CHAPTER 94 • LACROSSE 551
ii. Use of appropriate shoulder protection (del-
toid cup) important in prevention.
iii. Monitoring for myositis ossificans is impor-
tant (see Contact.1.c.iv. below).
c. Medial and lateral epicondylitis
i. Usually result of cradling motion in the
throwing arm.
ii. Cradling of the ball requires rapid prona-
tion/supination and flexion/extension of the
arm.
iii. Stretching of affected muscle groups along
with braces to reduce strain at tendinous
insertions have proven effective in treating
this injury.
- Others
a. Environmental
i.Exertional heat illness (EHI).
- May occur in both field, usually a spring
sport, as well as box lacrosse.
- Players with more protective equipment
(i.e., goalies) at higher risk.
- Hydration is essential.
4.Monitor players for signs/symptoms of EHI.
- Provide appropriate water and electrolytes
to players during games.
- Avoid conditions where EHI is more likely.
- Players showing signs of EHI should be
immediately removed from play, equip-
ment removed, and measures taken to
decrease body temperature.
b. Abrasions/turf burns
i. More common in box lacrosse or competi-
tion on artificial surfaces.
ii. Padding and lubrication with petroleum jelly
on at-risk areas may reduce incidence.
iii. Ensure antiseptic cleansing of wound and
clean dressings to reduce infection risk.
iv. Prepatellar bursitis is common complication,
especially in adolescent athletes.
c. Blisters
i. Occurs in areas of increased friction.
ii. Petroleum jelly, powders, moleskin, nylon
socks under thick socks may all help to
reduce friction.
iii. Treatment with donut pads to distribute
forces away from blister, appropriate cleans-
ing of blister (especially if it has opened).
d. Anterior tibial shin splints
i. Overuse injury.
ii.Associated with fatiguing tibialis anterior that
spasms with eccentrically decelerating forefoot.
iii. Irritation of fascia or anterior border of tibia
results.
iv. Prevention revolves around proper stretching.
e. Turf Toe
i. Hyperextension of first metatarsal.
ii. Associated with rapid deceleration, com-
monly on artificial turf.
iii. Inflammatory condition causes chronic pain.
iv. Prevention with proper shoe fit allowing
some toe and forefoot movement.
v. Limiting hyperextension by taping is appro-
priate treatment to allow for return to play.
- Contact
- Lower extremity
a. Much less common
b.Most often associated with stick-to-body or
ball-to-body contact
c. Contusions are common
i. May result from contact with hard rubber
ball, which may be propelled at up to 100
mph.
ii. Player controlling the ball is often repeatedly
hit in the upper torso and extremities by the
defender’s stick.
iii. Treated by standard PRICEMM (protection,
rest, ice, compression, elevation, modalities,
medication), may cover area with donut pro-
tection to distribute future forces to area
around injury.
iv. May be complicated by myositis ossificans.
- Inflammatory bony deposition in muscle
from repetitive trauma.
- Often occurs in vastus lateralis and del-
toid insertion of humerus.
- Areas receiving repeated trauma should
be protected with donut and hard plate
over area.
- Upper extremity
a. Olecranon bursitis
i.Often stick-to-body or body-to-ground contact
ii. Many players do not wear elbow pads, and
are thus more susceptible to this injury.
iii. Drainage of bursal fluid allows for improve-
ment of symptoms, and may respond to
steroid injection into bursal sac; protective
gear (i.e., elbow pads) reduces risk of fur-
ther complication.
b.AC separation
i. Associated with checks into the boards (box
lacrosse), stick-to-body contact with a
downward blow to the outer aspect of the
shoulder and fall on the outstretched hand
(FOOSH) mechanisms.
ii. AC immobilizers or specific taping systems
to hold the distal clavicle in place and allow
ligaments to heal in a shortened position.
iii. Reduces later step deformities.
