Ignoring this Small Skiing Injury Could Lead to Lifelong ProblemsThere's a common skiing injury that can… +10 More
December 17, 2014
Sports Medicine Interviewer: You come back from the slopes, and your thumb is hurting really, really badly. Is it something you should worry about or not? We'll find out next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: Dr. David Rothberg is an orthopedic surgeon at the University of Utah Hospital. We're going to talk about something called "skier's thumb" right now. So you go for a day of skiing, you come back, your thumb hurts. Do you have skier's thumb or not? How do you even know? First of all, what is skier's thumb? What Is Skier's Thumb?Dr. Rothberg: Skier's thumb is a relatively common injury of the upper extremity suffered when someone falls on a pole. So the most common scenario is with a grip-fitted poles, you fall, and the pole is forced into the palm as you place your hand down to slow your fall. People know when they have it because the actual ligament that's hurt is your ulnar collateral ligament on your thumb, and it supports your thumb as a post. So when you pinch with your forefinger and your thumb . . . Interviewer: Kind of making the "OK" symbol except for against the side of your thumb . . . Dr. Rothberg:That's putting pressure on that collateral ligament. Interviewer: Okay. Dr. Rothberg: If you think about all the daily tasks we do with grip strength and manipulating objects with your hand, it's really common that we use your thumb as a post. So the quickest and dirtiest way to figure this out is to use your thumb as a post. Press your forefinger against the side of your thumb and see if it hurts at the large knuckle at the base of your palm, or your MCP joint. Interviewer: So it refers pain down, because you're touching at the very top part of the thumb, and it's kind of coming down, the base of the nail almost, off to the side. Dr. Rothberg: Right, and you're going to feel that. Interviewer: Okay. And if you feel that, is it for sure that you've got skier's thumb? Dr. Rothberg: It may not be for sure, because like all ligament injuries, it can really come with a grade of injury, from a sprain, which the vast majorities will be, to complete tears, to fractures of the insertion of the ligament. When to See an Orthopedic Hand SurgeonInterviewer: So if you're feeling pain, should you go see somebody right away? Is it important that you see somebody or should you just kind of wait and see if it goes away? Dr. Rothberg: I think, in the very beginning, if this is something that gets better very quickly, then you're probably safe. But if you have a persistent pain lasting more than a day or two, and it's causing dysfunction, it's worthwhile to get checked out by an orthopedic hand surgeon. They're most commonly going to take an X-ray to rule out that scenario where there may be fracture associated with it. The reason that you want to take care of this is it can lead to a chronic instability of that joint, meaning that you're no longer able to fully use your thumb as a post because of non-healing of the ligament. So the typical course of treatment is in a non-operative setting, which is the vast majority, is a brace. That brace is going to hold your thumb in a position that protects it from being used as a post or really straining or stressing that ligament as it attaches at the MCP joint. Skier's Thumb BraceInterviewer: So it sounds like kind of a big deal, because it could hinder your usage of that for the rest of your life if you don't have something done to it, and it's simple. It's a brace. Dr. Rothberg: That's exactly right. When chronically injured, then it becomes something kind of interesting historically. It's called a "gamekeeper's thumb," and that referred to when people who farmed chickens they would break the neck of the chicken over their thumb, and it could lead to repetitive stress on the ligament, that then loosened it and then caused chronic disability. So that's the worry when you don't take care of this skier's thumb is that it becomes a chronic instability that causes pain and dysfunction. Interviewer: How long does it take for this to recover at this point, after you get the brace? Dr. Rothberg: Typically, people are in the brace from four to six weeks, and then depending on the range of motion and tasks that they have in their daily life, they may start some hand therapy. Motion tends to help with the healing process. All in all, people can be back to activities around the six week mark. Interviewer: So just for perspective, not something to be taken lightly. Not to go, "Aw, it's just my thumb. I won't worry about it." Dr. Rothberg: That's very true, and I think it's a real common one that people get and take lightly, and then are presenting to us later with problems. Is it too Late to Fix the Problem?Interviewer: Then it's too late. Is it too late at that point? I guess that's a good question. What if three years down the road, I come in? Is it too late to fix that problem? Dr. Rothberg: It isn't necessarily too late, depending on whether you've developed any arthritis in the joint because of instability. Certainly, there are late reconstructions, where we can reconstruct the ligament to give you stability. In most people, this tends to be something they pick up and don't really miss, because it does cause quite a bit of dysfunction. But getting it looked at sooner is always better than later. Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. 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Skiing and Snowboarding: Why Helmets Aren’t EnoughHelmet use is higher than ever, but there has… +10 More
February 17, 2014
Brain and Spine
Sports Medicine Tom: Ski helmets: are you really safer when you put one on? What you hear might surprise you, next on Scope Radio. Announcer: Medical News and Research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Tom: I'm here with William Couldwell, who is the chair of the University of Utah's Department of Neurosurgery. Bill is nationally recognized leader and researcher in complex cranial surgery and is the current President of the American Association of Neurological Surgeons. William: Well, I think there's two ways to look at this, Tom. I think they do help in that if you do have an injury, they reduce some of the impact to the brain. The problem with ski helmets is that it also may give you a false sense of security. And I think what's happening is that the culture of skiing and snowboarding is increasing the risks and the height and the speed and the rotational injuries. The other thing that helmets don't do is they do not prevent the brain from rotating within the skull. And so they don't prevent that mechanism of injury as well, which is an important one. Tom: Do you think that's the primary reason that people have traumatic brain injuries in . . . William: I think it's a combination of the magnitude of the injury, the speed, the torque and also the twisting. Tom: Well, here we are watching the Sochi Olympics and we're seeing these young athletes just taking great heights and great speeds. And they've always done that. But it seems like it's even accentuated now. And ski resorts are building train parks. And they're supporting events that get in to jumping and going faster. William: Yeah, I think also the culture is faster, higher. The superpipes now are much bigger than they used to be. Even, you saw Shaun White actually stepped out of the Olympics on the slope style event because he felt that the jumps were to big and it was unsafe. Tom: It's interesting. I mean, the article, the Times article reported a 250% increase in brain injuries among youths and teenagers between 1996 and 2010 even though the helmet use has increased in that period of time. Which means to me that, I mean, obviously they're doing things that are more intense than they were doing before. William: I think the bigger issue here is the culture behind it. We've seen over the last few years that NASCAR has done a good job. They've improved equipment and the safety level of their cars and their helmets and to reduce the neck injuries. I think the NFL, right now, is under scrutiny and will be looking at the whole concussion issue. And in the helmets, we're actually putting monitors to measure torque and pressure within the helmet to get an idea of the kind of stresses that these players are seeing during the individual games. Tom: And there's nothing yet like that in skiing. William: No, in fact, Kevin Pierce and I are talking about doing that within snowboard helmets now. Tom: Great. William: A study with torque monitors. Tom: So, finally, to our listeners, what advice would you have for the weekend warrior skier, or the teenage athlete, in terms of reducing their risk for traumatic brain injury? William: Well, I think the important thing is to remember that these injuries can be life changing. I think that we need to deliver that message stronger. I think we need to be . . . if I was a parent who had children of this age now, I'd have them wearing the best helmet, the best sanctioned helmet that you could buy for them. Tom: But that, there was another question I had. Are there differences between helmets? William: There are different types of helmets. And certainly a motorcycle helmet is much bigger and bulkier than a snowboarding helmet. The trouble is that with the snowboarding they want a light helmet with good visibility, but it doesn't give them the optimal protection. Tom: Exactly. William: Like a football helmet would. Or a motorcycle helmet. Tom: Or a motorcycle helmet with a chin guard on it, yeah. William: Exactly. And so that's the problem. So, you're fighting this compromise all the time. Tom: So, I'm sorry, I think your last piece of advice . . . William: Yeah, so I think we should buy the best equipment for our children. And we should encourage them to wear it. I think the other issue that we didn't discuss is the neck injury issue, and the spinal cord injury. Tom: Clearly. I mean, these helmets don't prevent against neck injury. William: Every year here we see significant spinal cord injuries. . . Tom: That's great to know that. William: . . . especially from these train parks. And the twisting and the falling and the torqueing of the neck can be just as much of an injury to the spinal cord. And that can have a huge impact on life as well. And so I think it's a combination of the head injury plus the neck injury that I'm concerned about. We have a greater responsibility as parents and business leaders. And I don't think that we should push the limits, understanding that they're not going to have the judgment to deal with that. Male: We're your daily dose of science, conversation and medicine. This is The Scope, University of Utah Health Sciences Radio. |