Upper Limb Winter Sports Injuries
Introduction[edit | edit source]
There are various winter sports injuries seen in the upper limb such as Skier's thumb, Stener lesion, Wrist injuries like Distal radius fracture, Scaphoid fracture, Scapholunate ligament injury, Shoulder injuries like Rotator cuff tear, Anterior dislocation of the shoulder, AC joint injuries and Clavicle fractures.Snowboarders present upper limb injuries more frequently.
Skier's Thumb[edit | edit source]
The mechanism of injury in skier's thumb is forced abduction and extension at the first Metacarpophalangeal joint (MCP) joint(outstretched hand) when a fall occurs with a ski pole in hand. There is an injury to the ulnar collateral ligament of the thumb. The diagnosis is made clinically and it is usually treated by conservative management.
Clinical features are pain in normal activities such as buttoning, rapid swelling.
On palpation, tenderness and pain are noted on the ulnar side of the thumb. If a firm lump is felt, it indicates a retracted tendon, and the diagnosis of stener lesion is to be considered.
Special Test[edit | edit source]
Stress Test[edit | edit source]
Valgus force is applied with the thumb in 30 degrees of flexion. If the laxity is more than 30 degrees, as compared to the other thumb, the involvement of the ulnar collateral ligament(UCL) is likely.
In an uncomplicated tear of the Ulnar collateral ligament, the splint is applied for 3 weeks to protect it from valgus stress. After that, physiotherapy treatment can be started and the splint is worn during the day for 3 more weeks. Heavy gripping or grasping should be avoided until original grip strength is restored.
Prevention Strategies[edit | edit source]
As mentioned above, the mechanism of injury is falling on the outstretched hand while holding the pole in the palm. This forces the thumb into radial deviation, injuring the Ulnar collateral ligament.
Hence the Skiers are instructed to leave the pole while falling so that they land on an empty palm which won't create any stress on Ulnar collateral ligament.
Correct pole holding technique has to be incorporated in order to prevent this injury.
Ski poles without wrist restraints are encouraged. Using poles with wrist strap release should also be considered.
Wrist Injuries[edit | edit source]
The wrist joint is commonly injured amongst snowboarders. The mechanism of injury is falling on the outstretched hand with the wrist in hyperextension. The injuries are fractures of the distal radius, scaphoid, or sprain of the scapholunate ligament.
Distal Radius Fracture[edit | edit source]
Distal radius fracture accounts for 10% of all snowboarding injuries which is quite high as compared to skiing injuries. Usually, the athletes undergo high energy impact, especially during the aerial maneuver.
The clinical features are usually pain, swelling, and a palpable step-off. The classic deformity seen is the 'dinner fork deformity.'
Undisplaced or minimally displaced fractures are managed conservatively by cast immobilisation of around 4 to 6 weeks.
Once the immobilization phase is completed, the cast is removed and physiotherapy management is started focusing on regaining the strength and range of motion.
If the fracture is displaced, a surgical procedure is required.
Scaphoid Fracture[edit | edit source]
The scaphoid bone is a poorly vascularized structure hence if the diagnosis is missed, it can lead to avascular necrosis.
There is tenderness on the anatomical snuff box is a typical feature of scaphoid fracture.
Usually, a plain radiograph is necessary for confirming the diagnosis.
Such fractures are immobilised in a cast for 12 weeks followed by physiotherapy treatment.
The immobilisation phase is usually large, due to which physiotherapy treatment helps to regain the functional level of the patient.
Scapholunate Ligament Injury[edit | edit source]
A Scapholunate ligament is the most common ligament to be injured in the wrist.
The mechanism of injury is a fall on an outstretched hand with the wrist in extension. There occurs a shift of carpal bones in the dorsal direction due to disruption of the supporting ligaments.
Clinical presentation is swelling, pain over scaphoid, and lunate.
Most of the ligamentous injuries are managed by immobilisation.
If conservative management fails, arthroscopy is considered by the doctor.
Shoulder Injuries[edit | edit source]
Anterior Shoulder Dislocation[edit | edit source]
An anterior shoulder dislocation is the second most commonly occurring injury during skiing. The mechanism of injury is a direct blow or forceful external rotation/ abduction of the shoulder.
Clinical features are anterior or posterior shoulder pain, loss of deltoid contour, increased prominence of the Acromion process. The patient holds the limb in abduction and internal rotation.
Radiographs are taken in 3 planes to confirm the diagnosis. MRI is done to detect rotator cuff /articular cartilage involvement
Early reduction is essential to reduce pain and other complications. During and after the reduction, it is important to check the neurovascular status in order to rule out axillary nerve injury.
Clavicular Fracture[edit | edit source]
A clavicular fracture is common in snowboarders and skiing due to direct blows or falls on the lateral part of the shoulder.
During the physical examination, it is important to rule out neurovascular damage, scapula/rib fractures or any intrathoracic injury.
Radiographs of anteroposterior direction in 2 planes. are used to make confirmed diagnoses.
It is usually managed conservatively and surgical intervention is rarely necessary.
Physiotherapy management is followed to restore the range of motion and functional activities.
Acromioclavicular Joint Injuries[edit | edit source]
Acromioclavicular joint injuries can result from the impaction of the humeral head on the acromion process. Other mechanisms are similar to those of clavicular fractures. Acromioclavicular joint injuries can be classified into 6 types. Type one is categorized as pain and type 6 is the complete dislocation of the joint.
On examination, there is tenderness over the superior aspect of the shoulder. A crossbody adduction test is done to detect joint injuries.
Usually, less complicated injuries are managed by immobilisation of one week.
Physiotherapy rehabilitation is followed for complete recovery.
Crossbody adduction test
The arm is held in elevation, internal rotation, and elbow flexion (90 degrees), and the hand is rested on the opposite shoulder.
The examiner provides overpressure in the position of cross adduction, pain on the Acromioclavicular(AC) joint indicates a positive test.
Rotator Cuff Tear[edit | edit source]
The typical presentation of Rotator cuff tear is pain and weakness over the lateral deltoid. Pain aggravates during overhead movements and there is the presence of night pain.
On examination the drop arm test is positive, weakness in the external rotation is evident, and active painful arc test is also positive.
Plain radiographs are prescribed to rule out fractures /dislocations/avulsions.
Full-thickness tears are managed surgically and partial-thickness tears are managed by medications and physiotherapy.
References[edit | edit source]
- Raiman L, Antbring R, Pyne D. Winter sports injuries of the upper limb. InnovAiT. 2020 Jan;13(1):7-12.
- Zacharopoulos AN, Tzanakakis NE, Douka MI. Skiing and snowboarding injuries in Greece: a two-year case-control study. Journal of ASTM International. 2008 Jun 19;5(6):1-8.
- Weber CD, Horst K, Lefering R, Hofman M, Dienstknecht T, Pape HC. Major trauma in winter sports: an international trauma database analysis. European journal of trauma and emergency surgery. 2016 Dec;42(6):741-7.
- Koehle MS, Lloyd-Smith R, Taunton JE. Alpine ski injuries and their prevention. Sports Medicine. 2002 Oct;32(12):785-93.