Skiing injuries of the upper limb

After a skiing accident resulting in complex trauma injuries, assessment and treatment are essential steps in the recovery process. While surgery may not be necessary in all cases, it can sometimes be the sole recourse. In this article, we delve into the insights of Professor Mohamed Imam, a distinguished orthopaedic surgeon, to shed light on the intricacies of treating complex trauma injuries stemming from skiing accidents.

•  What upper limb injuries commonly occur during skiing, and what are their causes?

Common Upper Limb Injuries:

1. Skier's Thumb (Ulnar Collateral Ligament Injury): Skier's thumb can occur when a skier falls while holding a ski pole, resulting in hyperextension of the thumb and causing damage to the ulnar collateral ligament. This injury can lead to pain, instability, and limited range of motion in the thumb.
2. Shoulder Dislocations and Fractures: High-impact falls or collisions during skiing can lead to shoulder dislocations or fractures. These injuries often occur when skiers attempt to break a fall with outstretched arms, resulting in significant force being applied to the shoulder joint.
3. Wrist Fractures and Sprains: Landing on an outstretched hand during a fall can cause wrist fractures or sprains. The impact on the hard snow surface can lead to fractures of the wrist bones or stretching and tearing of ligaments, resulting in pain, swelling, and limited wrist mobility.
4. Elbow Injuries: Direct trauma or twisting forces during skiing accidents can cause elbow injuries such as fractures or dislocations. These injuries may occur due to collisions with objects or other skiers, leading to pain, swelling, and difficulty moving the affected elbow.

 Causes of Upper Limb Injuries:

1. High-speed falls: Skiers may experience high-speed falls while navigating steep slopes or attempting challenging manoeuvres, increasing the risk of upper limb injuries.
2. Collisions with objects or other skiers: Contact with trees, rocks, or other obstacles on the ski slope can result in upper limb injuries. Additionally, collisions with other skiers can lead to traumatic impacts, causing shoulder, wrist, or elbow injuries.
3. Inadequate technique or skill level: Skiers who lack proper technique or experience may be more prone to falls and injuries. Poor balance, improper pole usage, or incorrect arm positioning can increase the likelihood of upper limb injuries during skiing.
4. Equipment malfunctions: Malfunctioning ski equipment, such as faulty bindings or poles, can contribute to accidents and lead to upper limb injuries. Equipment failure may result in sudden falls or loss of control and increase the risk of injury to the arms and hands.

• How can skiers recognise symptoms of upper limb injuries sustained while skiing, and why is swift identification crucial?

Recognising Symptoms:

1. Persistent pain and tenderness in the affected area: Skiers should pay attention to any ongoing pain or tenderness in their upper limbs, especially after a fall or collision. Persistent discomfort, particularly during movement or when pressure is applied to the injured area, can indicate an underlying injury such as a fracture or ligament tear.
2. Swelling, bruising, or deformity:Visible signs of swelling, bruising, or deformity in the upper limb should not be ignored. Swelling and bruising often occur as a result of tissue damage and internal bleeding following an injury. Additionally, any noticeable deformity in the shape or alignment of the arm, shoulder, wrist, or hand could indicate a fracture or dislocation.
3. Difficulty moving or bearing weight on the injured limb:Skiers may experience difficulty moving or using the injured limb due to pain, weakness, or instability. Difficulty in performing basic tasks such as grasping objects, lifting weights, or moving the arm through its full range of motion suggests an upper limb injury that requires medical attention.
4. Numbness or tingling sensations:Sensations of numbness, tingling, or pins and needles in the upper limb can indicate nerve involvement or compression. These symptoms may be present immediately after an injury or develop gradually over time. Skiers should be vigilant and report any unusual sensations in their arms or hands to a healthcare professional.

Importance of Swift Identification:

1. Swift identification allows for prompt medical attention and proper diagnosis of the injury: Recognising and addressing upper limb injuries promptly can prevent complications and facilitate effective treatment. Prompt medical evaluation enables healthcare providers to assess the extent of the injury, order appropriate diagnostic tests, and initiate timely interventions to promote healing and recovery.
2. Delayed treatment could lead to complications and prolonged recovery times:Neglecting or delaying treatment for upper limb injuries may exacerbate the condition and increase the risk of complications such as chronic pain, stiffness, and reduced functionality. Delayed healing may also prolong the recovery process, potentially impacting a skier's ability to return to the slopes and resume normal activities.
3. Early intervention prevents further damage and improves the prognosis of the injury:Early identification and intervention allow healthcare providers to implement measures to prevent further damage to the injured limb. Prompt immobilisation, pain management, and rehabilitation strategies can facilitate optimal healing and minimise long-term consequences associated with upper limb injuries sustained during skiing accidents.

• What are the most effective treatments for upper limb injuries resulting from skiing accidents, and how can individuals choose the right treatment plan?

Effective Treatments:

1. Rest, ice and compression, and elevation (RICE) for initial management of acute injuries:The RICE protocol is a standard approach for managing acute upper limb injuries sustained during skiing. Resting the injured limb helps prevent further damage and promotes healing while applying ice reduces inflammation and alleviates pain. Compression with a bandage and wrap helps control swelling, and elevation of the injured limb above heart level reduces swelling and improves circulation, aiding in recovery.
2. Immobilisation with splints, braces, or casts to stabilise fractures or sprains: Immobilisation is often necessary to stabilise fractures or sprains in the upper limb following a skiing injury. Splints, braces, or casts may restrict movement and protect the injured area from further trauma, allowing the tissues to heal correctly. Immobilisation devices are customised to the specific injury and may be worn for a specified period to ensure adequate healing and recovery.
3. Physiotherapy to regain strength, flexibility, and range of motion:Physiotherapy is crucial in rehabilitating upper limb injuries sustained during skiing. Skilled physiotherapists design tailored exercise programs to address muscle weakness, and stiffness, and reduced range of motion resulting from the injury. Rehabilitation exercises focus on strengthening the muscles surrounding the injured area, improving flexibility, and restoring functional movement patterns, facilitating a safe and effective return to skiing activities.
4. Surgery for severe fractures or ligament tears, followed by rehabilitation: In cases of severe upper limb injuries, such as complex fractures or complete ligament tears, surgical intervention may be necessary to restore stability and function. Orthopaedic surgeons perform internal fixation, external fixation, or ligament reconstruction to realign fractured bones or repair damaged ligaments. Following surgery, patients undergo comprehensive rehabilitation under the guidance of physiotherapists to regain strength, mobility, and function in the affected limb.

Choosing the Right Treatment Plan:

1. Consultation with a medical professional for proper assessment and diagnosis:Skiers who sustain upper limb injuries while skiing should seek prompt medical attention from a qualified healthcare provider for accurate assessment and diagnosis. A thorough evaluation of the injury, including imaging studies such as X-rays or MRI scans, helps determine the extent & severity of the damage and enables the formulation of the appropriate treatment plan.
2. Consideration of the severity and type of injury, as well as individual factors such as age and overall health:The choice of treatment for upper limb injuries depends on various factors, including the nature and severity of the injury, the individual's age, overall health status, and activity level. Minor injuries may respond well to conservative measures such as rest, ice, and physiotherapy, while more severe injuries may require surgical intervention for optimal outcomes.
3. Collaboration with healthcare providers to develop a personalised treatment plan that aligns with the individual's goals and preferences:Skiers should actively participate in discussions with their healthcare providers to create a personalised treatment plan that addresses their unique needs, preferences, and goals. Collaborative decision-making ensures that the chosen treatment approach is tailored to the individual's circumstances, maximising the likelihood of successful recovery and return to skiing activities.

• What preventive measures and recovery strategies can skiers implement to minimise upper limb injuries and return to skiing confidently?

Preventive Measures:

1. Proper skiing technique and skill development through lessons or training:Skiers can reduce the risk of upper limb injuries by learning and mastering proper skiing techniques under the guidance of certified instructors. Attending ski lessons or training sessions helps skiers develop essential skills such as maintaining balance, executing turns, and controlling speed, which can help prevent falls and collisions that may lead to upper limb injuries.
2. Use of appropriate protective gear, including helmets, wrist guards, and padded gloves:Wearing protective gear is essential for skier safety, particularly when preventing upper limb injuries. Helmets that protect the head and reduce the risk of traumatic brain injuries in the event of a fall or collision.Wrist guards provide support and stability to the wrists, decreasing the likelihood of wrist fractures or sprains. Padded gloves offer additional cushioning and protection for the hands and fingers, minimising the impact of falls and reducing the risk of soft tissue injuries.
3. Regular equipment maintenance or inspection to ensure proper function and fit:Skiers should regularly inspect their skiing equipment, including skis, bindings, poles, and protective gear, to ensure that everything is in good working condition. Properly maintained equipment decreases the risk of malfunctions or failures that could contribute to slope accidents and injuries. Additionally, skiers should ensure that their equipment fits correctly and comfortably, as ill-fitting gear can impair performance and increase the risk of injury.
4. Awareness of surroundings and adherence to safety guidelines on the slopes: Skiers should maintain awareness of their surroundings and exercise caution while navigating the slopes to avoid collisions with other skiers, obstacles, or hazardous terrain. Adhering to safety guidelines, such as observing speed limits, yielding to slower skiers, and avoiding restricted areas, helps maintain a safe skiing environment for all participants and reduces the likelihood of accidents and injuries.

Recovery Strategies:

1. Adherence to recommended treatment plans and rehabilitation exercises prescribed by healthcare providers:
2. Following a skiing-related upper limb injury, skiers should comply with the treatment plan outlined by their healthcare providers, which may include rest, immobilisation, pain management, and physical therapy. Engaging in prescribed rehabilitation exercises helps promote healing, restore strength and flexibility, and prevent complications during recovery.
3. Gradual return to skiing activities based on the individual's recovery progress and medical clearance:Skiers should gradually reintroduce skiing activities into their routine as they progress through the recovery process and receive clearance from their healthcare providers.Starting with low-impact activities and progressively increasing intensity and duration allows skiers to rebuild confidence, assess their physical capabilities, and minimise re-injury risk.
4. Implementation of injury prevention strategies, such as strengthening exercises and flexibility training: Skiers can reduce the risk of recurrent upper limb injuries by incorporating injury prevention strategies into their training regimen.Strengthening exercises targeting the muscles surrounding the shoulders, elbows, wrists, and hands help improve stability and resilience.At the same time, flexibility training enhances joint mobility ,range of motion, reducing the risk of strains and sprains during skiing activities.
5. Mindful skiing practices to minimise re-injury risk and promote long-term musculoskeletal health:Skiers should adopt mindful skiing practices that prioritise safety, technique, and injury prevention. This includes maintaining proper body mechanics, avoiding risky manoeuvres or terrain, and listening to the body's signals to prevent overexertion or fatigue.By practising mindfulness and respecting their physical limits, skiers can enjoy skiing safely while minimising the risk of upper limb injuries and preserving long-term musculoskeletal health.