Snowboarding is the fastest growing winter sport in North America. Sherman Poppen invented snowboarding in 1965 when he bolted two skis together and named his invention a 'Snurfer'. Poppen, it would seem, boarded by himself for a decade or so because commercial snowboards did not become available until the late 1970's. Ski resorts were not impressed. In the early years of the sport, snowboarders were not permitted on the mountains. At the time, the majority of snowboarders were young males and the ski resorts regarded them as a fringe, undesirable clientele. Today, snowboarders account for 20 percent of the visitors to U.S. ski resorts. This number is higher in other regions of North America that have become 'hotbeds' of snowboarding. The local mountains surrounding Vancouver might show a percentage of snowboarders closer to 50%. The male to female ratio of snowboarders has dramatically decreased over the last 10 years from 9:1 to 3:1. Age demographics have also been crossed in recent years. Snowboarding reached the height of its credibility in the world of sport when it was introduced as an official Olympic Sport at the 1998 Winter Games in Nagano, Japan.

Injury Patterns Between Boarders and Skiers

Injuries sustained by boarders usually involve the upper extremity, whereas skiing injuries typically involve the lower extremity. This difference is likely due to the fundamental difference between the two sports; snowboarders ride with both feet affixed to a single board by non-releasable bindings. When balance is lost during snowboarding, the rider is unable to release his feet from the board and usually has to break a fall by reaching for the ground with arms extended. This potential mechanism for injury is called a FOOSH injury (Fall On OutStretched Hand). This mechanism may result in an injury of the wrist, elbow and/or shoulder. Snowboarding injury statistics suggest the wrist is the most common joint to be injured during a fall, commonly resulting in a ligament sprain or bone fracture.

Wrist Anatomy

The wrist is a complicated joint and involves the articulation of several bones. The forearm is made up of two bones, the radius and the ulna, running parallel to one another to form one joint surface. The radius and ulna then articulate with the carpal bones, two rows of four small bones. The wrist joint is then reinforced with a complicated arrangement of ligaments to reinforce the stability of the joint while maintaining mobility. A FOOSH mechanism may result in a fracture of any of these bones or sprain of any of these ligaments. A severe ligament sprain could compromise the stability of the joint and allow dislocation. A fracture could be complicated with an associated dislocation.

Signs and Symptoms of Injury

Wrist Sprain

A wrist sprain presents with localized pain and tenderness. All wrist movements may increase pain, but specific movements will likely intensify the pain more than others. Swelling may present shortly after injury. At the time of injury, and audible "pop" may be heard. Ligament injury may range from mild to severe. A mild sprain may allow the boarder to continue boarding the rest of the day. A moderate to severe sprain may require assistance from the ski patrol to safely reach the bottom of the mountain and receive appropriate intervention.

Wrist Fracture

At first, it may be difficult to determine the difference between a fracture and a moderate/severe ligament sprain. Usually, a fracture will present with greater pain intensity and a decreased willingness to move the joint. Movement in any direction will increase pain. An audible "snap" or "crack" sound may be heard. In some cases, a noticeable step deformity may exist close to the wrist joint.

Note: A severe sprain may be a fracture. See a physician to assess the severity of the injury. Only an x-ray can reliably determine whether a fracture has occurred.

Treatment

Wrist Sprain

Early treatment of a wrist sprain begins with ice, as it will help to decrease/minimize swelling. Rest is also important during early stages, the amount of which is dependent on the severity of the injury. Therapy may consist of mobility exercise in early stages and progressed with strengthening exercise as the healing process continues. Joint mobilization by a therapist may also be required to normalize biomechanics of the injured wrist.

Wrist Fracture

Fractures are usually cast for a period of time to restrict movement and to allow bony healing. After a prolonged period of immobilization, a joint becomes very stiff and the surrounding muscles atrophy. Joint mobilization and exercise are indicated at this time to address these issues.

Prevention

Wrist braces, similar to those worn by inline skaters, have been recommended by various health professionals to wear while snowboarding. Controversy exists with regard to the efficacy of wrist braces and their ability to prevent snowboard injuries. An argument has been proposed that wearing a wrist brace during a FOOSH fall will simply transmit the sustained forces higher up the forearm to the edge of the brace. The edge of the brace is then thought to act as a fulcrum of force which could result in a fracture of the radius and/or ulna. At this time, statistics have not shown a great incidence of upper forearm fractures while wearing a brace snowboarding. Isolated cases of upper forearm fractures have been reported, but compared to the thousands of potential wrist injuries which may have been prevented by wearing braces, the benefits may outweigh the risk.

Another suggestion proposed is to teach beginner snowboarders to fall with a clinched fist. A clinched fist may help keep the wrist closer to the joints' neutral position (the mid-position between flexion and extension). During a FOOSH fall, the wrist impacts the ground in an extreme range of forced extension. Forced extension is a very vulnerable position of the wrist joint and is the reason a FOOSH fall can result in such significant injuries.

References:

1. First Aid: The Vital Link by Red Cross
2. www.about.com - Wrist Sprains
3. www.ski-injury.com
4. www.clinicalsportsmedicine.com