skiing injuries andrew getzin, md cayuga medical center sports medicine and athletic performance
TRANSCRIPT
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Skiing InjuriesAndrew Getzin, MD
Cayuga Medical CenterSports Medicine and Athletic Performance
www.cayugamed.org/sportsmedicine
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Overview
• Statistics
• Head injuries
• Skier’s thumb
• Knee injuries
• Prevention
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Injury Statistics
• 200 million skiers 70 million snowboarders in the world
• 2 injuries for every 1000 ski days
• Increased risk with newer skiers and those who try to ski slopes beyond their ability
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Skiing Injuries in Children
Contusion
MCL sprain
Skier's thumb
Concussion
Tibia Fracture
Laceration
Facial
Hand Fracture
Other
Deibert, JBJS 1998A
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Skiing Injuries in Adolescents
Contusion
Skier's Thumb
Hand Fracture
MCL Sprain
Laceration
ACL Sprain
Concussion
Shoulder
Other
Deibert, JBJS 1998A
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Skiing Injuries in AdultsACL Sprain
MCL Sprain
Contusion
Skier's Thumb
Laceration
AC sprain
ShoulderDislocation
Other
Deibert, JBJS 1998A
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Traumatic Brain injuries
• The leading cause of ski hospitalizations
• 50-88% of total deaths in skiers and snowboarders
• US Product Safety Commission estimates that 44% of these injuries could be eliminated with helmet use
• No increase risk for neck injuries
Cusimano and Kwok. JAMA 2010
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Risk Factor for Head Injuries in Skiing
• Male gender• Youth• Low skill level• Use of rented equipment• Absence of a helmet
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Which Skier’s with Head Injuries Need to be Seen by Medical Personnel?
• Almost all!• Any loss of consciousness• Memory problems• Headaches• Vomiting• Why take chances?
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What is a Concussion?
• Mild traumatic brain injury• A disruption in normal brain function
due to a blow or jolt to the head• CT or MRI is normal• Invisible injury
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Common Physical Symptoms• Headache• Nausea and vomiting• Clumsiness and poor balance• Dizziness and lightheadedness• Blurred vision and light sensitivity• Fatigue and lack of energy• Sleep disturbance• Symptoms often get worse before they get
better
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Who Should Have a CT Scan?
• What are we looking for?– Intracranial bleed– Cerebral edema– Skull fracture
• <10% of patients with mTBI have CT abnormalities
• <1% require neurosurgical intervention• Radiation exposure, Cost
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Principles of Concussion Treatment
• No cure for concussion, but treatment can help the person feel better and function better while symptomatic
• Early diagnosis and education is critical, and can improve outcome
• Rest early (7-10 days?) and then gradually increase activity
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Skier’s thumb
• Skiing into a planted pole
• Disruption or sprain to the ulnar collateral ligament (MCP joint)
• Pain with opening and grabbing things
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Skier’s Thumb: Exam
• Difficulty opposing pinky to thumb• Swelling and black and blue over thenar
eminence• Can’t hold an OK sign
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Skier’s Radiology
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Skier’s Thumb: Treatment
• Splint or cast 6-8 weeks• Ice, elevate, pain
medication• Rare cases need surgery
– Non-healing– Stenner’s lesion
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Knee Injuries
• ACL injury– Often feel a pop– Usually can’t keep skiing– Requires surgery
• Medial Collateral ligament– Often can keep skiing– Non-surgical– brace
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ACL Injuries
• Most common knee injury• 20% incidence in French ski team• 40% recurrence
Pujol, AJSM 2007
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Phantom foot ACL Injury
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Boot-Induced ACL Injury
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ACL Awareness Training
• Serious knee injury reduced by 62% in patrollers and instructors who participated in awareness training
• Study involved 42 areas and encompassed 24% US skiers
• Can education benefit the novice skier?• http://www.vermontskisafety.com/
kneefriendly.php
Ettingler AJSM 1995
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ACL Dos
• Arms forwards• Skies together• Hands over skis
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ACL Don’ts
• Don’t straighten your legs when you fall• Don’t try to get up until you have stopped• Don’t land on your hand• Don’t jump unless you know how and where
to land
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General Injury Prevention
• Take a lesson• When skiing, look uphill before you ski and
assess your surroundings• Prepare your body for ski season• Ease into the season: increase by <10%/week• www.ski-injury.com
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Equipment Changes for Prevention
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Multi-faceted approach with ski helmets
• Mountain bike use at resorts 80-90%• Incentives- discounted tickets or helmets• Include with all child and youth rental
packages• Insurance premiums to ski resorts• Education• Look at reduction in medical cost• Ski patrollers role models
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Common Sense
• Sun Screen, only 65% of skiers• Warm clothes• Eye protection• Warm up or Warm
down
Hason and Sutherland, Curr Sports Med Reports 2010
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Rule of 3s
• Never start a run after 3p• Take the 3rd day off• Beware above 3000 meters• Fewer than 3 drinks the day before skiing
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ENJOY YOUR SKI SEASON