of the radial nerve typically occurs as it pierces the
supinator muscle (Archade of Frohse).- Neuroma: Neuroma formation may occur especially
in the residual limb of amputees. Symptoms typically
include sharp/lancinating pain during direct pressure
on the neuroma. This may significantly impact on the
athlete’s ability to wear the prosthesis both during ath-
letics as well as daily activities. The neuroma can
often be visualized by MRI. Treatment should start
with providing pressure relief, through prosthetic
socket modification. Often a local injection with a
combination of anesthetic and steroid is needed. In
addition, tricyclic antidepressants (TCA) or anti-
seizure medications may be helpful at diminishing the
pain. Surgical excision is indicated for refractory
cases.
SKIN INJURIES
•Wheelchair athletes are at particular risk for traumatic
injuries to their hands and fingers from contact with
the wheel, spokes, hand brakes, or the wheelchair of
an opponent. In addition, chafing may occur to the
inner aspect of the arm from contact with the wheel.
Protection through the use of gloves or padded sleeves
will reduce injuries.
- Multiple skin disorders may arise in the residual limb
of an amputee, which are typically related to poor skin
care or a poorly fitting prosthesis. Amputee athletes
should be educated on the proper care of their limbs
and be monitored closely during the initial phase of
athletic activity with a new prosthesis. - Athletes who wear prostheses are at risk for skin
breakdown in areas in contact with the prosthesis.
Strategies used to decrease risk include a proper pros-
thetic fit and an adequate suspension system, assess-
ment for a silicone liner, adequate cushioning with
socks and padding, and sports-specific biomechanics
training with the prosthesis. Avoiding a moist skin
environment also helps. - Pressure sores are always a risk for insensate skin.
Wheelchair athletes should perform daily skin checks
and practice good pressure relief techniques (lifting
off of their seat or weight shifting) throughout the day.
Sports chairs may offer better maneuverability and
aerodynamics, but often do so at the expense of pres-
sure distribution, therefore wheelchair athletes should
be especially cautious when using a new chair or start-
ing a new sport. - The most common areas at risk for pressure sores in
wheelchair athletes include the sacrum and coccyx,
ischial tuberosity, posterior knee, foot, and shoulder
blade. Strategies used to decrease risk include methods
to reduce friction forces (padding) and moist skin envi-
ronments (moisture-wicking clothing).- The following classifications (based on depth of
involvement) are according to the National Pressure
Ulcer Advisory Panel:
a. Grade 1: Nonblanchable erythema
b.Grade 2: Partial thickness breakdown through the
epidermis
c. Grade 3: Full thickness breakdown at the dermis
into the subcutaneous tissue
d. Grade 4: Deep tissue breakdown to the fascia,
muscle, bone, or joint
MEDICAL ISSUES (Dec, Sparrow, and
McKeag, 2000)THERMOREGULATION (Price and Campbell,
1999; Armstrong et al, 1995)- Individuals with neurologic impairments, especially
spinal cord injuries, have impaired autonomic control
ofheat generation through shivering or heat dissipa-
tion through sweating, vascular redistribution, and
vasodialation. Therefore they are at particular risk for
thermal injuries. - Proper clothing, hydration, and avoidance of activities
during extreme temperatures are imperative for injury
prevention. Athletes participating in cold whether
sports should carefully inspect their digits frequently
to avoid frostbite injury given their impaired sensation
to recognize early symptoms. Early signs of heat
injury may include erratic wheelchair propulsion.
Local cooling strategies, such as ice to the axilla,
groin, and neck are inadequate to properly reduce an
athlete’s core body temperature. Therefore cold water
immersion is recommended for the treatment of
hyperthemia with careful monitoring of core body
temperature to avoid overcooling. - Amputee athletes may experience excessive heat or
sweating at the interface of their residual limb with
their prosthetic socket. Care must be taken to avoid
skin maceration, breakdown, and infection. Frequent
socket or liner changing and residual limb care is
imperative to avoid injury. Persistent problems may
necessitate a change of socket or liner material.
AUTONOMIC DYSREFLEXIA (Pasquina, Houston,
and Belandres, 1998)- Athletes with spinal cord injuries(SCI) at or above the
T6 level are at risk for autonomic dysreflexia, a condi-
tion typically resulting from a noxious stimulus below
590 SECTION 7 • SPECIAL POPULATIONS