Upper body strength and endurance conditioning programs help reduce tennis-related orthopaedic injuries

ROSEMONT, Ill.—An estimated 11 million Americans play tennis each year. In tennis, as in many sports, the repetitive motions and large loads of force on the shoulder and elbow joints of tennis players can greatly increase risk for injury. Sudden stops and shifts in motion also can lead to lower extremity injuries. A literature review published in the March issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) discusses ways to help recreational and professional tennis players minimize injury risks.

“Acute [sudden, sharp onset] injuries occur more frequently and often affect the lower extremity. Chronic injuries also occur, but these tend to commonly affect the upper extremity,” says orthopaedic surgeon Joshua S. Dines, MD, lead study author.

Recreational Player Injuries

Tennis elbow likely affects recreational players more than it does professionals. Recreational players tend to hit their backhand strokes with their wrists in a more flexed position—bending the palm down towards the wrist. The flexed position causes repetitive microtrauma to forearm muscles and tendons that normally help stabilize the wrist when the elbow is straight. Weakened from overuse, these muscles can develop microscopic tendon tears, inflammation and pain, often seen in tennis elbow. Professional players tend to increase wrist extension—raising the back of the hand—just before ball contact. Treatment of most tennis elbow cases includes rest and physical therapy including stretching. Corticosteroid injections, when indicated, can greatly reduce inflammation after an injury. When nonsurgical treatment fails, surgery can be successful in most cases to remove tissue or repair affected tendons.

Professional Player Injuries Professional tennis players tend to injure the inner side of the elbow due to excessive wrist snap on serve and forehand strokes, open-stance hitting, and short-arming strokes. Symptoms may include excessive tenderness and pain and/or weakness while extending the wrist, raising the back of the hand, against resistance. “Tennis-specific preventive programs can address the muscular imbalances identified in musculoskeletal profiling studies from elite players and may help to reduce the incidence of injuries that these athletes experience,” says Dr. Dines. These exercises include squats, which strengthen the legs to enable them to generate power and absorb loads better; trunk rotations; and stabilization exercises for the shoulders and wrists.

• Hit the ball at the center of the three racquet “sweet spots” to minimize loads on wrist and arm: these will reduce the vibrations that occur.
• Reduced grip forces decrease the vibration load on the arm and help minimize the chances that tennis elbow will develop.
• A multidisciplinary approach using bracing along with proprioceptive training and muscle recruitment evaluation can be an effective program to prevent ankle sprains for tennis players.

Quoted from aaos.org

ROSEMONT, Ill.—Hand injuries are frequently caused by human and animal bites, prompting as many as 330,000 emergency department visits in the United States each year. A literature review appearing in the January issue of theJournal of the American Academy of Orthopaedic Surgeons (JAAOS) outlines the potential complications of human and animal bites to the hand, the importance of early injury assessment, and the use of antibiotic and other treatment methods to avoid infection, permanent disability, and amputation.

“Although many people may be reluctant to immediately go to a doctor, all bites to the hand should receive medical care,” said orthopaedic surgeon and lead study author Stephen A. Kennedy, MD. “And while routine antibiotics are not necessarily recommended for other bite wounds, they are recommended for a bite to the hand to reduce the risk of infection and disability.”

Human bites to the hand—while accounting for only two to three percent of all hand bite injuries—can occur during altercations and include wounds caused by punching type contact with the mouth or teeth, domestic abuse, or accidentally during sports, play, or other activities. Human bites to the fingers and hand that penetrate through the skin can transmit infection through oral flora, or saliva, which contains more than 600 bacterial species.

Animals also have saliva containing a broad range of bacteria. Adult dog jaws, especially among larger breeds, are capable of exerting a bite force of more than 300 pounds, and when combined with the variety and sharpness of their teeth—designed to clamp, hold, tear, and crush food—can cause significant injuries to hand and finger ligaments, tendons, and bones. Cats do not have the jaw strength of dogs; however, their sharp, narrow teeth also can cause serious injury. An estimated 30 percent to 50 percent of cat bites are complicated by infections, which can occur as early as three hours after injury in approximately 50 percent of the infection cases. Infections due to dog bites typically occur at less than half the rate of cat bites.

By the numbers:

• More than half of all Americans will sustain an animal bite in their lifetimes.
• Bites from domestic animals (primarily dogs) account for more than 90 percent of bites. In the United States, approximately 4.5 million people are bitten by dogs each year.
• The annual health care costs associated with cat and dog bites are estimated at more than $850 million.

If a hand-to-mouth injury or bite occurs:

• Inspect the hand carefully for any puncture wounds. Even a small wound can inject virulent bacteria under the skin.
• If there is a puncture wound of any size, wash as soon as possible with soap and water then seek medical advice.
• If you see redness, feel increasing pain over time or see red streaking up the hand or arm (or along a tendon), these are signs of a significant infection and immediate medical attention is needed.

Prompt treatment, ideally within 24 hours of an animal or human bite, can prevent serious injury or infection:

• Symptoms of infection include erythema (redness), edema (swelling), progressive pain, and fever.
• The patient’s medical, immunization, and recent antibiotic history, as well as the timing and location of injury, should be considered when determining treatment. Patients who have prosthetic joints are at risk of an infection “seeding,” or anchoring, at the site of the metal, ceramic, or plastic device.
• The size and depth of the wound and the amount of devitalized (dead) tissue should be assessed along with potential damage to neurovascular structures and tendons, underlying fractures, the presence of exposed bone and/or infection, and the integrity of the joint.
• All patients with hand bites should receive antibiotic treatment, which can lower the infection rate from an average of 28 percent to 2 percent.
• Open wounds may need to be surgically irrigated and débrided (cleaned, including removal of unhealthy or dead tissue).

Quoted from www.aaos.org

ROSEMONT, Ill. – When it comes to snow removal, shovels aren’t the only things you need this winter. Be prepared with safety tips to help you avoid back strains and other common injuries.

According to the U.S. Consumer Product Safety Commission in 2013:

• More than 119,000 people were treated in hospital emergency rooms, doctors’ offices,
  clinics and other medical settings for injuries sustained while using manual snow removal tools.
• Nearly 20,000 people were injured using snow throwers or blowers.

EXPERT ADVICE
“Because of the freezing weather, people tend to rush through the snow removal process and not focus on the task at hand,” said orthopaedic trauma surgeon and AAOS spokesperson
Lisa Cannada, MD. “This can lead to preventable injuries. Always dress warm before heading outdoors, practice safe lifting techniques and follow the warning rules on snow removal tools.”

The AAOS recommends the following safety tips for snow removal:

Shoveling:

• Push the snow instead of lifting it. If you must lift, take small amounts of snow, and lift
  it with your legs: squat with your legs apart, knees bent and back straight. Lift by
  straightening your legs, without bending at the waist.
• Do not throw the snow over your shoulder or to the side. This requires a twisting motion that puts stress on your back. Instead, walk to where you want to dump the snow.
• Clear snow early and often. Begin when a light covering of snow is on the ground to
  avoid having to clear packed, heavy snow.
• Pace yourself. Take frequent breaks and replenish with fluids to prevent dehydration. If you experience chest pain, shortness of breath or other signs of a heart attack, seek immediate emergency care.

Snow blowing:

• Follow instructions. Prior to operating a snow blower, read the instruction manual for specific safety hazards, unfamiliar features, or for repair and maintenance.
• Never stick your hands or feet in the snow blower. If snow becomes impacted, stop
  the engine and wait at least five seconds. Consider unplugging the snow blower. Use a solid object to clear wet snow or debris from the chute. Beware of the recoil of the motor and blades after the machine has been turned off.
• Do not leave the snow blower unattended when it is running. Shut off the engine if you must walk away from the machine.
• Watch the snow blower cord. If you are operating an electric snow blower, be aware of where the power cord is at all times so you do not trip and fall.

Quoted from www.aaos.org

ROSEMONT, Ill.—Prompt and appropriate treatment of a dislocated shoulder—when the head of the upper arm bone (humerus) is completely knocked out of the shoulder socket (glenoid)—can minimize risk for future dislocations as well as the effects of related bone, muscle and nerve injuries, according to a literature review appearing in the December issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

The shoulder has the greatest range of motion of any joint in the human body and is the most common site for a full or partial dislocation. Shoulder dislocations are classified as “traumatic” or “atraumatic.” Up to 96 percent of dislocations are traumatic, occurring most often during contact sports or when someone falls onto an outstretched hand. Atraumatic dislocations—when the shoulder starts to slip part way out without trauma—can cause limited shoulder movement in multiple directions.

In 2011, shoulder dislocations accounted for 175,641 emergency department visits in the U.S., although some patients choose to reset the joint without any medical assistance.

“We do not recommend self-setting of shoulder dislocations,” says Richelle Takemoto, MD, an orthopaedic surgeon with Kauai Medical Clinic/Wilcox Memorial Hospital. Dr. Takemoto and her co-authors recommend immediate medical attention for a dislocated shoulder that includes radiographic images before and after reduction (resetting of the shoulder) to check for related fractures and other musculoskeletal injuries.

The cause of injury, the presence of an associated fracture and/or nerve injury, and the difficulty in resetting the shoulder all contribute to a patient’s outcome.

“Acute shoulder dislocations can be effectively managed by closed reduction maneuvers,” says lead study author Thomas Youm, MD, clinical assistant professor, New York University Hospital for Joint Diseases. “There are a plethora of closed reduction techniques available for relocation of a dislocated shoulder. A thorough understanding of these reduction techniques as well as immobilization strategy and rehabilitation regimens can successfully treat dislocations of the shoulder and hopefully prevent the need for surgery.”

If you have dislocated your shoulder

• Promptly seek orthopaedic care—at latest, within one week from injury—to ensure the best diagnosis and treatment.
• Monitor for possible nerve damage pre- and post-reduction surgery.
• Once the ligaments have healed, appropriate counseling is needed to rehabilitate the injury and to prevent frozen shoulder. Among seniors, persistent weakness in the shoulder should be checked for a possible rotator cuff tear(s).

By the numbers

• Forty percent of shoulder dislocation patients have an associated structural (ligament or muscle) injury.
• One of three shoulder dislocation patients also has a rotator cuff tear.
• Males ages 10 to 20 have the highest rate of shoulder dislocation.
• Recurrent dislocations are most likely to occur within two years after an initial dislocation, most often in patients younger than 20.
• Six of 10 younger patients developed instability over two years and seven of 10 over five years following a dislocated shoulder.
• Men are more likely to have recurrent instability following a shoulder dislocation than women.

Quoted from aaos.org