Hand Injuries

Authors: Nancy Vang, Yer Vang, Marilyn Herrera, Desirae Young, Jose Arellano

Overview

Our article is about hands injuries in young athletes. Hand injuries are very common in children. The children’s bones are still growing and are weak. The growth plate in children can impact treatment and return play guideline.Growing bones are more fragile than mature bones. Children are more likely to fracture bones. The injuries to the hands and fingers not only affect function, skills and athletic participation but also self-esteem and confidence. Children are very playful and are not cautious so they have many type of hand injuries such as the jersey finger, mallet finger, skier’s thumb(gamekeepers thumb) middle phalangeal fractures, proximal phalangeal fractures, and boxer’s fracture.

Injuries and Treatments

There are many fractures that can occur in the hand. It’s interesting how the hand can break in many ways. There are 7 fractures that can occur: Jersey Finger, Mallet Finger, Skier’s Thumb, Middle Phallangeal Fractures, Proximal Phallangal Fractures, Boxers Fractures, and Dislocations.

Jersey Finger

Forced extension of the distal phalanx while actively flexing at the distal interphalangeal may cause a rupture of the flexor digitorum profundus tendon which causes jersey finger. There may be pain, swelling, and a popping sensation. The finger that was injured should be treated immediately and referred to a orthopedic surgeon. They may return to physical activity 6-12 weeks after surgery.

 
Mallet Finger

An axial  load or forced flexion placed  against an actively extending finger can lead to a rupture of the extensor digitorum tendon. This is known as mallet finger. If there is no avulsion, the injured joint needs to be splinted in full extension for 6-8 weeks with additional 6-8 weeks of splinting during sports. If there is an avulsion, the finger needs to be put in a dorsal splint  in full extension for 4 weeks. Some athlete in reliable condition can return immediately with appropriate extension splinting.

Skier's Thumb (Gamekeeper's Thumb) 

Hyperabduction of the thumb metacarpal-phalangeal joint can produce a rupture of the ulnar collateral ligament. This is known as skier’s thumb because it mostly occurs to skiers who fall while holding their ski poles.For treatment, the hand should be put in a thumb spica short arm cast for 4-6 weeks. If there is avulsion fractures, the athlete needs to be referred to orthopedic surgeon immediately. The athlete may return to activity after complete casting with subsequent splinting or bracing for sports activities for another 2-4 months.

Middle Phalangeal Fractures 

Middle phalangeal fractures can result from direct trauma and twisting forces. If there is pain, swelling, deformity and tenderness, it may indicate fractures. A doctor can examine it and evaluate it for rotation, angulation, and displacement. If the fracture is not displaced or angulated, it can be splinted for 3-4 weeks and buddy taped. If this is the case, the athlete can return immediately to activity. If the fracture is unstable, the athlete need to be referred immediately to an orthopedic surgeon.

Proximal Phalangeal

Proximal Phalangeal fractures may be indicated by pain, swelling, and deformity at the base of an athlete’s finger. They are hard to treat with close management and need to be inspected by x-ray.  The examiner needs to check for shortening, displacement, or angulation. These fractures need to be treated with immobilization for 3-4 weeks. The wrist needs to be in slight extension.

Boxer's Fracture

Boxer’s fracture can result from poor punching techniques that create an axial load on the fourth and fifth metacarpal. There may be swelling, pain, and there may be rotational and angular deformity. These kinds of fractures can be closely examined with PA radiographs. The assessment of rotational deformity is very important because these fractures require reduction and stabilization. They can be temporarily immobilized with ulnar gutter splints with MCP joints flexed at 70 degrees. They can return to play while casted or with splinting 4-6 weeks after cast is removed.

Dislocations

Most dislocations are dorsal and are caused by hyperextension of joints with simultaneous axial load. If there is pain, swelling, or the inability to move joint, it may indicate a dislocation. X-rays can check if there is also a fracture involved. If no fracture is present, traction with pressure can be applied to slowly put back the joint. Radiographs after joint is back in are recommended to check for anatomic alignment of the joint. After reduction,  the finger should be splinted at 30 degrees of flexion at the injured joint. These injuries require 2-3 weeks of splinting. ROM activities are highly encouraged to prevent stiffness and permanent loss of ROM. If going back to sport activities, buddy-taping for 4-6 weeks is recommended.

Conclusion

As student athletic trainers, this article provided many insights to our role. It provided different hand injuries to learn about. The article also gives information about how hand injuries affect the epiphyseal plate. It made us learn how serious a hand injury can be, and how it can require surgical attention. In the future, we will examine these injuries more carefully to see how dangerous they can really be. To expand our knowledge even more, we can observe even more hand injuries

Hand Injuries in Young Athletes, Rachel A. Coel, University of Colorado, Physician Perspective, July 2010

Skull Fracture & Concussion

Authors

Alicia Aguilar, Akram Mohsin, Angelica Colores

Overview

In the athletes world he/she wants to become the best of the best, by pushing themselves to ultimate limits and possibilities. Some go so far that they don't take or look at the risks seriously. When he/she is challenged physically against a mental thought, the athlete will not be cautious about dangers which result in serious or deadly injuries. The most serious is head injuries, such as a skull fracture or concussion. Skull fractures occur when a great amount of force is being placed against the head, causing a break in the skull which could possibly damage the brain resulting in a life threatening matter. Same goes for concussions, which are also looked at with great caution because when the head is hit or moved with excessive force, the brain can also move which may cause swelling to the brain which is an uncontrollable injury.

Treatment and Recovery

Once you have received a head injury the first thing you should do is go to the nearest Emergency Room. There the doctor can then run tests on the patient such as a CT Scan as well as checking if there is dizziness, vomiting, a headache, or any sign of a concussion. A CT Scan is a computed tomography X-Ray that produces images or ‘slices’ of the body part that got scanned. A CT Scan of the skull can reveal fractures. If you do happen to have a fracture in the skull or a concussion your physical activity should be monitored for a couple of weeks. After a couple of weeks you should return to the doctor for a neurologic examination. A neurologic examination is an overlook of the sensory responses, motor responses, and your reflexes. Once you have passed that examination you are allowed to go back to physical activity but try to do as little as possible and to keep it minimal.

                   

Conclusion

I have made many discoveries as an athletic trainer student, I know not all human beings hit by a baseball bat could get a concussion. In my article, ‘Skull Fracture and Brain Contusion in a Baseball Player : A Case Report, ’ a 19 year-old male got struck on the right side of his right side of his skull with a baseball  bat. He only complained of a headache. However, on his CT scan,his brain showed that there was a ‘right parietal fracture and small parietal contusion,with no midline shift’ ! Also, his neurologic examination was normal.

I will make use of this knowledge in the future if a player gets knocked unconscious. I would have to use the ‘ABC’ which is airway, breathing,and circulation. Also the player must (MUST) have a clinical evaluation to decrease the possibility to have another concussion. I would additionally recommend the player to have a neuropsychological examination often.

I will expand my knowledge of this article by searching about what questions are asked in a neuropsychological test. So, if it ever happens to a player I will take him or her to the  hospital for examination sooner. I will also practice using my ‘ABC’’s , and be more observant to the player who had suffered a concussion.

Reference

Case Review: Skull Fracture and Brain Contusion in a Baseball Player. (n.d.).Journals.

Retrieved September 27, 2013, from http://journals.humankinetics.com/

Head Injury | Johns Hopkins Medicine Health Library. (n.d.). Johns Hopkins Medicine, based in Baltimore, Maryland. Retrieved September 27, 2013, from http://www.hopkinsmedicine.org/

Myofascial Release

Authors: Rebekah Vang, Shoua Yang, Dylan Nguyen, Alex Lemon

Myofascial releases is an effective massage therapy technique. Myofascial is the tissue between the skin and the muscle. There are two types of massages that are use to release muscle pain. They are call trigger points and sweeping pressure. Trigger points uses the thumb and is to relieve muscular pain aches and pain. Sweeping pressures uses the palm to massage and to relax muscle. This massage helps the break down pain Spasm Cycle. The pain is develop because the muscle spasm. So in order to release this pain, these two types of massages are use. It is a type of therapy that athletic trainers and therapists uses. Myofascial release is a significant to the body along with health.

There are lots of ways to massage someone. Each massages has their own name. Not all massages are suppose to feel the same way. Certain massages relaxes certain muscles and more. The most effective massages are trigger point massages.

Sweeping Pressure

One of the trigger point massages are called, Myofascial Trigger Point. It's found in the belly of a muscle as opposed to its insertion points. They can both be active and latent trigger points. They can also be located in different areas to massage. Not all massages have to be in the back.

Active Trigger Points produce symptoms of local or referred pain, whereas a latent trigger point will only be painful when stimulated. To locate a trigger point, the clinician palpates the muscle perpendicular to its fiber, feeling for a taut band of tissue. When the taut band is found, the athletic trainer or therapist has to look for the most tender spots.

Trigger Points

There are two types of myofascial techniques. One technique involves application of direct, focused pressure to the adhesion or spasm. The slow sweeping pressure promotes soft tissue extensibility, and breaks up adhesion's and scar tissue. Direct pressure breaks up adhesion and muscle spasms.

Self Myofascial Release is when you use a foam roller; to roll your muscles, tendons and ligaments, It takes about 30-90 seconds. It's good to do be relieved and can function together correctly. Foam rolling decreases adhesion or spasms. This all affects the kinetic chain, which is made up of soft tissues such as muscles, tendons, ligaments, and fascia. Foam rollings basically correct muscle imbalances and improve joint range of motion.

What we thought that was interesting, is how there's different types of techniques  on releasing pain. Also, not only that, we as athletic trainers can accomplish the techniques. The techniques are safe, yield high patient satisfaction, and reduce pain. We can use these massaging techniques for patients who are in pain, soar, or stress out. Leaning different types of massaging techniques help us, athletic trainers, to help out people in the future. The article agreed that relieving spasm, breaking adhesion, and increasing blood flow help increase soft tissue extensibility. We, athletic trainers, can learn as easy and quick way to reduce pain and still help out a person.

Reference

John Paolini, 2009. Review of Myofascial Release as an Effective Massage Therapy Technique, Athletic, Human Kinetics-ATT14(5), 30-34

Lower Back Pain

Authors

Kritsada Yang, Rachel Flores, John Estrada, Kayla Wettlaufer

Overview

     Nowadays, there are many people that are involved in athletic activities. The many talks about being active almost always include the possibility of somebody getting injured by participating in contact sports or the stunt of growth of a adolescent by exercising and weightlifting but, the truth is, not everybody will get hit in the sport and suffer an injury and those who do lift weights won´t always have their growth stunted. The only way for a person to stunt their growth by weightlifting is by lifting too heavy of a weight and damaging any of their epiphyseal plate (growth plate) that is located in their bones. Although those hypothesis aren't true, there are many other problems an athlete could come in contact with. In the article "Multiple Spinal Anomalies in a High School Wrestler", a 14 year old athlete who is an active participant of motocross racing, competitive wrestling, and a weight lifter, suffered from lower back pain. Lower back pain is common with adolescents who are still having development in their bones. Half of the population that age from 18-20 suffer from lower back pain as well. The symptoms that accompany lower back pain are fevers, the loss of weight, constant pain, pain in the night, and/or a pain that progresses over time. There are many reasons that could be the cause of lower back pain. The causes include a defect at birth, infection, trauma, idiopathic pain, sickle-cell crisis or an overloaded backpack.

Treatment

     Like with any other type of pain, there is almost always a treatment. Lower back pain can either be acute, meaning temporary and for a short duration or chronic, meaning it's a long-lasting back pain that may be there for their entire lifespan. To treat an acute back pain, heat or ice pads can be applied to the area, pain killers and muscle relaxants can be consumed, epidural steroid shots can be injected, stimulation from electricity can be used, massages can be given, and a proliferant shot can be injected. The key to getting back to normal while suffering from lower back pain is to stay active. That does not particularly mean to go back to contact sports but just to exercise minimally to keep your body healthy. Proliferant shots have been used for over 60 years at the spondylolisthesis and transitional vertebrae. Chronic lower back pain is a lifetime of back pain unless it is treated correctly. To treat chronic lower back pain, acupuncture can be done on the area, biofeedback, cognitive-behavioral therapy, chiropractics, and a comprehensive amounts of rehabilitation programs.

Conclusion and comments

     After reading through this article and doing some research, I was able to find this entire topic educating. I have learned that the teenage group is the most active, but, with being the most active group, we are the ones most prone to suffer from lower back pain. At the conclusion of this research, I not only learned about the hazards of being active, but, I also feel obligated to help not only myself, but, also others that suffer from lower back pain. Before this article, I was unaware that lower back pain was this common. It's really something amazing when I have the chance to help another person and that's exactly what I'm going to do with this newly acquired information. I too, have lower back pain, and with this knowledge, I will attempt to help others and myself. This knowledge sparked something else, I will continue to learn about the teenage population and the common disorders they can have and will do the best of my ability to educate and treat others to the extent of my knowledge.

References

Barrall, S. Amy. (2009). Multiple Spinal Anomalies in a High School Wrestler. 2009 Human Kinetics, ATT 14(2), pp. 19-22.

WebMd. (June 29, 2012) Lower Back Strain Causes, Treatments, Exercises, and More - Back Pain Health Center. Retrieved from http://www.webmd.com/back-pain/guide/low-back-strain 2005-2013 WebMD, LLC

Foot & Ankle Rehabilitation

Authors:   Fabian Ochoa, Alex Sevillano, Crystal Reyes

The human foot is a complex structure that serves as a foundation of support.  When an injury occurs, the foot will need rehabilitation (foot exercises) that will help regain a solid foundation for the kinetic chain.

Foot Massage!!!

Rehabilitation of the foot is a long process that can be both painful and difficult, depending on the injury. Some Rehabilitation procedures can be lifting the foot or massages. At the end of this long process, the foot well be healed but it wont 

It also adds that some patients get frustrated when doing this long process.  It might help to not get frustrated as well.  Talk in a low, calm, and soothing voice to try and bring down the frustration.  Remember that one has to have more patience than the patient themselves.

It is interesting on how rehabilitation works.  By lifting the foot or curling the toes, the muscles slowly, but surely are recuperating.

The ankle is a very important part of the human body.  Even the smallest of muscles that are in the ankle are very important.  While we walk, the ankle takes up more than 150% of body weight as it adapts to uneven grounds, helps in the attenuation of forces associated with gait, and functions as a lever for propulsion.  

The foot & ankle contains:
26 bones
33 joints
more than 100 muscles, tendons, and ligaments

Knowledge of ankle deformities and treatments are helpful in cases that may hit close to home; either something that has happened to you or to a family member.  I personally look forward to using these different techniques either at home or at school (Washington Union High School).

And if this article hasn't helped you out, I encourage readers to research deeper into this subject.  

Music in Rehabilitation

Authors: Shelby Surabian, Amanda Espindola, Karen Victoria, Alejandra Aguiniga

Athletes going through rehabilitation go through several emotional stages. Some athletes find there way through different types of music. Music is able to mask feelings of discomfort during the rehabilitation process. Music can relieve the athlete of stress and anxiety to get them back to their stage of confidence. When listening to music during your rehabilitation process it can be uplifting and put you in a better mood to get better.

Music can be used in various ways. A recent discovery has proved that music can help patients focus when rehabilitating. It can also help mask feelings and encourage you to try harder. Every athlete has his/her own individual rhythm, which is very important because they can go at their own personal pace. Lastly its very efficient and helps you as a patient emotionally.

Overall, finding rhythm in rehabilitation is all about using music in their therapy sessions to boost and focus on a quicker recovery. Also, keeping in mind that every athlete is different so they would have their own rhythms and limitations. Frustration is less likely to happen while listening to music. We believe that people adapt to the rhythm which helps them while in rehabilitation.

Comments:
We believe that using music to rehabilitate is a very good source that helps the healing process. 
You heal faster and you can apply it to injured athletes by helping them mask their feelings.
We also believe that music can help you relax by having injured athletes find his/her individual rhythm.
We could also apply it at Washington Union High School Sports Medicine Program.

 

           Different types of music changes the babies emotions.

Reference:
Saalfield, A.G.(November2008) Finding Rhythm in Rehabilitation. Athletic Therapy Today, 13-14.

Chronic Encephalopathy (CTE) May Affect Memory, Mood, Behavior

Chronic Encephalopathy (CTE) is a disease caused by repeated brain trauma. The disease has been seen in patients as young as 17 years old. Currently, the disease can only be diagnosed postmortem and has been in the spotlight lately due to the rising focus on concussions. CTE has been blamed for several suicides and even murders. Last year, 2012, Junior Seau (retired NLF player) committed suicide and it was highly speculated that CTE was the culprit. Pathology reports confirmed that Seau's brain showed evidence of this chronic condition. In 2007, Chris Benoit, a WWE wrestler, committed suicide after killing his wife and son. At first, it was thought that Benoit's behavior was due to abusing anabolic steroids.  

Research: 

In a recent study published online in an issue of Neurology, the medical journal of the American Academy of Neurology, scientists examined the brains of 36 male athletes, ages 17 to 98, diagnosed with CTE after death, and who had no other brain disease, such as Alzheimer's. The majority of the athletes had played amateur or professional football, with the rest participating in hockey, wrestling or boxing.

The medical records were examined by researchers and families were also interviewed. The families were asked about the athletes' behavior, changes in memory, dementia and mood.

Results:

Behavior and Mood Problems (Group 1):

22 of the athletes had behavior and mood problems as their first symptoms of CTE with symptoms appearing at an average age of 35. 91 percent of this group experienced symptoms of memory and thinking decline at some point. This group was more explosive, out of control, physically and verbally violent and depressed more than the group that experienced memory and thinking deficits, with family members reporting that 73 percent of those in the first group were "explosive," compared to 27 percent in the second group. 64 percent of the this group were described as being "out of control". 68 percent were physically violent. 74 percent were verbally violent.  And 86 percent had depression.

Memory and Thinking Problems (Group 2):

11 had memory and thinking problems as their first symptoms with symptoms appearing at an average age of 59. 55 percent of this group experienced behavior symptoms and 64 percent experienced mood symptoms at some point. 27 percent of this group were described as being "out of control". 18 percent were physically violent, verbally violent, and had depression. 

Comments:

It is very evident from the results that a person that is suffering from CTE is going to exhibit memory, mood, and behavior problems. The only issue cited by the researchers is that this study did not have a control group of players that did not suffer from CTE. The interest in concussions has increased in the last couple of years and so have the studies in this area. As a clinician that sees the prevalence of concussion, I see the need of more research in the area as well. We need better guidelines for return to play and I also hope to see a way of diagnosing CTE through the use of imaging. 

Reference:

American Academy of Neurology (AAN). "Disease caused by repeat brain trauma in athletes may affect memory, mood, behavior."ScienceDaily, 21 Aug. 2013. Web. 1 Sep. 2013.