Wrist, hand injuries a concern in youth sports

Youth sports injuries have become a topic of concern for physicians, coaches and athletes. The biggest fear centers on how these injuries will affect a child’s growth and intellectual abilities. 

Among the injuries that have raised the most interest is concussion. But a recent study published this month in the medical journal for Pediatrics reports that the rates of injuries to the wrist and hand are unusually high.

Sports such as football, ice and field hockey, lacrosse, softball and wrestling were most represented in frequency of injury. Overall, any stick, puck, ball or contact sport can have a high rate of injury. The human wrist is a complex joint that consists of 15 bones that form connections enabling the wrist to move in multiple planes.

The carpal bones in the hand attach to the two bones of the forearm: the ulna and radius.

These bones are connected to each other as well as various muscles by an intricate network of tendons and ligaments. Blood vessels and nerves are intertwined in this grid to provide circulation and sensation.

The most common injuries cited in the study include fracture, contusion, and ligament sprain in descending order of frequency. While most of the injured athletes were able to return to their sports in seven days or less, 12.4 per cent were out for more than three weeks.

Initial treatment often includes rest, ice and immobilization but some fractures may require surgery. 

“Persistent pain and swelling after a wrist or hand injury in a child requires further evaluation by a physician,” reports Dr. Joel Ferreira, an Assistant Professor of Orthopaedics at the University of Connecticut, where he specializes in hand and wrist injuries. “Imaging studies may be necessary to rule out fractures affecting the growth plate that may result in a chronic condition.”

Prompt evaluation and treatment of hand and wrist injuries in young athletes can help speed recovery.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Improper use of smelling salts a growing concern

Athletes are always looking for an edge that will improve performance.

Often these efforts are ill-advised and at times harmful. One practice that has become popular among high-level athletes is the use of smelling salts to increase alertness.

Smelling salts consist of spirits of ammonia. The use of smelling salts dates back to the Roman Empire but they became popular during the Victorian era. They were used to help revive women who were fainting.

Syncope or fainting is a loss of consciousness as a result of a slowed heart rate triggered by a vagal reflex. This reflex is often initiated by dehydration, anxiety or pain. Ammonia salts directly irritate the nasal mucosa and elicit a noxious reflex. This causes the heart to beat faster and hopefully counteract the vagal response.

Approximately 50 years ago, they became popular in sports to supposedly counteract the effects of head trauma. Smelling salts became popular in boxing where their use eventually was banned.

Trauma patients often suffer neck injuries that may be undetected. The first response to the noxious smell is to suddenly jerk the head away from the stimulus. This can result in dislocating an injured spine and potential paralysis.

More recently, athletes have begun to use smelling salts with the belief that their use will keep them more alert.

The use of smelling salts is particularly popular among football and hockey players who believe this reflex will counteract the effects of concussion.

Recent estimates report 80 percent of NFL players using smelling salts, according to a recent article in ESPN The Magazine.

It is only natural that athletes at lower levels will follow this practice.

Smelling salts should only be used in limited situations under the guidance of a health professional.

Coaches, parents and athletic trainers are crucial to ending the inappropriate use of smelling salts in young athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport.