JAMMED FINGER- SEE A DOCTOR OR NOT?

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A jammed finger occurs with direct impact to the tip of a finger and is generally a mild sprain that resolves in a few days
  • Some finger injuries can be more serious and require urgent evaluation. Examples would include complete tendon tears, joint dislocation, or broken bone.
  • Use The SAFE Method™ (Story, Appearance, Feel, Effort) to rapidly evaluate an injured finger

Catching or getting hit by a ball on the tip of a finger- a football, volleyball, or basketball- is generalyouthbasketball a common way kids and young adults can injure a finger. Fortunately, most finger injuries are reasonably mild and will allow for a quick return to sport. A “jammed finger” is a sprain of the soft tissue structures surrounding a joint. But sometimes a tendon (a structure that links muscle to bone, and cause fingers to move) can be torn, or a joint can be dislocated, or one of the bones broken.

There are some simple steps you can take to rapidly evaluate an injury and make a reasonable determination about whether it’s safe to continue play, or perhaps whether you should seek urgent physician evaluation. At Sideline Sports Doc, we use a simple evaluation for sports injuries that we call The SAFE Method™. The SAFE Method™ is an acronym for Story, Appearance, Feel, and Effort. You use these four points to evaluate pretty much any sports injury. Here’s how you use it for a jammed finger.

Story

Basically this means “how did it get hurt”. Most of the time there will be direct contact to the tip of the finger, that’s pretty obvious. But here you want to be on the lookout for things such as very severe pain, whether you may have heard a pop, or whether you may have felt something crack. Those are all “red flags” indicating that you might have a significant injury. If you have any of those red flags I’d recommend evaluation in an urgent care facility. And if you don’t have any red flags, move on to…

Appearance

What does it look like? In most typical jammed fingers your finger should look pretty normal in the first several minutes after the injury, this is common with a simple jammed finger. (It may get swollen an hour or two later…) But what if it is rapidly becoming swollen, or if it’s bent at an unusual angle, or if the joint is obviously out of position? If any of those things are what you’re seeing then go to an emergency room for proper treatment. Does it look normal? That’s good, so move on next to Feel.

Feel

In “feel” you want to press lightly on the injured joint. Generally this will produce mild soreness with a common jammed finger. But if your light touch feels really painful that’s a red flag indicating the need for urgent evaluation. Significant pain with light touch is often present with broken bones. Are you still doing ok? Then move on to the last evaluation step, Effort.

Effort

In this last step you want to make an effort at moving the injured area on your own. For hand injuries this is done by making a fist and opening the fingers out straight. If you’re able to do this fairly easily, that’s good and generally goes along with a jammed finger. But what if you can’t make a fist, can’t open the fingers, or if the joint just won’t move? That could mean a torn tendon, or possibly another significant injury. Get yourself to an urgent care facility.

So if you pass each of the four steps without any red flags or areas of concern youSideLineSportsDoc probably have a sprain or a jammed finger. Get home and apply RICE (rest, ice, compression, elevation) and monitor your progress each day. But if things don’t start turning back to normal in the next few days, or if you have concerns that it isn’t healing as you’d expect then it’s always safe to seek proper physician evaluation.

INJURY PREVENTION WARMUP PROGRAMS WORK- USE ONE!

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Warmup based injury prevention programs such as the FIFA 11+ and others show a dramatic reduction in injury rates for young athletes
  • The results are so impressive that I believe all youth sport organizations should recommend one of these warmup based injury prevention programs for their young athletes

I’m a big believer in using warmup based training programs as part of the overall effort to soccer training closeupreduce the numbers of injuries in athletes. I’ve previously written about the FIFA 11+ and we include videos with support from Dr. Bert Mandelbaum in our Sideline Sports Doc injury recognition course for coaches. The early evidence about the FIFA 11+ showed dramatic reductions in many types of lower extremity injuries in soccer with no downside.

Over time additional positive evidence has surfaced. In Europe, the FIFA 11+ has been used in sports outside soccer such as basketball, and some new training methods have also been developed. A study published in September 2016 in the American Journal of Sports Medicine came to one solid conclusion: these training methods are effective in reducing injury rates for adolescent athletes in a variety of sports, and teams would be wise to implement one of these.

The study is a “meta analysis”, where results from several studies are pooled and statistically analyzed for quality and strength of the evidence. Ten independently produced studies were analyzed. The pooled results demonstrated a significant injury rate reduction with the use of injury prevention programs versus control interventions overall. Interestingly, basketball/handball experienced a greater injury rate reduction with injury prevention programs than in soccer. Non-FIFA11+ programs experienced a larger injury reduction rate than FIFA11+ programs. But results for all the programs were impressive.

Here are some of the key findings:

  • Five of the included studies used the FIFA11+ injury prevention program, while the remaining five studies investigated generic programs with warm-up, stretching, strengthening, and balance board exercises.
  • Injury prevention programs were associated with a statistically significant 40% reduction in injury rate over a total of 756,461 training and match exposure hours when compared to control groups
  • Handball/basketball experienced a 51% reduction in injury rate with injury prevention programs versus control while a 30% reduction was observed in soccer
  • Non-FIFA11+ programs were associated with a 48% reduction in injury rate compared to control while FIFA11+ programs demonstrated a 32% reduction in injury rate

The results of this study suggest that the consistent use of injury prevention programs can help to reduce the risk of injury in adolescents competing in team sports. Further research is necessary to dig deeper into the possible differences of the training programs by sport, but overall I would have to say that all of the programs showed large reductions in injury rates. The improvements are so large with essentially no downside that I think every youth sport organization should be recommending one of these for their members.

Search your local sport organization or children’s hospital for programs you can use; there are quite a few in the U.S., Canada, and Europe. If you live in the New York City area I like the Hospital For Special Surgery’s Sports Safety Program, and the downloadable FIFA 11+ can be found here.

Bottom line: injury prevention programs are effective in reducing injury rates for adolescent athletes. Find one and use one.

WHAT IF YOU COULD REGROW A TORN ACL?

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A new technique pioneered by Boston orthopedic surgeon Dr. Martha Murray carries the promise of harnessing the body’s ability to heal a torn ACL through a minimally invasive approach
  • The technique is in the earliest phases of clinical testing, several more years will be required to prove the result
  • If successful, this technique could revolutionize the way we treat the torn ACL

By now most everyone involved in sports has heard about the dreaded ACL tear. The ACL ACL repair Murrayis a key stabilizing ligament in the knee, especially responsible for stability of the knee with forceful rotational movements. If your ACL is torn you’ll have an exceptionally difficult time returning to any sport requiring those types of forceful rotational movements, unless you have surgery to replace your torn ACL with a new one. We call this “ACL reconstruction”, meaning that we use another piece of tissue to create a new ACL.

The reconstruction works very well with generally excellent results. But there are downsides, such as the need to take a piece of tissue from somewhere in the body where it’s serving a perfectly useful purpose and putting it inside the knee. The recovery is long. For young athletes with open growth plates there’s a risk of growth disturbance.

What if the torn ACL could be repaired rather than replaced? For example, if you get a cut in the skin you can get stitches and eventually the cut skin is healed and turned into normal skin. Well the reality of the torn ACL is that the healing response and the environment on the inside of the knee are radically different than the surface of the skin. There have been many attempts at ACL repair over the course of the last several decades of orthopedic history, with generally very poor results.

But that may be about to change. At Boston Children’s Hospital, orthopedic surgeon Dr. Martha Murray has devoted much of her professional life to methods to repair rather than replace a torn ACL. She’s now completed an early trial of her method to use an absorbable scaffold infiltrated with elements from the patient’s own blood stream to regenerate a torn ACL.

Read about the trial and future plans in this article from the Boston Globe. And watch this brief excellent video about the Bridge Enhanced ACL Repair here.

This is potentially revolutionary stuff but we need a healthy dose of caution here because the research is in the very early phases. The early clinical trial was mainly focused on safety of the procedure with a very small number of patients (ten only). The next phase will start looking at a larger number of patients, about a hundred, and will require a few years of followup.

Aside from eliminating the need for a “graft” for the ACL reconstruction, a repair of a torn ACL has many other possible benefits. No need for the surgeon to drill tunnels through the bone, no risk to growth plates of growing youngsters, and possibly a faster return to sports.

There’s much yet to be proven but I have a hunch Dr. Murray and her colleagues are on to something big. We’ll keep a close eye on the results with great hope.

Boston Children’s Hospital ACL Repair Program

ANKLE SPRAIN: WHEN CAN I PLAY AGAIN

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Recovery and return to play after ankle sprains will vary depending on the severity of the injury, and the injured athlete’s unique healing response
  • Sport specific reconditioning after an ankle sprain often takes much longer than you think
  • For the common Grade 1 sprain, I typically see return to play with a brace at 1-2 weeks after injury
  • For the common Grade 2 sprain, I typically see return to play with a brace at 4-5 weeks after injury

There’s never a good time to be injured. As we come up to the end of many winter sports, SwollenAnkle_2players often have their eyes on championships or important tournaments. When an injury happens one of the most important questions the young athlete wants to know is “when can I play again?” Usually their point of reference is the newsfeed on some professional athlete’s injury, and the answer from the news media is almost always “2-3 weeks.” The reality, however, is that full recovery as I outline below can often take much longer than that. Let me outline the general phases for injury recovery, and finish with some rough timelines for return to play after ankle sprains.

Treating the Injury

The treatment phase involves the healing of the injured part. For an ankle sprain, this may involve a brace, sometimes crutches, and typically “RICE”: rest, ice, compression, and elevation. Ankle sprains are classified by physicians in “grades”, ranging from Grade 1 (mild) to Grade 3 (severe, with complete ligament tear).

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins. This will often involve referral to a qualified physical therapist or working with your athletic trainer. The physical therapist and athletic trainer are highly trained in techniques to restore function of the injured ankle, develop a plan for sport-specific training, or suggest equipment modification such as bracing. For many injuries we’ve learned over the years that early involvement by an athletic trainer or physical therapist speeds up return to play.

Conditioning the Injured Athlete for Return to Play

Here’s the part that can take some time, often much longer than you initially realize. Let’s say you’ve had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks. Now we’re up to 4-8 weeks from the time of your injury, and you know what you haven’t been doing- practicing or playing sports. Getting yourself fit will take a few more weeks (or even months, if you’ve been out a long time). In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.

Putting it All Together- How Long Until You Can Play Again?

ssd.bannerI’ve broken the process into “phases” above, but the reality is that there’s a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Additionally, each person responds differently to injury and healing. So each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on real world experience from my orthopedic practice.

  • “Mild” or Grade 1 ankle sprain: Brace or Ace wrap for 3-5 days, Return to play with ankle brace 1-2 weeks
  • “Moderate” or Grade 2 ankle sprain: Brace 2 weeks, Rehab and conditioning 2 weeks, Full return to training 4-5 weeks after injury
  • “Severe” or Grade 3 ankle sprain: Boot or brace 3 weeks, Rehab and conditioning 4-6 weeks, Full return to training 7-9 weeks after injury
  • “High Ankle” or syndesmosis sprain (highly variable return times): Boot or cast 3 weeks, possibly crutches as well, Rehab and conditioning 6-12 weeks, Full return to training 9-15 weeks after injury