast, the Fourth of the July is one of the most celebrated holidays of summer and an opportunity to enjoy every bit of what the outdoor has to offer.  Unfortunately there are thousands of injuries incurred across the United States every year at this time, as a result of firework accidents.

Ensuring family fun this Fourth of July.

Ensuring family fun this Fourth of July.

Unofficially, those at highest risk for firework injuries are teenaged boys.  Adult men closely follow in the second highest risk group, according to reports of ER physicians and orthopedic hand specialists….

It is estimated that over 40 percent of firework injuries occur to the hand and upper extremity.

Injuries most commonly occur when an ignited firework seemingly fails to go off, though explodes when checked – often in a hand.  Other injuries occur from the unexpected heat many fireworks omit.  Even an 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 the least feared.

Among the most common hand and upper extremity traumatic injuries caused by fireworks include:

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

Medical Attention for a Traumatic Firework Injury

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

With approximately 50 nerves in the hand, 34 muscles moving the fingers and thumb, over 120 known ligaments, 30 major joints, 30 bones and a myriad of connective tendons, it is imperative that you follow up with a hand specialist following an ER or urgent care visit should such an accident happen.

Hand function and quality of life is dependent on not only immediate care but proper follow up to a hand injury.  If such injuries are not adequately addressed, irreversible 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 Injury

While many of the tips for reducing risk of hand injury trauma from fireworks seem common sense, they are often lost during the festivities surrounding such holidays and warrant repeating.

  • 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.

Have a happy and safe Fourth of the July!