iv. Activity without pain is key to return to play.
c. Scaphoid fracture
i. Most often from FOOSH injury.
ii. Immobilization is appropriate treatment.
d.Metacarpal, phalangeal, and interphalangeal
joint dislocations
i. Immediate traction and reduction is ideal.
ii. Often associated with stick checking or falls
where the stick traps the hand/fingers in
pathologic manner.
e. Gamekeeper’s or skier’s thumb
i. Associated typically with falls in which the
thumb is trapped by the stick.
ii. Hyperextension results in a tear of the ulnar
collateral ligament.
iii. May be complicated by an avulsion frac-
ture from the proximal phalanx (Stener
lesion).
f. Forearm fractures
i. Either from stick-to-body contact during
checking or from FOOSH injuries.
ii. Immobilization is mainstay of treatment.
iii. Surgical reduction and fixation may be
required depending on severity of injury.
g. Shoulder burners (stingers)
i. Commonly result of stick-to-body contact
with a check to the shoulder or a fall onto
head or shoulder.
ii. Downward, forward depression of the
shoulder.
iii. Often present with acute, shooting, shock-
like pain in extremity.
iv. May have some transient motor deficits.
v.Typically resolves without complication.
•Others
- Lacerations
a. Pressure, hemostasis, and suturing if needed - Nose bleeds
a. Hold head forward (player may choke on own
blood).
b.Pressure on lower two-thirds of nostrils.
c. Packing may aid in tamponading bleed. - Concussions
a. Head injuries account for 3.1% of lacrosse
injuries.
b.Lacrosse helmets are designed to deflect blows
from a stick or ball, but are not meant to protect
against high-velocity impacts, like being thrust
into the boards (box lacrosse), or impact into the
ground.
c. Also common when players are crouched down
for scooping ground balls and are struck by
another player.
d. Treatment is based on degree of injury.
i. Most injury scales refer to amnesia, loss of
consciousness, and current mental status as
markers of severity.
ii. When in doubt, withhold player from play
till symptom-free and a full assessment can
be made.- Eye injuries (Waicus, 2002; Webster et al, 1999)
a.Much more common in women’s lacrosse
owing to minimal protective gear.
i. It’s felt that appropriate enforcement of the
rules for contact will minimize eye and
facial injuries.
ii. Waicus and Webster et al have both argued
for mandatory eyewear because of the
increased incidence of injury compared to
those who wear protective eyewear.
iii. Others feel that mandatory eyewear will
lead to poorer compliance to rules and other
head injuries.
b.Eye protection is available but not required.
c. May be the result of contact with ball or inad-
vertent stick contact.
d. Opponents of mandatory eye protection state
that this will encourage more stick-to-body con-
tact, and proper enforcement of current rules are
sufficient to protect players.
e. Traumatic eye injuries should be referred for
immediate ophthalmologic examination.
i. Sunken eyes or extraocular muscle deficien-
cies may represent periorbital skull frac-
tures.
ii. Assessment for associated closed head
injury may be warranted. - Rib fractures and abdominal trauma
a. Most commonly from stick checking.
b.Injuries to abdominal organs are uncommon,
but should be entertained in cases of significant
abdominal pain.
c. Rib padding may offer some protection. - Throat trauma
a. Usually the result of the ball striking the throat.
b.Goalies most at risk.
c. Throat deflectors significantly reduce the inci-
dence of injury. - Goalkeeper’s thumb (Elkousy et al, 2000)
a. Fracture of distal or proximal phalanx of thumb.
b.Typically impact of ball directly on extending
thumb as goalie is attempting to save shot on
goal.
c. May require surgical fixation or immobilization.
- May be prevented with rigid covering over distal end
of thumb.
552 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS