Posted on Fri, Feb 03, 2012 @ 07:14 AM
Have you ever asked yourself any of the following questions or wondered about the answers to these questions??
• What is a concussion?
• What are the symptoms of a concussion?
• What do I do if I think I or my child has a concussion?
• How are concussions diagnosed?
• If I think I have a concussion should I go to the ER? Should I have an MRI? Or CT scan?
• What happens during a concussion? Why does it happen?
• What activities can cause a concussion?
• What does this mean for my future?
• What is Second Impact Syndrome?
• How can I prevent a concussion?
• When can I return to school/work/sports after a concussion?
• What is neurocognitive testing? Who should take neurocognitive testing?
• What do the scores on neurocognitive tests mean?
• Are there any laws or guidelines in RI for concussion management?
These are some of the most Frequently Asked Questions regarding Sports Concussions. If you would like to know the answer to these questions & learn so much more about concussions, please SAVE THE DATE April 5, 2012.
SAVE THE DATE
Thursday, April 5, 2012
6-8pm
Foundry Orthopedics & Sports Medicine
will host several MD guest speakers from around the state to address the questions listed above & answer any other questions in its
1st Annual Community Concussion
Awareness Seminar
This will be a FREE event Open to the Public & ALL are encouraged to attend & pass along this information to anyone you think may be interested
SIGN UP to register today to save your spot!
We look forward to seeing you all there!
-- Sarah Bicknell PT, MSPT, ATC
Posted on Wed, Jan 25, 2012 @ 03:33 PM
Previous blogs have dealt with the issue of knee arthritis: diagnosis, treatment options, etc. For those patients who have failed to improve with conservative care, knee replacement is an option. One of the requirements for a good end result after knee replacement surgery is a structured rehabilitation program. This blog will lay out this rehab process, so that in the end, both patient and surgeon are happy with the results.
If you are a candidate for knee replacement surgery, you probably anticipate that life after the surgery will be much as it was before surgery, only without the pain. In many ways, you are correct. But change does not happen overnight, and your active participation in the healing process is necessary to ensure a successful outcome.
Although you will be able to resume most activities, you should avoid activities that place excessive stress on the new knee. The following suggestions will help you adapt to your new joint and resume your daily activities safely.
Activities in the Hospital
The knee is the largest joint in the body, and replacing it requires major surgery.
Early Mobilization
Although you will probably want to rest after surgery, early mobilization is important. If you had considerable pain in your knee, you probably cut back on your activities before surgery and your leg muscles may be weak. You will need to build up strength in your quadriceps muscles to develop control of your new joint. Early activity is also important to counteract the effects of the anesthesia and to encourage healing. Your doctor and a physical therapist will give you specific instructions on wound care, pain control, diet, and exercise.
Pain Management
Proper pain management is important in early recovery. Although pain after surgery is quite variable and not entirely predictable, it can be controlled with medication. Initially, you will probably receive pain control medication through an intravenous (IV) tube so that you can regulate the amount of medication you need. Remember that it is easier to prevent pain than to control it. You do not have to worry about becoming dependent on the medication; after a day or two, injections or pills will replace the IV tube.
Other Postoperative Activities
You will also have to take antibiotics and blood-thinning medication to help prevent blood clots from forming in the veins of your thighs and calves.
You may lose your appetite and feel nauseous or constipated for a couple of days. These are normal reactions. You may be fitted with a urinary catheter during surgery and be given stool softeners or laxatives to ease the constipation caused by the pain medication after surgery. You will be taught to do breathing exercises to prevent congestion from developing in your chest and lungs.
Initially, you will have a bulky dressing around the knee and may have a drain to remove any fluid build-up around the knee. The drain will be removed in a day or two. You may also be wearing elastic hose and, possibly, compression stocking sleeves around your legs. These plastic sleeves are connected to a machine that circulates air around your legs to help keep blood flowing normally.
Physical Therapy
A physical therapist will typically visit you on the day after your surgery and begin teaching you how to use your new knee. You may be fitted with a continuous passive motion (CPM) exercise machine that will slowly and smoothly straighten and bend your knee. Even as you lie in bed, you can pedal your feet and pump your ankles on a regular basis to promote blood flow in your legs.
Discharge
Your hospital stay may last from 3 to 7 days, depending on how well you heal after surgery. Before you go home, you will need to meet several goals:
• Get in and out of bed by yourself
• Bend your knee approximately 90° or show good progress in bending your knee
• Extend (straighten) your knee fully
• Walk with crutches or a walker on a level surface and to climb up and down 2 or 3 stairs
• Do the prescribed home exercises
You may experience mild swelling in your leg after you are discharged. Elevating the leg, wearing compression hose, and applying an ice pack for 15 to 20 minutes at a time will help reduce the swelling. You may be permitted to take the continuous passive motion exercise machine home with you for a few weeks, but this is not a substitute for the prescribed exercises.
Activities at Home
You will probably need some help at home for several weeks. If you do not have sufficient help at home, you may be temporarily transferred to a rehabilitation center. The following tips can make your homecoming more comfortable:
• Rearrange furniture so you can maneuver with a walker or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
• Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
• Install a shower chair, gripping bar, and raised toilet in the bathroom.
• Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending too far over.
Wound Care
General guidelines for wound care include:
• Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Ask for instructions on how to change the dressing before you leave the hospital.
• Do not shower or bathe until the sutures or staples are removed, usually a week to 10 days after surgery. Again, the wound should be kept clean and dry.
• Notify your doctor if the wound appears red or begins to drain.
• Take your temperature twice daily and notify your doctor if it exceeds 100.5°F.
• Swelling is normal for the first 3 to 6 months after surgery. Elevate your leg slightly and apply ice.
• Calf pain, chest pain, or shortness of breath are signs of a possible blood clot. Notify your doctor immediately if you notice any of these symptoms.
Medication
Take all medications as directed. You will probably be given a blood thinner to prevent clots from forming in the veins of your calf and thigh because these clots can be life-threatening. If a blood clot forms and then breaks free, it could travel to your lungs, resulting in a pulmonary embolism, a potentially fatal condition.
Because you have an artificial joint, it is especially important to prevent any bacterial infections from settling in your joint implant. You should get a medical alert card and take antibiotics whenever there is the possibility of a bacterial infection, such as when you have dental work. Be sure to notify your dentist that you have a joint implant and let your doctor know if your dentist schedules an extraction, periodontal work, dental implant, or root canal work.
Diet
By the time you go home from the hospital, you should be eating a normal diet. Your physician may recommend that you take iron and vitamin C supplements. Continue to drink plenty of fluids and avoid excessive intake of vitamin K while you are taking the blood thinner medication. Foods rich in vitamin K include broccoli, cauliflower, Brussels sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions. Try to limit coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.
Resuming Normal Activities
Once home, you should continue to stay active. The key is to remember not to overdo it! While you can expect some good days and some bad days, you should notice a gradual improvement and a gradual increase in your endurance over the next 6 to 12 months. The following guidelines are generally applicable, but the final answer on each of these issues should come from your doctor.
• Physical Therapy Exercises - Continue to do the exercises prescribed for at least two months after surgery. Riding a stationary bicycle can help maintain muscle tone and keep your knee flexible. Try to achieve the maximum degree of bending and extension possible.
• Driving - If your left knee was replaced and you have an automatic transmission, you may be able to begin driving in a week or so, provided you are no longer taking narcotic pain medication. If your right knee was replaced, avoid driving for 6 to 8 weeks. Remember that your reflexes may not be as sharp as before your surgery.
• Airport Metal Detectors - The sensitivity of metal detectors varies and it is unlikely that your prosthesis will cause an alarm. You should carry a medic alert card indicating you have an artificial joint, just in case.
• Sexual Activity - can be safely resumed approximately 4 to 6 weeks after surgery.
• Sleeping Positions - You can safely sleep on your back, on either side, or on your stomach.
• Return to Work - Depending on the type of activities you perform, it may be 6 to 8 weeks before you return to work.
• Other Activities - Walk as much as you like, but remember that walking is no substitute for the exercises your doctor and physical therapist will prescribe. Swimming is also recommended; you can begin as soon as the sutures have been removed and the wound is healed, approximately 6 to 8 weeks after surgery. Acceptable activities include dancing, golfing (with spikeless shoes and a cart), and bicycling (on level surfaces). Avoid activities that put stress on the knee. These activities include: tennis, badminton, contact sports (such as football, baseball), squash or racquetball, jumping, squats, skiing, or jogging. Do not do any heavy lifting (more than 40 lb) or weight lifting.
-- Cote
Portions of this blog entry are taken from aaos.org
Posted on Thu, Jan 19, 2012 @ 06:35 AM
Microfracture is a surgical procedure aimed at cartilage regeneration most commonly performed in the knee. Cartilage allows for the bones to glide smoothly over one another and, as a result of injury or trauma, some of this cartilage may become removed from the bone causing every day activities such as squatting, kneeling or performing stairs as well as more complex movements such as jumping, cutting or playing sports to be painful. If your doctor recommended this procedure it is important to know the restrictions and rehab process in order to ensure the best possible outcome of the surgery.
The most important initial aspects are range of motion and weight bearing restrictions. The sooner the motion is restored in your knee the better and, by starting physical therapy 3-5 days after surgery, you will decrease the risk of adhesions and scar tissue formation which could lead to joint contractures. Your therapist will give you a home stretching and range of motion program to help with your motion progress when not in therapy. Furthermore, it is important to not put any weight on your leg for 6 weeks to ensure that the clot that is formed from the surgery to promote the new cartilage does not become displaced.
Within these first 6 weeks you and your therapist will be working toward:
1. Reduce pain and swelling by using modalities such as ice or electric stimulation
2. Restore soft tissue balance by using techniques such as stretching, soft tissue mobilizations, massage and passive range of motion to improve knee flexion and extension
3. Restore muscle function by performing non-weight bearing exercises for the hip, knee and ankle. The therapist may also use electric stimulation to help stimulate the quadriceps muscle group to contract and stay strong.
After week 6 and your doctor has cleared you to become weight bearing, you will be working towards:
1. Improving your gait mechanics by decreasing your use of brace and crutches and educate on the proper mechanics of walking
2. Increase proprioception and neuromuscular control by performing balance exercises
3. Continue to improve muscle strength and function by increasing strengthening exercises to squatting, hip and glute strengthening, biking, lunges, stairs and weight machines if present in clinic
Between week 12 and 16 you and your therapist will be introducing jogging and agilities such as jumping and cutting. Your therapist will customize your program depending on your goals and activities or sports that you want to get back to performing.
Everyone will progress differently through the program based on age and past medical history and with close communication with your therapist, exercises may be added at different stages based on symptoms and progress. Finally, patient compliance in terms of completing the home exercise program and attending regular therapy sessions will ensure the best possible rehab outcomes.
-- LaChance
Posted on Fri, Jan 13, 2012 @ 05:55 AM
History
In 1882, Edward Hallaran Bennett, MD, described this fracture of the base of the first metacarpal. It is the most common of thumb metacarpal fractures. Bennett described the anatomic details of the fracture and suggested that early diagnosis and treatment are imperative to prevent loss of function of this highly mobile joint. Bennett said his fracture "passed obliquely across the base of the bone, detaching the greater part of the articular surface, and "the separated fragment was very large and the deformity that resulted there-from seemed more a dorsal subluxation of the first metacarpal". Interestingly, Bennett was also the surgeon that introduced Lister’s concept of asepsis into Ireland.
Mechanism of Injury
Axial loading of a partially flexed thumb metacarpal causes this injury. This type of compression along the metacarpal bone is often sustained when a person punches a hard object, such as the skull or tibia of an opponent, or a wall. It can also occur as a result of a fall onto the thumb such as that sustained by Bears quarterback Jay Cutler while trying to make a tackle during the 2011 season. Indeed, this injury is fairly common in football and rugby, and males outnumber females by 10:1.
Problem
This fracture separates the important volar oblique ligament along with a portion of the joint surface of the base of the thumb metacarpal from the rest of the thumb metacarpal, and without this stabilizer, the joint can subluxate or dislocate under the pull of the APL tendon. Without prompt and appropriate treatment, this intra-articular fracture may result in an unstable arthritic joint with subsequent loss of strength, motion, and pain. Because the thumb carpometacarpal (CMC) joint is critical for pinch and opposition, this injury may severely affect overall function of the hand.
Presentation
Patients present with swelling and pain at the thumb base after an impact injury to the thumb. On examination, motion is limited and CMC instability is frequently noted with gentle stress of the thumb metacarpal.
Workup
Xrays are usually adequate to make the diagnosis of this injury. Occasionally, special views will be useful to assess for fragmentation, and computed tomography, or CT, can be helpful in defining the degree of fragmentation (comminution) or if there is impaction of the joint surface.
Treatment
Closed reduction and thumb spica cast immobilization are effective in the treatment of Bennett fractures if the reduction can be maintained and the fracture fragment very small. The strong pull of the APL frequently leads to displacement, necessitating surgical intervention. Frequently, surgery is the most reliable method of stabilizing these fractures. In many cases, surgery can be done without incisions and under Xray control, using two small pins to stabilize the fracture after restoring normal position. Large and displaced fracture fragments may need an open incision and use of screws or pins. These operations are done as ambulatory or out-patient surgery, and pins will typically be removed in 4 to 6 weeks. The patient is usually casted during this interval following
which bracing and therapy will be initiated.
Prognosis
The outcome after Bennett fractures is most closely related to the amount of energy associated with the original injury. High-energy injuries that produce extensive comminution, articular surface damage, and extensive soft-tissue injury, will tend to have a less successful outcome. With anatomic restoration of the joint surface and reestablishment of stability, the outcome is routinely good, especially in low-energy injuries with simple fracture patterns and limited soft-tissue involvement.
-- Lee
Posted on Thu, Jan 05, 2012 @ 07:00 AM
Suprascapular nerve entrapment is a condition that occurs in a variety of different patients with many potential causes of the condition.
Nerve entrapment can lead to Suprascapular nerve palsy resulting in shoulder weakness and possible shoulder pain. The most common clinical presentation is dull, nonspecific shoulder pain and sometimes weakness, although many times the condition is not recognized until significant shoulder muscle weakness is present or the patient fails rotator cuff rehab. It is often confused for a rotator cuff tear.
The Suprascapular nerve originates from the superior trunk of the brachial plexus and mainly from cervical nerve five and six. The Suprascapular nerve gives both motor and sensory innervation but has no cutaneous sensory innervations. Its motor innervations are to the Supraspinatus and Infraspinatus muscles of the rotator cuff. The nerve passes deep to the trapezius muscle and suprascapular notch.
The Suprascapular nerve maybe injured by a variety of different traumas or conditions. The recovery prognosis is related to the extent of the trauma and the duration of the condition. The nerve may be injured with clavicle and scapula fractures. Shoulder dislocations are also implicated as a cause of nerve injury. Labral tears with associated paralabral cyst may cause nerve entrapment with a possible dramatic resolution of weakness with surgical decompression of the cyst. Certain anatomic variations may also be the cause such as a narrow V shaped suprascapular notch. The condition is also seen as a result of a post viral syndrome and possibly from viral vaccinations.
Those individuals most commonly affected usually perform repetitive overhead activities. Classically, they are throwing athletes such as pitchers or tennis players. Swimmers also may present with this condition. I have seen this condition in a backpacker from external compression from the pack frame.
The clinical presentation is classically pain if a post viral syndrome is associated with it or more commonly weakness of the Infraspinatus and Supraspinatus muscles of the rotator cuff. Frequently, significant muscle wasting is associated with it due to a delay in diagnosis or a failure of rehabilitation. Biomechanical abnormalities from muscle weakness such as shoulder impingement syndrome or shoulder instability may be present.
The diagnosis is made from a good clinical exam individually testing the strength of shoulder girdle muscles. MRI is indicated to rule out soft tissue mass such as paralabral cyst or tumor. EMG is also indicated to help differentiate from other nerve related conditions and to help localize the site and cause of the nerve entrapment.
The mainstay of treatment is identification of the cause and cessation of offending activities. Rest and prolonged physical therapy are usually successful but may take months before muscle strength is restored. Pharmacologic treatment with prednisone, NSAIDs, and Gabapentin have also been found to be effective in some cases. In cases where physical compression is present and conservative measures fail, then a variety of surgical decompression procedures may be indicated.
Suprascapular nerve entrapment must be considered in all patients with shoulder pain or weakness.
-- Furcolo
Posted on Thu, Dec 29, 2011 @ 07:04 AM
Walk into any physical therapy clinic, health club or personal training studio and you will more than likely see someone rolling back and forth on a Styrofoam tube. What are they doing and how can something that looks so uncomfortable be beneficial?
Foam rolling is a way of self mobilizing connective tissue that encases all of our muscles. The connective tissue, or fascia, that encases the muscles is the white, sinewy tissue that you see when you look at a piece of meat. This fascia, consisting of the epimysium, perimysium, and endomysium, is a critical part of the musculoskeletal system that enables us to move efficiently.
The connective tissue helps to transfer energy through the body as the muscles contract, much like how a spring works. The muscles apply a force to the bones and fascia, which is then transferred through our arms and legs helping us to move. If we did not have this fascia, our muscles would have to work constantly as opposed to turning on and off, which would leave us exhausted with even the most simple of tasks.
What are the benefits of foam rolling? Foam rolling helps to maintain the elasticity of the fascia, which is lost most often as we age or after immobilization or injury. After exercising, foam rolling can help to promote tissue healing and decrease the severity of delayed onset muscle soreness (DOMS) by facilitating blood flow through the muscles. In cases of chronic inflammation (tendonitis, tendinosis, etc…) the inflammatory process causes scar tissue formation that decreases the elasticity of the fascia.
Why can some areas of the body that we foam roll be so much more painful than others? The muscle tissue and fascia both have nerve endings that send sensory input to the brain. Some of the more painful areas can be trigger points in the muscle tissue. The American Academy of Family Physicians defines trigger points as: discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. The compression of the foam roller can help to decrease the sensitivity of the areas and relax some of the muscle fibers. As the connective tissue gains mobility and the muscle spasm decreases, range of motion and strength are often regained.
There are alternatives to the foam roller to address elasticity of the fascia in our bodies. “The Stick” is a hand tool which is effective on small localized areas and has been used by athletes for years.
There are also manual techniques such as Rolfing and myofascial release that skilled practitioners and clinicians can perform on patients to restore lost range of motion and function.
Adding foam rolling to your exercise routine can help to decrease the aches and pain that occur after performing the activities that you enjoy!
-- Kinne
Posted on Wed, Dec 21, 2011 @ 02:46 PM
Punishing sports like professional football and competitive gymnastics take a toll on athletes' bodies, but even recreational sports or aerobics can result in sports-related injuries. Even yoga, one of the gentlest forms of physical activity, resulted in an average of one injury severe enough to merit a doctor's visit per 5,000 participants last year, according to Yoga Journal.
While any intense pain during activity requires medical attention to check for more severe injury, knowing some first aid can bring you relief until you get to the clinic.
Travel with a Phone or a Friend
One of the best first aid measures you can take for sports-related injuries takes place even before you're injured. If you're going hiking, biking or even walking in the park, take along a phone or a companion. A significant injury could leave you stranded, so make sure you have a way to get help before you need it.
Stop the Activity
As unpleasant as it is, pain serves a purpose: it's your body's way of telling you that something is wrong. Listen to your body and heed its advice by immediately stopping your activity. Sudden pain could mean a serious injury such as a tear or sprain, and trying to work through that pain could exacerbate the injury. Take any weight off the affected limb as soon as possible.
Ice the Injury
When you sustain an activity-related injury, the tissues surrounding the injured area swell as your body sends its defenses to the site of the damage. This inflammation puts additional pressure on the injured tissues, causing pain and immobility. Ice a sports-related injury to bring down the swelling and dull the pain. Wrap the ice in a towel and keep it on the affected area for no more than 20 minutes at a time to avoid skin damage due to frostbite. In a pinch, frozen vegetables in a sturdy bag make a good ice pack.
Wrap It Up
Another means of bringing down swelling is compression at the site of the injury. Bandaging the afflicted limb applies steady compression from all directions and also helps hold the injured area immobile, preventing further damage. Wrap bandages firmly, but not tightly; a too-tight bandage reduces blood circulation to the soft tissues surrounding the injured area.
Make an Appointment
Assessing the damage is a job for a sports medicine specialist. Your doctor will use the latest medical imaging technology to determine the extent of the injury, recommend a specific course of home treatment and possibly prescribe medications to help with the pain and swelling. If you've followed the first aid advice to rest, ice and apply compression to the injury, you've done all you can; let your sports medicine specialist take over to speed you on your way back to health.
-- The above article was written by guest blogger Jordan Allen on behalf of Northern Nevada Medical Center. Thank you Jordan and Happy Holidays to all
Posted on Thu, Dec 15, 2011 @ 11:58 AM
What is Sports Imagery?
Sport Imagery is the mental rehearsal or visualization to improve athletic performance. Performing imagery can be done in a variety of ways based on what is most effective for the athlete.
The two most common methods to use imagery are an internal and external perspective. An internal perspective allows the athlete to imagine the situation from their own point of view, where an external perspective is from the point of view of a spectator, teammate, or as if you were watching yourself on TV. Both internal and external perspectives are useful and productive. Detail during each of these perspectives is what makes the imagery effective. The athlete must be able to picture every aspect of the scenario that they are creating. This must include sounds, smells, and emotions in addition to the actual movements, body positions and actions. The use of imagery is most effective when it is in high detail, uses all your senses, and has positive focus.
How to practice imagery
When practicing imagery it is important to stay simple at first, then continue to progress in complexity. It may take practice to develop this skill, so begin with small ideas until you can progress to complex scenarios. When beginning, it may be beneficial for the athlete to only practice their imagery in a calm, relaxed, quiet environment. It is important to have control over the events in the image to maintain its positive focus. Once the use of imagery is mastered it is often applied just prior to the event that is being pictured. This will allow you to transfer that scenario to a real time performance.
What are the benefits of using sports imagery?
Using imagery allows an athlete to train when training isn’t possible. Visualizing the weight they want to lift, the pitch they want to throw, or the putt they want to make.
Imagery can also help to maintain motivation. Picturing the high level of performance you want to reach helps to set goals and stay motivated through the difficult physical aspects of achieving them.
The use of imagery also allows athletes to regulate anxiety and conquer the weaknesses of their game. Visualizing the ability to hit the curveball you’ve struck out on will increase confidence, and allow you to maintain the mental toughness to perform.
Controlling your mental image
The ability to control the image you’re creating will determine its effectiveness. When a quarterback is picturing the final play of the championship game, they must be able to control all of their senses and sensations down to every detail. Is the crowd loud, or have you shut out all noise? How is the traction of your cleats, or your grip on the ball? They must be able to feel a smooth snap, a fluid drop back, and continue to a perfect release. Everything that you see and feel must be perfectly selected to maintain a positive mental image to even the most difficulty situations. The details of a scenario add realism, and mental control will ensure success.
Practice, Practice, Practice
To make sports imagery effective in your game requires practice to master control over your images, and continuous repetition to make the scenario a reality. Using imagery in your training routine has been shown to increase performance of every athlete, from professionals to weekend warriors.
-- Anderson
Posted on Thu, Dec 08, 2011 @ 09:53 AM
The term skier’s thumb refers to acute ulnar collateral ligament (UCL) injuries of the thumb which can occur when a skier falls on an open hand or the ski pole is forcibly twisted out of the hand. These injuries often consist of forceful combined radial deviation and hyperextension of the thumb (the thumb bends backwards). To decrease your risk of injury, release your grasp on the ski pole when you fall or consider using strapless poles.
The radial and ulnar collateral ligaments (RCL and UCL) along with the volar plate are the primary stabilizers of the small joints of the thumb and fingers. The ligaments of the thumb and fingers provide stability for functional use of the hand. Without the stability provided by these structures, manipulation and grasp would be difficult. The ability for pinching and grasping of large objects is dependent on intact ligaments at the thumb MP joint.
The most commonly injured ligaments in the thumb are the collateral ligaments of the metacarpophalangeal (MCP) joint. UCL injuries are far more common than RCL injuries. Common terminology for injuries to the UCL include skiers thumb or gamekeepers thumb. The term gamekeepers thumb often refers to an injury due to a chronic strain on the UCL historically seen in Scottish gamekeepers twisting the head of wounded rabbits. This term is generally reserved for reference to chronic UCL injuries.
A UCL tear can be partial or full. A full tear often has a Stener lesion. When this occurs, the torn ligaments slide out from the adductor muscles and become trapped superficially. During your exam, your physician may exam/palpate your thumb for tenderness and pain at the area of the ligament injury, stress test for stability with the thumb in several different positions and order radiography.
Type I and II UCL injuries are incomplete sprains, whereas, type III is a complete rupture of the ligament. Grade I and II sprains as well as minimally displaced avulsion fractures may be treated in a hand based thumb orthotic which allows for some thumb motion. 
Your physician may keep you in the orthotic for 1-2 weeks depending on the severity of your injury. You will then begin working on regaining pain free movement at the thumb joint, gradually progressing to strengthening activities. Certain pinch and grasp motions are avoided for approximately 8 weeks.
Ligament avulsions will require surgical repair. If the ligament is partially torn and the joint has only minimal instability, the physician may immobilize the thumb in a splint or cast. A displaced avulsion fracture occurs when there is a complete tear in conjunction with a fracture. In this case, hardware (wires,screws or bone anchors) may be used to stabilize the fracture as well as repair the ligament. The thumb will likely be immobilized for 4 weeks after surgery. Once the hardware is removed protected range of motion activities will be initiated with anticipated return to full activity at around 3 months. While recovering from this injury, one must remember that effective thumb function is more dependent on thumb stability than mobility therefore, aggressive activity should be avoided until ordered by your physician or therapist.
-- Bergeron
Posted on Thu, Dec 01, 2011 @ 03:01 PM
Most people would recognize an athletic trainer if they saw them run out onto a sports field however, many people would most likely not know much about the profession and how important one can be to high school student athletes.
What is an Athletic Trainer
An athletic trainer (ATC) is a health care professional that works in various settings and assists individuals to prevent, treat and rehabilitate injuries. Athletic trainers collaborate with physicians to limit athletes’ time on the “sidelines” and optimize performance after injury. The field of athletic training includes, but is not limited to, prevention, diagnosis, intervention of emergency medicine, acute and chronic medical conditions as well as rehabilitation. Athletic trainers have either a 4-year bachelor's or 2 years master's degree from an accredited program. Athletic trainers are certified by the National Athletic Training Association and hold a state license in their state of practice. Common athletic training settings include high schools, physical therapy clinics, doctors’ offices, hospitals, industrial settings, orthopedic product development, military, performing arts, college and professional sports. ATC’s keep their knowledge current by participating in continuing education courses throughout the year.
Many times Athletic Trainers are confused with personal trainers. Although many athletic trainers are also personal trainers, they hold different roles in their respective fields. A personal trainer is someone who determines, monitors and adjusts an exercise program for an individual participating in a fitness setting.
Stress of High School Sports
High School sports in today’s culture place a lot of stress on student athletes. The students feel that they need to excel and an injury will slow down their acceleration process. At times an athletic trainer is making a split second decision on an athletes’ return to play status. This decision can change an athlete’s entire season and it is important for athletes to remember an ATC is always looking out for their well being. Unfortunately some media outlets attempt to make the high-pressure situation of sports more intense by applying stress to the already hard decision an athletic trainer has to make about an athlete's medical status. Because of an athletic trainer’s background and organized manner, they are able to manage their time wisely and handle the difficult situations along with the stress associated with them.
Need for Athletic Trainers
Although many high school athletic directors feel that it is important for their schools to have athletic trainers, it is sometime difficult to fit into the budget or convince school administrators of the school's/athletes' needs. When a cost to safety comparison is done in the long run it will be seen that having an athletic trainer present at practices and sporting events will provide a more cost effective solution for a school as opposed to the alternatives. An athletic trainer needs to work with the athletic director because they are a team and the first line of risk management for the student athletes. Working together, the two can determine areas of risk within emergency policies at the school and find areas of improvement for an overall goal of student athlete safety and championship level competition.
What ATC’s provide to Athletes
Athletic Trainers are in high schools and are there to attend to student athletes at the time of injury. They educate the students on their injury and what proper immediate care of their injury includes. If necessary, an Athletic Trainer can apply tape or a protective brace for an injury and advise athletes on assistive devices such as crutches.
Athletic trainers also attend sporting events and are the first to arrive at the scene of an injury. They are able to assess and triage the injury to the proper medical professional and will later collaborate in the athlete's care with the other health care practitioner. Athletic trainers can be the quick link to other medical professionals for their athletes because they are many times working under the supervision of physicians.
For many athletic trainers during the school year, being responsible for the care of athletes is their full time job. They schedule their office hours and practice coverage hours around what is going on at the high school and many times travel to away games when their schedule permits. Also during the school years many times you will find an athletic trainer teaching students in the classroom or out of their athletic training room or even on the field.
How parents, athletes and coaches can help
Everyone involved in high school athletics can be an advocate for bringing and keeping an athletic trainer at their school. Education on who and what an ATC can do for a school is important for all parties involved in high school athletics. It is important for everyone to know that athletic trainers are part of the team and are trying to get everyone back into the game.
For more information log into;
www.nata.org
http://www.bocatc.org