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!

STRIKE!

Looking behind the baseball at UCL injuries … and the role former Los Angeles Dodgers pitcher Tommy John plays

 

The goal of every great baseball pitcher is to strike out the batter.  To do this requires not only talent but extreme power every…single…pitch.

Few other athletes are required to throw with this kind of power as frequently as a pitcher.

Over the course of a baseball career, particularly if begun at a young age and played competitively, this high speed force repeatedly placed on the elbow can take a toll.

Often beginning with Little Leaguer’s Elbow, a condition affecting young pitchers who do not allow adequate rest between pitches, a baseball player’s elbow joint absorbs a tremendous amount of repetitive stress over the seasons.  The impact of this type of overhead throwing irritates the tendons and ligaments supporting the elbow joint, predisposing pitchers to more serious problems.  One such injury is an Ulnar Collateral Ligament (UCL) injury.

Once seen primarily in adult athletes, the dramatic increase in more serious overuse injuries like UCL damage, Flexor Tendinitis and Valgus Extension Overload (VEO) in young players prompted the American Sports Medicine Institute (ASMI) and the USA Baseball, Little League Baseball and Major League Baseball organizations to establish Pitch Count Guidelines.

While these changes and educational efforts are expected to reduce the number of overuse injuries seen in young players, competitive league players remain at risk.

Ulnar Collateral Ligament (UCL) Injury

Elbow Anatomy and UCL Injury

The Elbow Joint and location of the Ulnar Collateral Ligament

The ulnar collateral ligament (UCL) is among the most commonly injured ligament in throwing athletes.  To accommodate the high speed throwing motions, the ligament stretches and lengthens until it can no longer hold the elbow bones tightly enough. Severity of the injury can range from a sprain with minor damage and inflammation to a complete tear.

Symptoms Include:

baseball bullet

Pain on the inside of the elbow

baseball bulletA feeling of instability in the elbow

baseball bulletLoss of strength in throwing

baseball bulletIrritation of the ulnar nerve (funny bone) causing numbness in the small and ring fingers

Diagnosis and Treatment

A UCL injury is diagnosed based on the results of a physical examination, X-ray and MRI.  Depending on the severity of the damage, rest and refrain from play along with rehabilitative exercises and anti inflammatory medication may be indicated. Work with an athletic trainer may also be helpful, to assess throwing mechanics and improve body positioning which can reduce excessive stress on the elbow.

If there is a complete tear of the ligament and patients fail to improve with conservative treatment, surgery may be indicated.

The UCL reconstruction procedure, which was performed on former Los Angeles Dodgers pitcher Tommy John and is more commonly known as Tommy John surgery today, has dramatically changed the outcome for athletes.  In fact, his results were so impressive, it is reported that young players not actually suffering from a UCL injury have sought Tommy John surgery in hope that it would improve their performance [1]!  The procedure, though, is performed only when necessary to repair a severely torn UCL.

Tommy John surgery is a surgical graft procedure in which the injured UCL is replaced with a tendon graft taken from the forearm or the hamstring tendons.  This procedure is followed by an intense rehabilitation program that lasts from six months to a year, depending on the position an athlete plays.  Throwing exercises can begin in about 16 weeks.

The Role Tommy John Continues to Play

In the medical community, Tommy John remains credited with the shift in how athletes view UCL injuries. Once career ending, today UCL reconstruction has become a common procedure – returning most athletes to their sport at a pre injury level of play.

In the sports world, Tommy John is still revered for the excellent athlete he was, choosing baseball as his sport of choice and playing in all three of the Yankees vs Dodgers World Series in his era (1977, 1978 and 1981).

Undergoing the procedure in 1974 and spending his entire 1975 season in recovery, he learned to pitch in a way that relieved the stress he was placing on his arm and leg.  He returned to the Dodgers in 1976. His 10-10 record that year was considered “miraculous.”  But, he went on to pitch until 1989 winning 164 games after his surgery – just one game shy of baseball great Sandy Koufax.

The recognition he received for his unexpected success following the procedure now donning his name became the launching pad for other endeavors benefiting young baseball players.

His “Let’s Do It” foundation, which umbrellas the Tommy John Pitching Academy, is today dedicated to research in preventing such injuries and teaching pitching techniques that minimize the physical impact. The foundation also supports the efforts of the American Orthopedic Society for Sports Medicine (AOSSM) and its collaborators’ STOP Sports Injuries Campaign as well as the American Foundation of Suicide Prevention (AFSP).  AFSP and its outreach effort is an important component in the foundation’s efforts in memory of his son.

 References

  1. Longman, Jere. Fit young pitchers see elbow repair as cure-all. 2007 Jul.

 

 

Baseball Fit – Preventive Exercises for a Winning Season

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

Now is the time to begin preparing.High School baseball

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

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

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

Some of the most common baseball injuries include:

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

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

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

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

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

Strength and Conditioning Exercises – Upper Body

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

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

Some Effective Arm, Shoulder and Core Exercises Include:

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

Exercises to Improve Leg Strength

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

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

Stretching

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

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

Some easy, yet effective stretches include:

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

TOP PREVENTION TIP

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

Track and Field Hand & Upper Extremity Injuries and Conditions

As track season sprints past, we begin to see some common overuse injuries and conditions in these athletes.  While the vast majority of those seen in track and field affect the lower body, there are several common hand and upper extremity injuries and conditions seen in throwing events such as the javelin, shot put, hammer and discus.

Between weekly practices and weekend competitions, overuse injuries and conditions in throwing events account for most upper extremity injuries in track and field. These overuse conditions often affect the rotator cuff and shoulder labrum. Overuse conditions are those resulting from the repetitive use of a particular limb/joint(s) and are frequently seen in baseball, swim and tennis as well.

Other track and field injuries include ulnar collateral ligament (UCL) tears of the elbow (also known as a Tommy John injury) and thumb.  Also metacarpal (hand) fractures are seen resulting from repeated stress on the small bones of the hand.

Rotator Cuff Injury

There are four tendons and muscles that make up what is known as the “rotator cuff,” providing coverage around the shoulder joint at the top of the humerus. The rotator cuff holds the arm in place and allows it to move with the broad range of motion we demand not only in everyday activity but also in many throwing sports. This broad range of motion, though, predisposes the shoulder to injury.  Repetitive stress on the rotator cuff can cause partial tears and swelling in the tendons.  A “high impact” stress, such as the powerful force required in these track and field throwing events, may cause one of the tendons to pull away from the bone or tear.rotator cuff injuries cropped

Rotator Cuff Injury Symptoms and Diagnosis

While most rotator cuff injuries can be slow to develop – producing nagging pain in the shoulder and arm, shoulder weakness and difficulty lifting the arm overhead – sometimes they can be quite sudden. In this case, athletes may feel a “pop,” followed by strong pain and a weakened arm.  An orthopedic specialist will assess the injury initially with a physical examination and review of the activity leading up to the injury.  This may be followed by a shoulder x-ray, MRI and/or arthrogram.  Treatment depends on the severity of the condition and will include a period of rehabilitation therapy. Conservative, nonsurgical treatment is often considered initially.  Surgery may be indicated if shoulder instability persists or there is a complete rotator cuff tear.

Shoulder Labrum Tear 

Another common track and field throwing injury is a shoulder labrum injury.  Among the most commonly diagnosed shoulder labrum condition in athletes involved in throwing sports is known as a SLAP (superior labrum, anterior to posterior) tear. The labrum works to keep the arm bone in the shoulder socket. When the ring of firm tissue that helps to make the shoulder more stable becomes stressed, it can result in a SLAP tear, compromising shoulder stability.    Often damage to the labrum occurs in those athletes who are also suffering from rotator cuff injury or weakness.slap-tear-1

SLAP Tear Symptoms and Diagnosis

Some of the common symptoms associated with SLAP disorders include a popping, clicking or catching in the shoulder during throwing activity, aching pain and feeling of weakness.  Beyond a physical examination, a diagnosis may include an MRI and/or an arthrogram.  Occasionally minimally invasive arthroscopy may be used to confirm a tear.  If a tear is confirmed, the surgeon may choose to repair it at the same time.

UCL (Ulnar Collateral Ligament) Injury

Ulnar Collateral Ligament (UCL) injuries of the elbow frequently occur in javelin as a result of the throwing motion and stress on the elbow.  Also known as a Tommy John injury, it is similar to the stress placed on the elbow in baseball.

The elbow is basically a “hinge” joint allowing not only bending and straightening but also rotation from palm up to palm down.  Several important ligaments in the elbow joint facilitate this range of motion, connecting the bones (ulna, radius, humerus) and forming part of a lubricating joint capsule.UCL of elbow

Two of the key ligaments for elbow joint stability  include the lateral collateral ligament and the UCL, which is also known as the medial collateral ligament because of its location on the elbow (inside).

When overuse of the joint (force on the soft tissue exceeds that of the structure’s tensile strength), such as in a throwing sport like javelin, places stress on the UCL, tears can develop.  The ligament stretches and lengthens to the point that it can no longer hold the bones tightly enough during throwing activities.

UCL Injury Symptoms and Diagnosis

Athletes suffering from this type of overuse condition may experience pain along the inside of the elbow, which is worse during the “acceleration phase” of throwing.  There may also be swelling, reduced range of motion and feeling of instability in the elbow.  Throwers may also have tingling or numbness in the “pinky” and ring fingers and experience difficulty throwing.

Diagnosis includes a physical examination, x-ray and an MRI.  Treatment is initially conservative and may include rest, ice and anti-inflammatory medications, along with physical therapy to strengthen surrounding muscles and compensate for the injured UCL.  Following this, or in more severe cases, a UCL reconstruction may be indicated. Also known as Tommy John surgery (named for the Los Angeles Dodgers’ pitcher who first underwent the surgery), the procedure entails taking a tendon from another area of the patient’s body and replacing the injured UCL with it.

Metacarpal (Hand) Fracture

While less common than overuse injuries and conditions, hand fractures can result from the repetitive stress and force placed on the small bones of the hand.

With a total of 27 bones in the hand (14 phalanges, five metacarpal, eight carpal), more than half of the bones making up the entire upper extremity,metacarpals fractures are inevitable in sports placing extreme and repeated stress on the hands.

One such fracture is known as a metacarpal fracture, which affects the bone at the base of the finger closest to the wrist.

Metacarpal Fracture Symptoms and Diagnosis

Metacarpal fractures will cause immediate pain and possibly visible deformity. The injured finger(s) may swell, and there may be some bruising.

A physical examination and an x-ray Metacarpal hand fracture repairwill identify the location and severity of the fracture.  Treatment is determined based on whether the fracture is “stable” or “unstable” and the extent of injury.  More severe cases may require surgery and internal fixation (K-wires or plates and screws), followed by a period of splinting and hand therapy.

Prevention and Treatment

Understanding that adequate rest between practices and events is as important as the training will help reduce the likelihood that an overuse condition will result in a tear or stress fracture. Maintaining balanced strength and conditioning of opposing muscle groups is also an important prevention component.

When symptoms are addressed early, the injury often responds well to conservative treatment.

Protecting Fingers in Fall Sports

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

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

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

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

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

Sprains and DislocationsVolley Ball Finger Injuries

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

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

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

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

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

Finger Anatomy

 

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

Tendon Injuries

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

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

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

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

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

Symptoms of a flexor or extensor tendon rupture may include:

Flexor

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

Extensor

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

Finger Fractures

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

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

DIAGNOSIS

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

TREATMENT

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

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

PREVENTING INJURY

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

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

Texter’s Thumb – A Modern Day Malady?

While science explains how changes in our daily physical activity result in changes in our physical state, current culture seems to dictate the terms we use to identify these changes – reflecting what’s going on in the world around us.

Technology use gives new name to repetitive stress condition.

Technology use gives new name to repetitive stress condition.

In early hunting days (1955), Gamekeeper’s Thumb was coined by an orthopedic surgeon who repeatedly diagnosed Scottish gamekeepers with a thumb condition seemingly associated with the manner in which they killed small animals – and carried their game home in a leather thong attached to their thumb and draped over their shoulder.

Over time it became more commonly referred to as Skier’s Thumb – as similar damage occurred to skiers falling against a planted ski pole.  Our affection for the slopes boosted the popularity of the new terminology.

Similarly today’s activities have resulted in a new way to incur a long established condition – and the terminology associated with the diagnosis will provide future generations with some insight into the culture of our day!

Known as “Texter’s Thumb,” (also BlackBerry Thumb and Gamer’s Thumb),
de Quervain’s Disease or Syndrome is a painful inflammation of the tendons (fibrous connective tissue attaching muscle to bone), which control thumb movement and extend to the wrist (tenosynovitis).  The inflamed and swollen tendons and their coverings rub against the narrow tunnel through which they pass – causing pain at the base of the thumb which may extend to the lower arm.

Today's Texter's Thumb is  actually de Quervain's Disease.

Today’s Texter’s Thumb is actually de Quervain’s Disease.

Historically, this condition has also been called washerwoman’s sprain, mother’s wrist and mommy thumb.

Considered a repetitive stress injury (RSI), de Quervain’s Disease is often the result of repetitive activity/grasping – which results in irritation of the tendons and other soft tissue in the thumb.  The condition may also be caused by a direct blow to the thumb and inflammatory conditions such as rheumatoid arthritis.

In the activity of texting, it is thought that the problem is not caused by the tip of the thumb pressing the keys on a phone, but rather the frequent traveling of the thumb over the keyboard. The thumb joint is not meant to move rapidly in this manner – the confined space adding insult to injury.

Symptoms of Texter’s Thumb

Common symptoms of Texter’s Thumb (de Quervain’s syndrome) include swelling and pain that can run from the tip of the thumb to the wrist and into the forearm. This pain is primarily present when the wrist is flexed or turned – as well as when forming a fist or grabbing. There can also be pain when direct pressure is applied to the area.

Diagnosing Texter’s Thumb

To diagnose de Quervain’s, a physical examination and discussion of lifestyle and activity is assessed.  A Finkelstein test may also be performed.  This entails placing the thumb against the hand, making a fist with fingers closed over the thumb and then bending the wrist towards the little finger.  Pain with this maneuver is a positive test.

Finklestein's Test may be used in diagnosing de Quervain's.

Finkelstein’s Test may be used in diagnosing de Quervain’s.

Generally, this type of injury is treated conservatively and entails refraining from texting for a while (activity modification) and resting the affected thumb(s). Non steroidal anti inflammatory medication (NSAIDs) may also be prescribed and a splint that incorporates the thumb may be indicated.   When pain persists despite rest and refrain from the activity causing the condition, a steroid injection may be recommended. In chronic or severe cases, surgery to release the pressure in the compartment is performed – followed by rehabilitation therapy to regain strength. If untreated, the synovial sheaths will continue to thicken and degenerate. This can result in permanent damage and loss of grip strength and chronic pain.

 

Keeping Young Players in the Game This Season …. and the Next

Pitch Count Guidelines and Little League Recommendations

Last month we discussed the increase in injuries among Little Leaguers – particularly the prevalence of “Little Leaguer’s Elbow.”  We continue this discussion in this month’s blog with some of the things that the American Sports Medicine Institute (ASMI) and the USA Baseball, Little League Baseball and Major League Baseball organizations have done to ensure the safe play of our young athletes today….and tomorrow.

Avoiding little league injuries.

Pitch count regulations developed to reduce risk of injury in young players.

 New Recommendations

While curve balls are implicated in throwing injuries of the young athlete, because of inadequate physical development and neuromuscular control, scientific data does not yet support this.  Nonetheless, reducing the use of curve balls in Little League pitching is highly recommended.

Other recommendations include: 

  • Watching and responding to fatigue (decreased ball velocity/accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing.
  • No overhead throwing for at least two to three months per year (four months is preferred). No competitive baseball pitching for at least four months per year.
  • No pitching more than 100 innings in games – in any calendar year.
  • Follow limits for pitch counts and days of rest.
  • Avoid pitching on multiple teams with overlapping seasons.
  • Learn good throwing mechanics. First steps should be, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
  • Avoid using radar guns.
  • A pitcher should not also be a catcher. The pitcher-catcher combination results in many throws and may increase the risk of injury.
  • If a pitcher complains of elbow or shoulder pain, discontinue pitching until evaluated by a sports medicine physician.

Pitch Count

The pitch count restrictions for Little League Baseball were established to reduce the number of overuse throwing injuries among these young players and vary by age.  While the complete pitch count restrictions/recommendations can be reviewed on the ASMI website (www.asmi.org ), below is a listing of the latest Little League “daily” limits.

Daily Limits
17-18 N/A 105/day
15-16 N/A 95/day
13-14 75/game 95/day
11-12 75/game 85/day
9-10 50/game 75/day
7-8 N/A 50/day

(Resources – recommendations and pitch count: American Sports Medicine Institute, Position Statement for Youth Baseball Pitchers http://www.asmi.org/research.php?page=research&section=positionStatement

 

Little Leaguer’s Elbow

With baseball season in full swing we begin to see an increase in upper extremity injuries in young athletes. One of the most common injuries we treat is a throwing injury known as medial apophysitis, or “Little Leaguer’s Elbow.”

This condition occurs when the repetitive stress of frequent throwing places excessive strain on the tendons, ligaments and cartilage of the elbow joint.  In the young player and immature elbow this is particularly concerning because of the damage it can cause to the growth plate.

The two “phases” of throwing which impact the elbow joint include the early acceleration phase (a pulling force on the growth plate of the inner elbow) and the throwing/release phase (strong inward and downward snap of the wrist).  A hinge and pivot joint, the elbow allows a broad range of motion.  The growth plate in the elbow, though, is comprised of growth cartilage – a soft substance that is not as strong as bone.  With repetitive stress, this growth cartilage can weaken, develop small fissures and in more severe cases pull apart from the bone. The repeated pulling can also tear ligaments and tendons away from the bone – possibly pulling tiny bone fragments with it.  In a young player, this could potentially disrupt normal bone growth and result in deformity.

Another less common though more serious throwing injury, known as Osteochondritis Dissecans, can occur in young athletes and involves the loosening and fragmenting of immature bone and cartilage. The pain associated with this condition is usually felt on the outside of the elbow.

Both prevention and early treatment of Little Leaguer’s Elbow are key for young players.

Symptoms of Little Leaguer’s Elbow

The most common symptom associated with Little Leaguer’s Elbow is pain on the inside of the elbow, which may be severe and occur abruptly, or mild – increasing in intensity, gradually over time.  Other symptoms may include swelling, redness and warmth over the inner elbow.  Range of motion may be restricted in some players, with an inability to straighten the elbow.

Diagnosis and Treatment

A physical examination and pain assessment will help diagnose Little Leaguer’s Elbow.  An X-ray or MRI may be indicated to assess irregularities in the elbow joint and growth plate damage.

When diagnosed early, nonsurgical treatment can effectively resolve the problem and may entail rest (refraining from throwing activity), as well as icing to reduce swelling.  Sports rehabilitation specialists may also be able to help young players refine their throwing technique to reduce stress on the elbow joint.

In more severe cases, surgery may be required to reattach a ligament and/or the bone or growth plate  – stabilizing the elbow joint.

Preventing Throwing Injuries in Little League Baseball

Understanding the impact of throwing injuries on the immature elbow is key for coaches, parents and players.  Risk of injury can be reduced by properly warming up and ensuring proper throwing technique.  And adequate rest is as equally important as practice for optimal performance.

The American Academy of Orthopaedic Surgeons (AAOS) recommends that young pitchers play no more than three to four innings each game, to prevent throwing injuries.

Pitch Count Guidelines and Little League Regulations

As competition in youth sports intensify and seasons extend to include tournaments and World Series games, we are seeing an alarming increase in throwing injuries in the young player.  This has prompted the American Sports Medicine Institute, together with USA Baseball, Little League Baseball and Major League Baseball to examine the impact of excessive throwing on the young, skeletally immature athlete.  Their findings have translated into new regulations, pitch count guidelines and educational initiatives in Little League Baseball.

Next month we’ll talk about pitch count guidelines and its role in protecting young baseball players.

 

 

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

Reference

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

http://www.wideopenspaces.com/ouch-the-7-common-fishing-injuries/

http://handlinefishing.com/whatsthisfish/dangerousfishes.htm

http://handlinefishing.com/whatsthisfish/dangerousfishes.htm

http://www.merckmanuals.com/vet/exotic_and_laboratory_animals/fish/mycotic_diseases_of_fish.html
http://www.drjball.com/article6.html

 

Hand and Wrist Pain in Exercise – Can Make it Hard to Power Through

Hand and wrist pain in exercise can affect men and women, young and mature alike.  From weightlifting and exercise machines to pushups, injuries and conditions can result from the repetitive stress of the activity or the sudden frequent exposure (training in an off season, sudden increase in weights or repetitions, new exercise program, etc.).

Powering Through

Exercise Impact on the Hand & Wrist

The hand and wrist conditions most commonly associated with these types of exercise regimens is tendinitis. Other less common injuries include stress fractures of the wrist.

If not addressed, pain and restricted hand and wrist function could hinder proper form during the activity and cause more serious injury.

Tendinitis – Symptoms and Diagnosis

Tendinitis is the inflammation of the tendon resulting from micro-tears that occur when the “musculotendinous unit” (muscular and tendinous tissue and its ability to be stretched) is severely overloaded with a excessive or sudden tensile force (resistance of a material to a force tending to tear it apart).

It can also be associated with Tendinosis, which is the degeneration of the tendon’s collagen in response to chronic or repetitive overuse.

Symptoms can vary depending on the area affected.  When affecting the fingers, symptoms can be similar to those experienced with trigger finger – catching or locking when bent.

Occurring where a tendon attaches to bone, other symptoms of tendinitis include:

  • Pain and/or tenderness in the hand or wrist when lifting weights
  • Possibly mild swelling

Tendinitis is confirmed upon physical examination and discussion of patient history.  It is generally resolved by resting and refraining temporarily from the activity causing the strain.  If this does not resolve the condition, anti inflammatory medications and hand therapy exercises may be recommended.  Only in extreme cases of tendon damage is surgery considered.

Stress Fractures – Symptoms and Diagnosis

A stress fracture is an overuse injury which occurs when muscles become fatigued – unable to absorb added shock therefore transferring the stress overload to the bone.  This can cause a tiny crack in the bone and is called a stress fracture.  While stress fractures are most commonly seen in the lower extremity, they can occasionally occur in the wrist when subjected to excessive strain or repetitive stress activity such as increasing the amount or intensity of an activity too rapidly.

A stress fracture can sometimes be confirmed on an x-ray, though may not be visible for several weeks despite the pain.  If necessary, a computed topography (CT) scan or magnetic resonance imaging (MRI) may be indicated to confirm the fracture.

Among the most effective treatments for a stress fracture is rest from the activity that caused the fracture for approximately six to eight weeks.  Resumption of activity before proper healing can result in a more serious fracture and potentially chronic problems.

Reducing Risks

There are a number of things that those engaged in weightlifting or related exercise program can do to reduce these types of hand and wrist injuries and conditions.

  • Build up gradually to increased weight and reps
  • Wear wrist guards or protective gloves (minimizing pressure and providing wrist assist)
  • Taking breaks to rest the hands and wrist
  • Using proper technique/form  

Learn more about common hand and wrist injuries and conditions.