The Future of Football Head Protection and Equipment Technologies

Dr. Brian Cole and Steve Kashul talk with Thad Ide, Senior VP of Research and Product Development for Riddell, about recent innovations in the future of football head protection and equipment technologies.

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An Inside Look Into Flexor Tendon Injuries

By: Brian Rog and Julianne Lessard, OTR/L,CHT for ATI Physical Therapy

An Inside Look Into Flexor Tendon Injuries

Our hands and fingers are among the most important assets to our body, so an injury, specifically to the hand’s control center, the flexor tendon, can open the door to a lengthy and exhausting road to recovery. If you are not familiar with the flexor tendon system, it consists of strong cords of tissue that connect the muscles of the forearm, through the wrist, and across the palm to the tips of the fingers and thumb. All four fingers connect to one primary muscle, which is responsible for controlling the middle knuckles and another muscle that controls the fingertips.

Flexor tendons are essential in enabling movement in the fingers and allow us to engage in simple activities like writing, holding a coffee cup, holding hands and zipping a coat. Unfortunately, this often overlooked muscle group can be damaged in an instant, so it’s important not to discount its value and susceptability to injury.

Injuries to the flexor tendons can happen so quickly that the individual affected by it does not have time to comprehend the severity of the damage. It’s important to know that almost any injury to the palm-side of the hand will involve the flexors.

When an injury does occur, more often than not, the cause of the injury is traumatic and can be be caused by something as simple as a laceration from the tip of a knife while cutting a vegetable, or a bit more harrowing such as a major contact injury from a table saw.

There are also closed inuries such as jersey finger that can result when a player grabs another player’s jersey as they pull away. The affected area mostly involves the tip of the finger, which is prone to avulsions and laceration injuries to the tendons.

Another common closed injury involving the covering of the tendons called sheaths can also occur. These are caused by overuse or strain and are usually categorized as tendonitis. Symptoms here are more subtle with a deep ache and sometimes a triggered or locked finger. Hand Therapy and an orthosis or brace can often help reduce swelling, however, in some cases, an injection or surgery is needed.

The good news in all of this is that treatment for a hand injury can be effective, but here’s the caveat, as we mentioned, it’s a tiring process, which will most likely require a surgical procedure, followed by a recovery period that can extend for several months and on. So do yourself a favor and keep your hands out of harms way – we know, it’s easier said than done.

There’s no denying that minor accidents will occur from time to time, so the more you know, the better you can prepare. If you have sustained an injury to your hand and are unsure of the steps needed to get back to life before the injury, stopy by your nearest ATI Physical Therapy clinic and ask our team for a complimentary injury screening. Our team will assess your injury, provide next step suggestions in care and get you on your way!

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Matthew’s Story

Matthew Lee, 22, of Oak Park, discovered his passion for playing lacrosse at a youngmatthew lee age. Although he also excelled in baseball and tennis, it was the ‘brotherhood’ of lacrosse that drew him into the sport.  Playing lacrosse gave him a supportive foundation throughout his years at Oak Park River Forest High School and when it was time to make college decisions, his love of lacrosse played a big part. He enrolled at Beloit College in Beloit, WI and joined its NCAA Division III lacrosse team.

College life and lacrosse were going very well for Matthew until his spring break trip to Washington, DC his sophomore year. This was a special time during which the team had an opportunity to scrimmage against the U.S. Naval Academy. While attempting a shot on goal, Matthew fell on his hand and wrist. He immediately felt a ‘pop’ followed by intense pain and swelling. To his disappointment, the team’s trainer had to sideline him for the rest of the trip.

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After returning to Wisconsin, he was evaluated at a local hospital where he was diagnosed with a fracture to the scaphoid bone, one of several small bones in the wrist. He was casted for six months and then underwent occupational therapy. It was tough time, but he looked forward to returning to lacrosse.

A Second Opinion

Unfortunately, after the cast was removed, he still felt pain and an unusual grinding sensation in his wrist. Matthew felt something was still wrong and his mother insisted they get a second opinion. After researching several specialists, they chose Dr. John Fernandez, a hand, wrist, and elbow specialist at Midwest Orthopaedics at Rush. They liked Dr. Fernandez’s reputation for treating high level athletes and for performing particularly challenging cases.  Coincidentally, Dr. Fernandez also has three sons who play lacrosse and is a big fan of the sport himself. He immediately connected with Matthew and understood his frustration.

Dr. Fernandez carefully assessed Matthew’s wrist.  He used simple measures like examining the normal side which no one had done previously.  He also used high-tech techniques including examining his wrist under a live video xray to see what the wrist was doing in real time and under stress. This led to the discovery that Matthew hadn’t suffered a wrist fracture at all.  Instead, he had torn a very important ligament in the wrist.

This ligament is a crucial connection between the carpal bones in the wrist. Without it healing, Matthew would likely have continued problems, including long term arthritis and disability.  This would make it hard for him to use his hand for simple tasks, much less playing lacrosse. He explained that Matthew needed surgery to repair the torn ligament and restore function. This was devastating news because it meant more time away from lacrosse.


“Even though it was tough to hear that the casting period was a waste of time, Dr. Fernandez and his amazing physician assistants were so helpful throughout the whole process.”


Dr. Fernandez recommended a technically demanding and unusual surgery to reconstruct the scapholunate ligament of the wrist. This required transplanting one of Matthew’s tendons to replace the ligament he had lost.  Stainless steel pins would be used across the bones to maintain alignment during the recovery process. This cutting-edge technique was designed for higher demand individuals with and a better success rate.

Complicating matters further, before his surgery Matthew fell and injured his other wrist. This time he truly did fracture his scaphoid bone.  But, instead of casting it, Dr. Fernandez suggested a method of repairing the bone internally with a screw. This would then act as an internal cast and decrease healing time.

Now, the stakes were higher. Matthew required a staged surgical approach so that he could use one of wrists during the healing process, but not compromise the outcome. Several surgeries and nine months of recovery were needed to make this work.  Dr. Fernandez and Matthew confidently agreed to take this plan head on. As hoped, the surgeries were successful and Matthew’s recovery was smooth.  Finally, eighteen months after his initial injury, Matthew was functioning well and pain free. He finally scored his ‘goal’ — with Dr. Fernandez making the assist.

Back on the Field

Dr. John Fernandez

Dr. John Fernandez

After a long time away from lacrosse, Matthew was able to join his teammates back on the field during his senior year. “I was able to score over 25 points this season and could not be more thankful to Dr. Fernandez, his PAs, and MOR for making my senior year a great one to remember,” he says.

During this process, Matthew received a unique look into the practice of orthopedics and expressed an interest in a career as a physician assistant. Dr. Fernandez admits that he has seen this happen before and encouraged Matthew to follow his passion. He hopes that one day Matthew will be able to pay it forward by performing a surgical assist of his own to help someone else score their goals.


To schedule an appointment with Dr. John Fernandez, call 877-MD-BONES.

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Preventing Cycling Arm and Hand Injuries

By Janet Apgar, OTR/L, CHT, ASTYM-cert for Athletico Physical Therapy

preventing cycling arm and hand injuries

As spring brings warmer weather and adds daylight hours, biking fever spreads!

Although biking is fun and can be good for your health, cyclists should still keep a few things about their bodies in mind before hitting those trails to prevent injury. Given its whole body involvement, cycling can involve a few injuries including ones to the upper body. In fact, one survey found that approximately 31 percent of cyclists reported overuse hand problems. So, whether your biking dreams entail off-road adventures or long-distance road cycling, it is important to take precautions to protect your arms and hands from injury, which can arise from one or more of these three causes: improper positioning, sustained positioning or trauma from a fall or collision.

Improper Positioning

Even after buying the correct sized bike and having the seat aligned, a misfit between the cyclist and the bike can occur affecting not only the spine and legs, but also the arms. Symptoms that may signal poor positioning can include numbness and tingling in the ring and small fingers, numbness and tingling in the thumb, index, and middle fingers, clumsiness with tasks involving hand coordination and pain in the arms, wrist, hands and back.

Some common positioning mistakes that can lead to numbness, tingling and wrist and thumb/hand pain include hands being positioned wider than shoulder-width apart and the wrists being angled too far back, forward or inward. These can be addressed by changing handle bars from straight to angled or using aero bars. Wearing padded gloves can also absorb the shock and vibration of the ride as well as allow for a looser grip.

Pain in the back and hands can stem from riding with rounded back and shoulders or with elbows locked in extension and can involve handle bars that are too low or too high in relation to the seat or tight hamstrings.

What is the right position then? The ideal riding position involves a neutral back, slight elbow bend, hands shoulder width apart and wrists in mid-position. Changes in handle bar height and angle (as mentioned above) as well as addition of ergonomic grips, added bar ends, adjustable height or adjustable angle handle bars can all assist to achieve the correct positioning.

If the above necessary positioning modifications are made and the affected body part is rested early enough, the symptoms should resolve within a couple of days. However, if symptoms involve coordination problems with the fingers or have been longstanding, it may take weeks to months to recover and may possibly require seeing a physician that is a hand specialist and/or an Occupational Therapist.

Sustained Positioning

Even with the best bike fit, sustained positioning while riding has the inherent risk of continuous pressure and requires constant shock absorption on the part of vital structures including: blood vessels, nerves, joints and muscles. This can lead to tissue breakdown and inflammation.

This can be especially prevalent with road bikes as their speed and aerodynamics require the trunk to be angled 60-75 degrees forward toward the bars (i.e., the cyclist is not as upright as the off road mountain biker or hybrid biker). This position requires strong overall core and upper body conditioning to go faster and/or longer distances. Addressing these areas as part of an overall fitness regimen can help prevent issues while riding.

Another way to counteract pain from sustained positioning is frequently moving the body parts that are typically static during a ride. This can be achieved by changing hand holds every three to five minutes and stretching on breaks or after the ride.

Here are a couple examples of stretches. Perform each stretch for five to ten seconds, repeating five to ten times during each break from riding. Notice that while both stretches involve the hands, they are stretched in opposite directions during each one.

  

Trauma

While the injuries that occur with bike falls and collisions are as varied as the impacts, two common bones broken are the clavicle (collar bone) and the scaphoid (wrist bone near the thumb). Extending the arm to break a fall focuses forces on these bones leading to injury during impact. Along with potential fractures, the clavicle is also prone to sprain or separation, which could require at a minimum sling usage or surgery depending on severity.

A scaphoid fracture can be easily missed as the telltale sign of this fracture, pain in the thumb side of the wrist, might not be felt as severely initially as other injuries. It is important to be vigilant of an injury in this area, however, as a design flaw in the blood supply to the scaphoid can lead to serious issues including avascular necrosis (failure of bone to heal) and long term functional impairment if not treated early. This is why it is important to not ignore wrist pain after a bike fall.

While prevention of falls and broken bones may not be entirely possible, if the biker holds on to the handle bars while falling, the entire body can absorb the blow of the impact rather than focusing the impact on these two bones in the outstretched arm. Wearing a helmet can also make the need to protect the head less of an issue during a fall.

Enjoying the Ride

By being aware of some of the most common arm and hand-related bike injuries, you can take the necessary steps to prevent these injuries from occurring during your rides. Should an injury occur, schedule an appointment at a nearby Athletico location so that our Occupational Therapists can help you heal in time for the next ride.

REQUEST AN APPOINTMENT

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