- Injury to teeth and alveolar processes represent 84.5%
of injuries (Sane, Ylipaavalniemi, and Leppanen,
1988).
a. Ice hockey accounts for roughly 40% of all sports-
related dental injuries (Hayrinen-Immonen et al,
1990).
•Maxillofacial injuries have been drastically reduced
since the introduction of mandatory facemasks in
many levels of the sport (Sane, Ylipaavalniemi, and
Leppanen, 1988). - 47% of the above reported facial injuries may have
been preventable through the use of protective visors
(Lorentzon et al, 1988). - Studies have shown the use of helmets with facemasks
significantly reduces (but does not completely elimi-
nate) the incidence of facial lacerations (Benson et al,
1999; LaPrade et al, 1995; Murray and Livingston,
1995).
a. Number of game induced facial lacerations with-
out facemask =70 per 1000 player-game hours
(Lorentzon et al, 1988; Lorentzon, Wedren, and
Pietila, 1988).
b. Number of game induced facial lacerations with
facemask =14.7–15.1 per 1000 player-game hours
(LaPrade et al, 1995).
c. Number of practice induced facial lacerations
without facemask =21.8 per 1000 player-practice
hours (Lorentzon et al, 1988; Lorentzon, Wedren,
and Pietila, 1988).
d. Number of practice induced facial lacerations with
facemask =0.0–0.2 per 1000 player-practice hours
(LaPrade et al, 1995). - Despite facemasks, facial lacerations still occur, and
the team physician should be prepared to evaluate and
repair these injuries appropriately. - Cervical Spine:The effect of helmet and facemask
use on cervical spine injury—the controversy.
a. After the increased use of helmets with facemasks
in ice hockey, there retrospectively appeared to be
an increasing incidence of cervical spine injury.
Several investigators hypothesize that this is
caused as a result of the player wearing a helmet
adopting a more aggressive style of play resulting
in more cervical injury (Murray and Livingston,
1995; Reynen and Clancy, Jr, 1994). It has been
proposed that the protective devices have also
altered how officials perceive game situations,
leading them to be more lenient in penalization.
The net result has been an increase in illegal and
injurious behaviors, such as checking from behind
(an activity associated with catastrophic cervical
spine injury) (Murray and Livingston, 1995).
b. However, LaPrade and colleagues’ prospective
study of intercollegiate athletes and facemask use
showed no increase in head and neck injuries
(LaPrade et al, 1995).- Mechanism of injury is axial loading caused by a
blow to the head from collision with the boards, other
players, the ice, or the goal post (Tator, 1987). - Many of the reported cervical spine injuries were a
result of either illegal play or high-risk aggressive
behavior. New rules have been instituted by both the
Canadian Amateur Hockey Association and USA
Hockey in an attempt to reduce the number of spinal
cord injuries. These new rules have moved the action
away from the boards and restricted checking; prelim-
inary results appear successful in limiting the inci-
dence of complete spinal cord injuries (Tator, Carson,
and Edmonds, 1998). - Shoulder:Clavicle fractures, acromioclavicular joint
separations, and glenohumeral subluxation/disloca-
tion are relatively common in ice hockey (Minkoff,
Varoltta, and Simonson, 1994; Bahr, Bendiksen, and
Engerbretsen, 1995; Thompson, and Scoles, 2000).
They usually are a high velocity injury, which is the
result of the shoulder be driven into the boards fol-
lowing aggressive body checks. - Elbow:A player who does not wear elbow pads may
receive a traumatic olecranon bursitis and/or elbow
fracture during collision with the ice or the boards. - Wrist, hand: When hockey players fight (which
occurs frequently at higher levels of play), the gloves
are typically thrown down, and blows are exchanged
using bare hands. The typical street fighter hand
injuries can then occur. - Gamekeeper’s thumb (ulnar collateral ligament
injury) has been reported (Sim et al, 1988) and is typ-
ically due to the player’s thumb being hyperabducted
when the stick handle is suddenly forced toward the
body during a collision with the boards. - Wartenberg’s syndrome:In hockey, direct trauma to
the superficial radial nerve at the wrist can occur when
an opponent strikes the distal forearm with the stick. The
athlete will complain of pain and/or parasthesias shoot-
ing up the thumb and dorsal wrist in a radial distribution
(Nuber, Assenmacher, and Bowen, 1998). Players who
use gloves with shorter cuffs (so as to increase wrist
mobility) are at increased risk for this injury. - Scaphoid fracture:Mechanism of injury usually is
fall on outstretched hand or a dorsiflexed wrist collid-
ing with the boards. The gloves provide some protec-
tion against this injury. - Chest:Commotio cordis has been reported in youth
ice hockey (Maron et al, 2002). League organizers
and physicians should consider having an automated
electric defibrillator(AED) available at the rink, as
there is a 16% survival with rapid defibrillation
(Maron et al, 2002).
510 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS