Mr Nashat Siddiqui
Consultant Upper Limb Orthopaedic Surgeon
The skiing season is upon us again. We are all aware of the typical skiing injuries to the knees and ankles, but did you know it is common to sustain an injury to your shoulder, elbow, or hand? Before hitting the slopes you should ensure you are as prepared as possible and know what to do if you do injure yourself.
- The shoulder is a very mobile joint, which is necessary for our daily function. This also means that it is prone to injury, either by being pulled too far out of its normal position following trauma or, more commonly, after repetitive use. Trauma can, of course, cause fractures which cannot be prevented.
- After a fall or wrenching injury the shoulder can dislocate or partially dislocate and then come back into joint. This can injure the cartilage and ligaments holding the joint in place, which can lead to pain, feelings of instability, or further dislocation. If there is a significant injury you may need to be seen by a surgeon to talk about surgery. However, if it is assessed as a minor injury, a course of exercise therapy should be all you need to regain normal shoulder function.
- Repetitive use of the shoulder in positions it is not used to can cause the tendons, known as rotator cuff tendons, to become inflamed and painful, and sometimes develop tears. Minor tendon problems usually resolve with rest, exercises and painkillers, and occasionally a steroid (cortisone) injection. But if it is a more significant or persistent problem you may need surgery to help deal with the inflammations or tears.
- The good news is that a lot of these injuries can be prevented by undergoing an assessment and exercise regime prior to taking to the slopes. You should ideally spend at least 4-6 weeks developing your posture and strengthening the correct muscles in order to prevent some of the more minor injuries. The same goes for preventing elbow injuries.
Elbow dislocations or injuries to the ligaments or joint itself require a high degree of trauma, but tendon problems affecting the inner (medial epicondylitis or golfer’s elbow) or outer elbow (lateral epicondylitis or tennis elbow) occur frequently. Usually, however, these respond well to exercise regimes. Steroid injections (cortisone) are being used less frequently these days, in favour of physiotherapy and even injections of your own blood.
The Hand and Wrist
- The hand and wrist are prone to injury, not just by falling, but also from repetitive use and poor grip of ski poles. Twisting injuries can occur as a result of the poles getting stuck in the snow, and the hand, particularly the thumb, can then be wrenched by the sudden deceleration. One such example is “skier’s thumb” where the thumb is twisted from the grip on the pole and results in one of the thumb ligaments being torn off requiring surgical repair.
- Ligament injuries to the hand and wrist can be very subtle when examining or even scanning the wrist, yet can result in long term pain and disability. Fractures are also frequent, some of which may need surgery. If there is a minor ligament injury, strengthening exercises are often sufficient and should be done with the assistance of a physiotherapist or Hand Therapist.
In summary, while upper limb injuries are less common than those of the knee or ankle, they are difficult to correctly diagnose. You should therefore see a doctor if pain doesn’t settle in the first few days.
Mr Nashat Siddiqui – Consultant Upper Limb Orthopaedic Surgeon