DEAR DR. DONOHUE: I have been a skier for more than 10 years and never had an injury until last week. I fell, and my thumb got jammed against the ski pole. It’s still hurting. I iced it at first, and now I’m soaking it in hot water. I think it’s just a ligament thing. What do you think? – L.R.

ANSWER: I think you’ve suffered a common skiing injury – skier’s thumb. It is a ligament thing, but ligament things can be most serious.

Your kind of injury happens when a skier falls while holding onto the ski pole with a firm grip. Upon the body’s impact with the ground, the ski pole stays vertical in the snow, and the thumb is forced backward and outward. That violent and extreme thumb motion tears the ligaments that hold the thumb joint in place.

Pain is felt at the base of the thumb – the first thumb knuckle – on the back of the knuckle, and on the little finger side. The area is swollen and tender to touch.

Tears (sprain) of the ligament come in three grades.

With a grade 1 sprain, there are microscopic tears of a few ligament fibers.

A grade 2 sprain involves disruption of some ligament fibers. They are torn apart.

With a grade 3 sprain, all ligament fibers are torn.

A splint is the usual treatment of grades 1 and 2 sprains. It can take up to six weeks for the ligament to heal.

A grade 3 sprain usually requires surgical treatment, and it is best if the surgery is done within two weeks of the injury.

How do you know if you’ve sustained a grade 3 sprain? The thumb is unstable – wobbly. This isn’t something that an untrained person can assess easily. The thumb plays such an important role in hand function that such an injury should be evaluated by a professional, and an X-ray is often required to detect any fracture.

DEAR DR. DONOHUE: My daughter is 12 and has been into gymnastics for three years. By “into” I mean total dedication. She dreams of Olympic glory.

Her left wrist hurts her. She didn’t tell me. She won’t tell me about any injury. I noticed she was using her hand in a funny way. After I asked her, she admitted that the wrist hurt, but she won’t take a break from her gymnastics. What could this be? – K.M.

ANSWER:
It could be a number of things, some of which are serious and some not so serious.

The wrists take a beating in gymnastics. They often have to withstand forces that are more than twice the person’s body weight. Fully 70 percent of young female gymnasts complain of wrist pain at some time in their careers.

Her pain might be nothing more than pain that comes with overuse. Rest is the appropriate treatment for that. Rest is enforced until the pain has gone.

However, it could represent something with greater significance. In the immature wrist, the growth plate is quite susceptible to injury. The growth plate is the part of the bone that hasn’t become bone yet. It allows the bone to elongate. Growth plates can sustain tiny fractures that can affect the bone’s growth if healing is not allowed to take place.

Your daughter has to see a doctor, and she should have an X-ray. If she does have a growth plate fracture, she might be facing three or more months of rest. If the condition is caught early, rest is more on the order of weeks.

DEAR DR. DONOHUE: Is it safe to play a sport when a person has a cold? Does it make the cold last longer? – W.J.

ANSWER:
If a person doesn’t have a fever and if symptoms are above the neck – runny nose, stuffy nose, sneezing – it’s all right to play or exercise. Physical activity won’t prolong the illness. However, if you’re dripping mucus all over the place and sneezing nonstop, others will appreciate your staying home.

DEAR DR. DONOHUE: Please tell me how to figure my body mass index. My doctor didn’t say. I am 61 and a female. My BMI is 28. How does one come up with that number? – D.K.

ANSWER
: Body mass index – BMI – provides a better picture of the body’s composition than does a weight reading from a scale. A scale can’t tell how much muscle, bone and fat contribute to body weight. If most of your weight is muscle and bone, that’s a good thing. If most of your weight is fat, that’s a bad thing. Body mass index gives a rough approximation of your body’s makeup.

First, convert your height to inches. Then step 1 is to multiply that number by itself. Step 2 is to take that number and divide it into your weight in pounds. Step 3 is to multiply the result by 703. Let’s say you are 5 feet 5 inches tall and weigh 170 pounds. Five feet 5 inches is 65 inches. Step one is to multiply 65 by 65. The result is 4,225. Step 2 is to divide your weight (170) by 4,225. That number is: 0.04. Step 3 is to multiply 0.04 by 703. The answer is 28, your body mass index. Canadians, conversant with metrics, can obtain the BMI by dividing their weight in kilograms by their height in meters squared.

A normal body mass index is 18.5 to 24.9. Overweight is a BMI of 25 to 29.9. Obesity is 30 to 39.9. Extreme obesity is 40 and higher.

Another way to assess your body’s correct fat content is to measure your waist. A man’s waist should not be more than 40 inches (101 cm) and a woman’s, 35 inches (89 cm). Or you can divide your waist measurement by your hip measurement (taken at their largest point). A healthy number for men is less than 0.9, and for women is less than 0.85.

To obtain a true assessment of body fat, sophisticated tests – not available to most people – are needed. However, another reader, J.D., informs me that there is a home scale that provides that information with a harmless electric current. His is a Tonita Model BC-553 Innerscan Body Composition Monitor that sells for $120. Most of us don’t need such accurate information.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com


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