The Remedy Report LifeBridge Health Sports Medicine Newsletter January 2006

Transcription

1 In this issue... ACL's, High Ankle Sprains and Stingers, Oh My... Meniscus Injuries and Treatment Lowering Your Risk for a Cold Finger Injuries in Basketball Players Our Sponsors The Remedy Report LifeBridge Health Sports Medicine Newsletter January 2006 Ask the Expert Do you have a question for the sports medicine physicians? Write in...let us help you. Our team of orthopaedic sports medicine physicians can help answer you sports medicine needs. Send to sprice@lifebridgesportsmedicine.com ACL's, High Ankle Sprains and Stingers, Oh My... Understanding Sports Announcers and Sports Injuries Have you ever heard a sports announcer say about an athlete, "He's torn his ACL". How about this one, "He s out of the game, those linemen are always getting stingers and not going back into the game!" or "He s suffering from turf toe and will be out for the next few games." What the heck are they talking about? That's a good question. Ask The Expert Physical Therapist Walk Ins located in the lobby of LifeBridge Health & Fitness The 1st Tuesday monring of each month, 7:00 AM to 8:00 AM The sports announcers are quick to make a birdseye view medical diagnosis of an athletes injury while watching a game, play by play. They may have been athletes in the past and draw on their "expert" knowledge of sports injury from past personal injury. Sometime, their comments are misleading. Who are those people that run out onto the athletic field when an athlete gets injured? They are the certified athletic trainers (ATC) who are practicing sports medicine in a quick on the field decision making setting. If the injury situation is quite serious, the team physician and team orthopaedist join the ATC to help make the diagnosis and determine if it is safe for the athlete to return to play. The ATC along with the physicians will make a proper diagnosis and then the details of the injury are released to the coach and the public if necessary. So what are they talking about from that plush skybox above the Astroturf field? Hopefully, this article will help give you an explanation of some common terms and understanding of what s going on when an athlete gets hurt on the field. What is a STINGER? A burner, also called a stinger, is a common injury in contact sports, especially football. The exact mechanism of the injury is not well understood, but a burner is thought to be due to either stretch or

2 The last Wednesday evening of each month, 7:00 PM to 8:00 PM PREPARE, Sports Safety Course Conference LifeBridge Health & Fitness Saturday, February 11, :00 to 12:00 Call WELL to register Cost: $35.00 ( pays for the booklets, certificate of achievement and patch of completion) compression, or a combination of both, of the brachial plexus. The brachial plexus is a network of nerves that has just exited the spinal cord. These nerves travel across the shoulder and into the arm. Symptoms of a burner are sudden pain and tingling extending from the neck and down the arm into the fingers. Most often burners are transient injuries, but they can be serious if they are persistent or recurrent. If a player has recurrent burners, he or she should be removed from competition until evaluated by a physician. What is a HIGH ANKLE SPRAIN? A "high" ankle sprain is used to describe an injury of the ligament that joins the two lower leg bones together. This ligament is called the syndesmosis ligament. The ligament is above the ankle, which is why it's called a high sprain. This type of injury occurs most often in hockey players and skiers. The foot and ankle get turned out or externally rotated. Since the foot is in a rigid skate or ski boot there's no "give" and the ligament tears. What is TURF TOE? Turf toe is really a bruise that occurs at the base of the big toe at the joint called the metatarsal phalangeal joint. It usually occurs when the toe is jammed forcibly into the ground or, more commonly, when the toe is bent backward too far and it goes beyond where it should go. It causes significant pain and swelling at the base of the big toe. It can be a significant problem because players use the toe when they run and plant and push off. What is the ACL? Anterior Cruciate Ligament, found in the knee, provides ligamentous support of the knee structure and prevents the anterior shifting of the femur ( thigh bone) over the tibia ( big bone, lower leg). This is a commonly injured ligament of the knee during activities of cutting with a foot planted and twisting about the knee joint. Do you have more questions about sports medicine injuries? Please contact us. Ask the Expert Sports Medicine Physicians at LifeBridge Health Sports Medicine. us, sprice@lifebridgesportsmedicine.com Meniscus Injuries and Treatment An understanding of the surgical procedures for repairing damage to the meniscus can help athletic trainers be more effective during the rehabilitation process. In the fast-paced world of athletics, with its recurrent twists and turns, knee injuries are becoming increasingly prevalent. Though the term "ACL" has almost become a household word, and even junior- high athletes tend to know that it will set you out for a season, there are other injuries of the knee that are less well known. One such injury is irritation of, or damage to, the meniscus. The meniscus in the human knee is the cushion for the weight-bearing motion of the leg. The medial and lateral menisci together provide a forceabsorbing cartilage layer between the femur and tibia. The menisci are anchored in place at the anterior and posterior horns, and around the edge

3 by menisci-tibial ligaments. This allows the menisci some freedom of movement as the femur presses toward the tibia during weight-bearing movement of the lower extremity. The difference between meniscal cartilage and most soft tissue in the body is that it has a varying vascular supply. The meniscus is divided into three sections in regard to vascular supply. The outer third, when looking at a cross section, has a higher wall and takes the first pressure from the femur. This section is commonly referred to as the "red-red zone" as it has a good vascular supply and, therefore, has a good opportunity at self healing. The middle third tends to have less substance and bears the full weight of the knee. Called the "redwhite zone," it has limited vascular supply and can provide some woundhealing qualities, but has significantly less self- healing capabilities. The final third portion of the meniscus tapers off into the joint. It holds weight during running and jogging and is often injured in overuse and sheering injuries. It is considered the "white-white," or the avascular zone of the meniscus. It has little to no vascular supply and cannot regenerate or heal itself [1]. As in most soft tissue injuries, there are two main types of meniscal injury: meniscal irritation, or a tear. With meniscal irritation there can be a pinching or a twisting of the cartilage without complete tearing of fibers. Repetitive irritation can lead to fraying of the meniscus, especially in the red-white and the white- white zones. This type of injury will often cause pain and swelling in the joint, but no catching or locking. This type of injury can often be treated conservatively with some rest and knee joint rehabilitative exercises, keeping the muscles surrounding the knee in shape for return to play or other activity. If it is a repetitive trauma, or if the knee does not respond to conservative treatment, surgical intervention may be required. In a tear type of injury there are three definitions commonly used for the meniscus. Most tears can be seen on an MRI and are typically treated surgically, with the exception to the rule being injuries to the red-red zone that are not causing catching or locking of the joint. Also, for less active individuals, some meniscal tears may be treated conservatively unless they are presenting with catching, locking, or unresolved inflammation. In the not so distant past, many meniscal tears were treated by removing the entire meniscus, also known as a menisectomy. However, this increased the rate of osteoarthritic changes in the knee, and often ended in increased knee pathology post-surgically [2]. The more common practices now are partial menisectomies, excision of the injured portion of the meniscus, or meniscal repairs, wherein the meniscus is sutured together or tacked down into the joint to allow it to heal. The criterion for meniscal repair relies on both the time since injury, as older tears tend to be less likely to heal, and the area where the meniscus was torn, referring to the vascular zones and chances for healing. In some more severe cases of meniscal injury or degeneration, meniscal replacement can be considered. This involves implanting cadaver meniscus into the damaged knee to completely replace the injured meniscus. One type of tear is called "longitudinal," in which the meniscus is usually torn through the red-white zone from anterior to posterior. When treated surgically this may be fixated arthroscopically using dart sutures, which are typically placed from the white- white zone of the meniscus and anchored

4 There are three bones ( phalanges) which comprise each finger and these are the most commonly fractured bones in the body. The proximal phalanx is fractured more than the middle and the distal phalanx. Many tendons attach to these finger bones that can tear with or without a fracture and the three joints, the DIP ( distal interphalangeal), PIP ( proximal interphalangeal) and MCP ( metacarpal interphalangeal) can also suffer outside the red-red zone. If the tear is more toward the center of the knee, in the white-white zone, it may be excised. Another tear, called a "bucket handle," occurs vertically through the meniscus. This can be a complete tear through different zones, or only partially through any given zone, and it resembles an incomplete ice cream scoop out of the meniscus. Often these types of tears, when located toward the inside of the knee, can shift in and out of the joint and cause locking and catching of the knee joint [3]. Depending on the location of the tear in one or more of the three zones, and the length of time passed since injury, the longer it has been, the more likely that the torn meniscus begins to fray and wear down as it moves into and out of the joint, in which case repair versus resection can be decided. There are two main types of meniscal repair that can be performed. The first is using a dart or arthroscopic suture, as described for the longitudinal repair. For bucket handle tears that are more extensive and/or are along the periphery of the meniscus, an inside- out repair design may be used. This involves an incision on the outside of the knee to pass sutures from the inside of the joint (arthroscopically assisted) to the outside and back to secure the meniscus. Following any meniscus surgery, proper rehabilitation is the key to a full recovery. Knowledge of the surgery will aid in the rehabilitative process by providing insight into the pains associated with the postoperative phase. As with all things, time is the best healer, and we just get to help it along. So best of luck! About the author: Shannon Ashe, M.Ed., ATC, CSCS, is an assistant athletic trainer at Birmingham-Southern College. The university's Web site is Lowering Your Risk for a Cold Wash your hands often with soap and water and use your own towel to dry them. If soap and water are not available, use an alcohol-based hand gel. Keep your hands away from your face. Avoid close contact with anyone who has a cold. Diseases Source: National Institute of Allergy and Infectious Finger Injuries in Basketball Players Basketball finger injuries can range from minor contusions to fractures, joint dislocations, and ligament ruptures. Many of these injuries occur in sport due to the need for mobility and dexterity of the wrist and hand for sports specific activity. This leaves the fingers unprotected and vulnerable to injury.

5