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De Quervain's Tenosynovitis: A Common Condition Among Heavy Wrist Users

De Quervain's tenosynovitis is a condition characterized by pain on the thumb side of the wrist, caused by inflammation of the tendons around the thumb. Normally, these tendons move smoothly through a tunnel-like structure called the sheath. When inflammation occurs, swelling restricts tendon movement within the sheath, causing pain, especially during activities that involve gripping or wrist movements. This condition is most commonly seen in people aged 30-50, with women being 8-10 times more likely to be affected than men. The most common symptom is wrist pain near the base of the thumb, often intensifying at night. Symptoms - Pain on the thumb side of the wrist, which may develop gradually or suddenly. - Pain radiating along the thumb or from the wrist down to the forearm. - Swelling on the thumb side of the wrist. - Tenderness or pain when moving the thumb. Treatment Treatment usually begins with non-surgical methods to relieve symptoms before considering surgery. Non-Surgical Treatment -Avoid repetitive wrist movements or use a splint to immobilize the wrist and thumb. Take non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation. -Avoid activities that cause pain. -Apply ice to the affected area to reduce swelling. -Steroid injections may be given to reduce inflammation, but generally should not exceed two injections. Surgical Treatment Surgery involves a small incision in the affected area to release the sheath, allowing more space for tendon movement. This procedure reduces pain and swelling, restoring normal movement.    

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Trigger Finger: A Common Occupational Hazard

Trigger finger, or stenosing tenosynovitis, is a condition resulting from inflammation of the sheath surrounding the flexor tendons in the palm near the base of the fingers. This condition can affect any finger and occurs due to the thickening of the tendon sheath at the base of the finger, making it difficult for the tendon to move through the sheath, leading to locking or pain.   This condition is more commonly seen in women, particularly middle-aged women, and is often associated with activities that require prolonged and repetitive use of the hands, such as household chores, carrying heavy objects, lifting, using scissors for gardening or cutting fabric, and extended use of mobile phones or tablets. These activities increase the risk of developing trigger finger.   Symptoms 1. Pain at the base of the finger, which may feel stiff, especially in the morning. 2. A clicking or snapping sensation when moving the finger, sometimes with a palpable nodule at the base of the finger. 3. Tightness and a feeling of a bump at the base of the affected finger. 4. The finger may lock in a bent position but can still be manually straightened. 5. The finger may lock in a bent position and cannot be manually straightened. Treatment Methods 1.Resting the Affected Hand: Avoid using the affected hand and refrain from repetitive finger movements for at least 2 weeks. 2.Warm Soaks and Massage: Soak the base of the finger in warm water and massage it, stretching the fingers as much as possible, especially in the morning, for at least 5-10 minutes daily. 3.Using a Finger Splint: Wear a finger splint to keep the finger in an extended position, preventing it from bending, particularly at night to reduce morning stiffness. 4.Physical Therapy: Includes using heat packs, gentle massage, stretching exercises, and using splints, often combined with medication and is effective in the early stages. 5.Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce tendon sheath inflammation. However, these medications have side effects and should be used under medical supervision. 6.Steroid Injections: For those with persistent symptoms, a doctor may inject steroids into the tendon sheath to reduce inflammation, pain, and swelling. This should only be done by a qualified physician. While effective, steroid injections are considered temporary and may need to be repeated if symptoms recur, usually within 3-6 months. It is not recommended to have more than two injections in the same finger. 7.Surgery: There are two surgical options: -Open Release Surgery: Performed in an operating room under local anesthesia, involving a small incision (about 1 cm) to release the tendon sheath, allowing the tendon to move freely. Post-surgery, heavy hand use should be avoided for about 2 weeks, and stitches are usually removed 10-14 days after surgery. -Percutaneous Release Surgery: Involves using a needle to release the tendon sheath. This method results in a smaller wound (about 2 mm), allowing for quicker recovery. However, it has higher equipment costs and carries a risk of damaging blood vessels or nerves, particularly in the thumb and index finger, as nerves are close to the surgical site. This method is suitable for patients with more advanced stages of the condition. In general, surgery offers the best chance of preventing recurrence of trigger finger.

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Plantar Fasciitis, also known as Heel Spur Disease

Plantar fasciitis is a condition characterized by inflammation of the plantar fascia, the tissue that runs along the bottom of your foot. This condition is quite common, especially among women, and typically manifests as pain in the heel area, particularly when weight is placed on the foot. The pain is often most severe in the morning when getting out of bed and tends to fluctuate based on activity. The inflammation occurs where the fascia connects to the heel bone and can extend to the Achilles tendon. If left untreated or improperly managed, the condition can become chronic and may cause pain throughout the day. Causes Plantar fasciitis is caused by excessive strain on the plantar fascia and arch of the foot, which absorbs shock when we walk or run. This strain can lead to the formation of fibrous tissue and chronic inflammation over time. Risk Factors 1.Abnormal foot structures, such as high arches or flat feet. 2.Excessive body weight, which increases stress on the feet. 3.Frequent wearing of high-heeled shoes. 4.Running with excessive heel strike. 5.Running on hard surfaces or wearing shoes that are too hard or thin and do not provide adequate cushioning. 6.Older age, as the plantar fascia loses elasticity. 7.Occupations that require prolonged standing or walking, causing the fascia to become tight. Symptoms The primary symptom of plantar fasciitis is pain in the bottom of the foot, around the heel and up to the Achilles tendon. The pain is typically sharp, like being stabbed or burned, and is most intense after periods of inactivity, such as after waking up or standing up from a seated position. While the pain may improve with activity, it can become chronic and severe if not properly treated, potentially interfering with daily life. Diagnosis Plantar fasciitis is usually diagnosed through a medical history and physical examination. Additional tests may include: X-ray: To detect calcium deposits at the attachment point of the fascia if inflammation has been present for a long time. Ultrasound: To show thickening of the plantar fascia, indicating inflammation. Treatment Treatment begins with medication and lifestyle modifications. If symptoms persist, further interventions may be necessary: - Medications: Anti-inflammatory drugs, muscle relaxants, and pain relievers should be taken under a doctor's supervision and not for extended periods. - Soft Cast: Used initially to reduce inflammation. - Stretching and Warm Soaks: Stretching the plantar fascia and soaking the feet in warm water. - Supportive Footwear: Using soft insoles or appropriate shoes. - Physical Therapy: Utilizing heat, such as ultrasound therapy. - Shock Wave Therapy: For cases unresponsive to medication and lifestyle changes, or to accelerate recovery. - Surgery: Considered when non-surgical treatments fail after a certain period, with the choice of technique tailored by the physician. Prevention Since plantar fasciitis is often related to lifestyle, self-care is crucial: - Choose Appropriate Footwear: Shoes that are not too tight, have soft soles, and include insoles, especially for those who are overweight or use their feet a lot. -  Maintain a Healthy Weight: To reduce stress on the feet. -  Avoid Prolonged Foot Stress: Such as standing or walking barefoot on hard surfaces. -  Proper Running Technique: Shorten strides and distribute weight evenly across the foot. - Take Breaks: When using feet intensively or wearing unsuitable shoes, take breaks and stretch the plantar fascia regularly. - Consult a Specialist: For those with abnormal foot structures, custom-made shoes may be necessary.

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แคลเซี่ยม และวิตามินดี กับการบำรุงกระดูก

กระดูก ทำหน้าที่เป็นโครงร่างให้ร่างกาย อวัยวะภายใน และเป็นที่เกาะของกล้ามเนื้อและเส้นเอ็น เพื่อการขยับเคลื่อนไหว ร่วมถึงเป็นแหล่งสร้างเม็ดเลือดแดงจากไขกระดูก และเป็นที่เก็บสะสมแร่ธาตุ โดยเฉพาะแคลเซี่ยม เพื่อใช้ในระบบต่างๆ เช่น การทำงานของกล้ามเนื้อ เส้นประสาท และให้ความแข็งแรงแก่เนื้อกระดูก แคลเซี่ยม เป็นแร่ธาตุที่มีมากที่สุดในร่างกาย โดยร้อยละ 99 สะสมที่กระดูกและฟัน และอีก 1% กระจายอยู่ในส่วนต่างๆของร่างกาย โดยมีกลไกควบคุมสมดุลให้ระดับแคลเซี่ยมในเลือดอยู่ในค่าปกติ 8.5 – 10.5 mg/dL การบำรุงรักษากระดูกให้แข็งแรงไม่ให้เกิดภาวะกระดูกพรุน จึงต้องได้รับแคลเซี่ยมจากอาหารที่เพียงพอ เพื่อรักษาระดับแคลเซี่ยมในเลือดไม่ให้ต่ำลงจากค่าปกติ จนร่างกายต้องดึงแคลเซี่ยมจากกระดูกออกมาใช้ รวมถึงมีระดับ วิตามินดีที่เพียงพอเพื่อช่วยการดูดซึมแคลเซี่ยมจากลำไส้เข้าสู่กระแสเลือด กระดูกและข้อไม่เหมือนกัน กระดูก เป็นอวัยวะที่มีความแข็ง แต่มีเส้นเลือดจำนวนมากในเนื้อกระดูก มีเซลล์ที่ทำหน้าที่สลายเนื้อกระดูก(Osteoclast) และสร้างเนื้อกระดูก(Osteoblast) ขึ้นมาใหม่ตลอดเวลา เพื่อสร้างเนื้อกระดูกให้แข็งแรงอยู่เสมอ โดยกระดูกประกอบด้วยส่วนที่เป็นเนื้อเยื้อเกี่ยวพันจากโปรตีน มีความยืดหยุ่น ได้แก่ คอลลาเจน(Collagen type1) และส่วนที่เป็นผลึกแคลเซี่ยมฟอสเฟส(Hydroxyappatite crystal) ให้ความแข็งของเนื้อกระดูก ข้อ หรือกระดูกอ่อนผิวข้อ เป็นอวัยวะที่พื้นผิวมัน ลื่น และมีความยืดหยุ่น เพื่อลดแรงเสียดทานระหว่างผิวข้อและกระจายแรงที่กระทำต่อข้อต่อ ไม่มีเส้นเลือดเข้ามาเลี้ยง ทำให้การซ่อมแซมไม่ดีเท่ากระดูก โดยกระดูกอ่อนผิวข้อประกอบด้วยเนื้อเยื้อเกี่ยวพันจากโปรตีน ได้แก่ คอลลาเจน(Collagen type2) แต่ไม่มีการตกผลึกแคลเซี่ยมฟอสเฟสเหมือนกระดูก การบำรุงกระดูกหรือข้อต่อ จึงไม่เหมือนกัน โดยกระดูกจะให้ความสำคัญกับแคลเซี่ยมเป็นหลัก แต่ในขณะที่การบำรุงข้อต่อ จะเน้นที่การซ่อมแซมเนื้อเยื้อเกี่ยวพันหรือกระดูกอ่อนผิวข้อ ดังนั้นการทานแคลเซี่ยมเสริมจะช่วยบำรุงความแข็งแรงของกระดูก แต่ไม่ช่วยบำรุงข้อต่อ       ปริมาณแคลเซี่ยมที่ต้องได้รับในแต่ละวัน                 ร่างกายได้รับแคลเซี่ยมจากการรับประทานอาหารเท่านั้น และปริมาณแคลเซี่ยมที่ต้องได้รับในแต่ละวันจะแตกต่างตามช่วงอายุ ในผู้ใหญ่ หรือคนสูงอายุควรได้รับแคลเซี่ยม ประมาณ 1,000 – 1,200 mg. ต่อวัน เพื่อคงสภาพความแข็งแรงของเนื้อกระดูก                 อาหารที่มีปริมาณแคลเซี่ยมสูง ได้แก่ผลิตภัณฑ์จากนม เช่น นมวัน 1 แก้ว(กล่อง) มีปริมาณแคลเซี่ยม ประมาณ 250 – 300 mg. ในคนสูงอายุ หรือต้องการควบคุมไขมัน สามารถดื่มนมไขมันต่ำแทน โดยไม่ทำให้ปริมาณแคลเซี่ยมลดลง ผลิตภัณฑ์จากนมอื่นๆ เช่น โยเกิร์ต 1 ถ้วย ชีส 1 แผ่น มีปริมาณแคลเซี่ยมประมาณ 200 – 300 mg. นอกจากนั้น อาหารที่มีปริมาณแคลเซี่ยมสูง ได้แก่ปลา หรือ สัตว์ที่ทานได้ทั้งก้างหรือกระดูก และผักใบเขียวบางชนิด เช่น บล็อคโคลี่ คะน้า ตำลึง รวมถึงเต้าหู้ขาว  ดังนั้นควรดื่มนมวันละ 1-2 แก้วต่อวันเพื่อให้ได้ปริมาณแคลเซี่มเพียงพอในหนึ่งวัน ความสำคัญของวิตามินดี                   การรักษาระดับแคลเซี่ยมในร่างกายให้ปกติ นอกจากได้รับแคลเซี่ยมที่เพียงพอ ต้องอาศัยวิตามินดีช่วยในการดูดซึมแคลเซี่ยมผ่านผนังลำไส้เข้าสู่กระแสเลือด และเพิ่มการดูดซึมแคลเซี่ยมกลับเข้ากระแสเลือดที่หลอดไต(Renal tubule)โดยระดับวิตามินดีในกระแสเลือดที่เหมาะสม(25OHD) ประมาณ 30 – 50 ng/ml. ร่างการได้รับวิตามินดีจากการสังเคราะห์ที่ผิวหนังโดยรังสี UVB จากแสงแดด และจากอาหาร ร่างกายได้รับวิตามินดีจากการสังเคราะห์ที่ผิวหนังเป็นหลัก ประมาณร้อยละ 80 – 90 โดยต้องได้รับแสงแดดที่แรง และระยะเวลาที่เหมาะสม โดยเฉพาะช่วง 10 โมงเช้า ถึง บ่าย 2 โมง ต้องใช้เวลาประมาณ 20 – 30 นาที โดยไม่ทาครีมกันแดด แต่ถ้าเป็นช่วงเวลาที่แดดอ่อน อาจต้องใช้เวลา 40 – 60 นาที เพื่อจะได้รับปริมาณวิตามินดีเพียงพอในหนึ่งวัน นอกจากการสังเคราะห์วิตามินดีจากแสงแดด ร่างกายยังได้รับวิตามินดีจากอาหารที่รับประทาน     โดยปริมาณวิตามินดีที่แนะนำในหนึ่งวันประมาณ 600 – 800 IU.  อาหารที่มีปริมาณวิตามินดีสูง ได้แก่ น้ำมันตับปลา 1 ช้อนชา มีปริมาณวิตามินดี 400 – 1,000 IU. ปลาแซลม่อน 100 gm. มีปริมาณวิตามินดี 300 – 600 IU. ปลาทูน่า ปลาซาดีน ปลาแมคเคอเรล 100 gm. หรือปลากระป๋อง 1 กระป๋อง มีปริมาณวิตามินดี 200 – 300 IU. และในผลิตภัณฑ์อาหารบางชนิดที่มีการเสริมวิตามินเข้าไป เช่น นม นมถัวเหลือง น้ำผลไม้ เป็นต้น  การใช้แคลเซี่ยม และวิตามินดีเสริม             การได้รับแคลเซี่ยมและวิตามินดีที่เพียงพอจากธรรมชาติ ทั้งจากอาหาร และการสังเคราะห์จากแสงแดด ดีที่สุด และไม่จำเป็นต้องรับแคลเซี่ยมและวิตามินดีเสริม แต่ในคนที่มีภาวะกระดูกพรุน หรือคนที่มีโอกาสขาดแคลเซี่ยมหรือวิตามินดี เช่น คนสูงอายุที่ทานได้น้อย หรือไม่โดนแสงแดด จำเป็นต้องได้รับแคลเซี่ยม และวิตามินดีเสริม การเลือกใช้แคลเซี่ยมเสริม ปริมาณแคลเซี่ยม ดูที่ปริมาณแคลเซี่ยมที่ได้รับจริงหลังจากแตกตัวหรือ Elemental calcium ที่ระบุบนผลิตภัณฑ์ โดยคิดจากปริมาณแคลเซี่ยมที่ขาดไปจากอาหารที่รับประทาน เช่น ร่างกายต้องได้รับแคลเซี่ยม 1000 mg. ต่อวัน แต่ได้รับจากอาหารประมาณ 400 mg. ต้องได้รับแคลเซี่ยมเสริมประมาณ 600 mg. เป็นต้น โดยไม่แนะนำให้ปริมาณแคลเซี่ยมมากกว่า 1,500 mg. ต่อวัน เนื่องจากไม่ได้ประโยชน์เพิ่มขึ้นจากปริมาณที่แนะนำ และอาจมีผลเสียจากปริมาณที่มากเกินไป ชนิดของแคลเซี่ยม มีหลายชนิด เช่น แคลเซี่ยมคาร์บอเนต แคลเซี่ยมซิเตรท แคลเซี่ยมแอลทริโอเนต โดยแตกต่างที่การแตกตัว การดูดซึม วิธีการใช้ และราคา ตามคำแนะนำมูลนิธิโรคกระดูกพรุนแห่งประเทศไทย ให้ใช้แคลเซี่ยมคาร์บอเนตก่อน เนื่องจากราคาถูก Elemental calcium มากที่สุด หาซื้อง่าย แต่มีข้อเสียสำคัญคือต้องอาศัยกรดในกระเพาะอาหารในการแตกตัว จึงต้องทานพร้อมอาหารหรือหลังอาหารทันที ไม่แนะนำทานตอนท้องว่าง และหลีกเลี่ยงการใช้ยาลดกรดในกระเพราะอาหาร และมีผลข้างเคียงที่พบได้บ่อยได้แก่ ท้องอืด ท้องผูก ไม่สบายท้อง ซึ่งลดผลข้างเคียงโดยแบ่งครึ่งเม็ดยา รับประทานวันละ 2 เวลา  หรือเปลี่ยนเป็นแคลเซี่ยมแบบละลายน้ำหรือใช้แคลเซี่ยมชนิดอื่นแทน วิธีใช้แคลเซี่ยมเสริม จะแตกกต่างตามชนิดของแคลเซี่ยมที่รับประทาน เช่น แคลเซี่ยมคาร์บอเนต ต้องทานพร้อมหรือหลังอาหารทันที ห้ามทานตอนท้องว่าง แคลเซี่ยมซิเตรท แคลเซี่ยมแอลทริโอเนต  สามารถรับประทานตอนไหนก็ได้ เนื่องจากไม่จำเป็นต้องอาศัยกรดในกระเพาะอาหารในการแตกตัว ควรแบ่งรับประทานแคลเซี่ยมเสริม 2 มื้อ และไม่ควรเกิน 600 mg. ต่อมื้อ และรับประทานวิตามินดีเสริมร่วมด้วย เพื่อให้ช่วยการดูดซึมแคลเซี่ยมจากลำไส้เข้าสู่กระแสเลือดได้มากที่สุด การเลือกใช้วิตามินดีเสริม                 วิตามินดีเสริม มีหลายประเภท โดยวิตามินดีเสริมที่แนะนำ ได้แก่ วิตามินดี 2 และวิตามินดี 3  โดยวิตามินดีเสริมทั้ง 2 ชนิดเป็นวิตามินดี ที่ยังไม่ออกฤทธิ์(Inactive vitamin D) ต้องผ่านการเปลี่ยนเป็นโครงสร้างโดยตับ และ ไต ได้เป็นวิตามินดีที่ออกฤทธิ์(Acitve vitamin D) แต่ในคนที่มีภาวะโรคตับและไต อาจต้องเปลี่ยนเป็นอนุพันธ์วิตามินดีเสริม(Active vitamin D supplement)แทน                 ปริมาณที่แนะนำ วิตามินดี 2 (Vitamin D2) 20,000 IU./สัปดาห์ วิตามินดี 3 (Vitamin D3) 800 – 2,000 IU./วัน ในปัจจุบันผลิตภัณฑ์แคลเซี่ยมเสริมหลายชนิด มีการเติมวิตามินดีเสริมเข้าไปด้วย ซึ่งสามารถเลือกรับประทานวิตามินดีเสริมได้ทั้งแบบ วิตามินดี ชนิดเดียว หรือ แบบผสมกับแคลเซี่ยมได้ ในปริมาณที่ต้องการ แต่ไม่แนะนำ ให้รับประทานวิตามินรวม(Multivitamin) เพื่อให้ได้รับวิตามินดีที่เพียงพอ ซึ่งจะทำให้ได้รับวิตามินชนิดอื่นในปริมาณที่สูงเกินไป การบำรุงรักษากระดูกให้แข็งแรง นอกจากการได้รับแคลเซี่ยม และวิตามินดีเพียงพอ ควรรับประทานอาหารครบ 5 หมู่ และได้รับโปรตีนจากอาหารที่เพียงพอ ร่วมกับการออกกำลังกายกลางแจ้งอย่างสม่ำเสมอ รวมทั้งงดการสูบบุหรี่ งดดื่มเครื่องดื่มแอลกอฮอล์ ไม่ดื่มกาแฟมากเกินไป และการตรวจมวลกระดูกเพื่อประเมินความแข็งแรงของกระดูกตามข้อบ่งชี้ เพื่อป้องกันไม่ให้เป็นโรคกระดูกพรุน   นายแพทย์พงศา มีมณี ศัลยแพทย์กระดูกและข้อ โรงพยาบาลวิภาวดี

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Preventing anterior cruciate ligament (ACL) injuries

Preventing anterior cruciate ligament (ACL) injuries   The anterior cruciate ligament (ACL) is a crucial ligament within the knee joint that helps maintain stability during knee bending and rotational movements. Individuals without an intact ACL may experience instability and a sense of their knee giving way when twisting or rotating the knee. This can lead to knee pain and potential tears in the knee's supporting structures, such as the meniscus or other ligaments. Frequent episodes of knee instability due to compromised ACL can also result in increased damage to the supporting structures, leading to early-onset knee osteoarthritis.   A complete ACL tear alone often does not cause pain, except for the initial 2-3 weeks following the injury. The problem with a torn ACL arises from the knee's instability when subjected to weight-bearing activities that involve twisting or changing directions, such as turning or pivoting while walking, running, or cycling. These activities requiring agility and rotational movements are often compromised without the stabilizing function of the ACL.   The ACL cannot naturally heal or repair itself. If one seeks to restore stability in the knee with rotational movements, a new ACL must be reconstructed. There are three potential sources for constructing a new ACL:   -               Utilizing hamstring tendons. -               Utilizing a portion of the patellar tendon. -               Using a donor tendon (allograft) from another individual.   Many professional athletes, both male and female, have successfully returned to high-level sports after ACL reconstruction surgery. The recovery process involves significant efforts in physical rehabilitation and psychological resilience. While there is no reason why professional athletes cannot return to their pre-injury performance standards, the dedication to rehabilitation is crucial for regaining physical and mental capabilities.   The occurrence of anterior cruciate ligament (ACL) injuries is often associated with certain sports that involve high levels of physical activity, such as football, basketball, and volleyball. In contrast, such injuries are less common in golf unless accidents happen. However, what is particularly interesting is the statistical data showing a higher incidence of ACL injuries in female athletes compared to male athletes. Specifically, the incidence is twice as high in female basketball players and four times as high in female football players. This accounts for approximately 60% of female basketball players experiencing ACL injuries while landing.   So, what exactly is the anterior cruciate ligament (ACL) and what is its function? The ACL is a ligament located within the knee joint that helps stabilize the tibia bone by preventing its forward movement beneath the femur bone. The ACL becomes taut when the knee is forcefully extended, twisted, or subjected to intense rotational forces, which can result in the ligament tearing and compromise the stability of the knee joint. If left untreated, this can lead to the displacement or rotational movement of the tibia bone beneath the knee, causing joint damage.   Studies have identified several factors that increase the risk of ACL injuries in female athletes. However, research on training methods and exercise management has shown promising results in reducing the incidence of ACL injuries.   During landing, it has been observed that female athletes tend to land with less knee flexion compared to male athletes. This leads to greater impact forces on the knee and consequently increases the risk of ACL injuries. When pivoting or twisting the knee, female athletes often perform these movements with greater knee extension. The bending and alignment of the knee and hip joints play a significant role in exerting forces on the ACL. In golf, for example, keeping the left knee slightly flexed while striking the ball can reduce the stress on the ACL compared to immediately extending the knee and hip joints. Tiger Woods, for instance, frequently employs this technique when he wants to increase the distance of his shot by an additional 30 to 40 yards.   The muscles that control the knee joint include the quadriceps muscle group, responsible for knee extension, located at the front of the thigh, and the hamstrings, responsible for knee flexion, located at the back of the thigh. Female athletes primarily rely on the quadriceps muscles when changing direction or pivoting, generating forces that pull the tibia bone forward and extend the knee joint, thus increasing the risk of ACL tears. By focusing on hamstring muscle training and increasing its involvement, the risk of ACL injuries can be reduced.     The prevention of injuries to the knee can be achieved by both male and female athletes through training the strength of the quadriceps and hamstring muscles, as well as practicing stretching exercises. This also encompasses maintaining balance and stability in the knees, which is beneficial for golfers. In addition to reducing the risk of injury, having strong leg muscles and good posture will result in more accurate and powerful golf swings, as well as improved direction control.   Muscle Stretching Exercises: Quadriceps Stretching: Stand next to a wall or a table, bend one knee and bring the foot towards the back, feeling a stretch in the front of the leg. Hold this position for 5-7 seconds, repeating 6-10 times on each side.   Hamstrings Stretching: Stretch one leg forward while bending the other leg, lean forward and backward, feeling a stretch in the back of the extended leg. Hold this position for 5-7 seconds, repeating 6-10 times on each side.   Muscle Strengthening Exercises: Quadriceps Strengthening: Sit on a high chair, bend the knees, hang the feet, and straighten the knees against resistance. This can be done using sandbags or resistance bands.   Hamstrings Strengthening: Lie face down, bend the knees, and resist against a force. You can use weights tied to the ankles or resistance from elastic bands.     Word count: 931

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Injuries To The Wrist And Fractures In Golfers

Injuries To The Wrist And Fractures In Golfers   Skilled right-handed golfers predominantly suffer injuries to the left hand (the hand closest to the target) during the swinging motion. The left hand exhibits movements diagonally across the palm towards the thumb (radial deviation), known as cocking, and tilting back towards the pinky finger (ulnar deviation), also referred to as uncocking. These movements involve the bones of the wrist and bending of the hand. Improper swing mechanics or excessive practice can lead to injuries in the wrist area.   Severe injuries resulting in fractures are not common but can occur, especially in golf. Some refer to this as a Golfer's fracture since the golf club's handle can impact the bone of the wrist when it strikes the ground or when it is forcefully released from the grip. This particular bone in the wrist is called the Hamate bone, which has an extension similar to a hook on the palm side, known as the Hook of Hamate.   Image 1 illustrates the relationship between the Hamate bone and the flexor tendons, ulnar artery, and nerve.   Image 2 depicts an improper grip or incorrect swing, causing the golf club's handle to rub against the glove near the Hamate bone. If the impact is forceful, it can result in a fracture of the Hamate bone.   The significance of this type of fracture is that it often goes undiagnosed and receives inadequate treatment in the early stages. This is due to the mild and unclear symptoms experienced after the injury, which may not be visibly apparent externally. Some golfers may only feel slight discomfort, a lack of strength, and an inability to hit the ball properly. Many golfers attempt self-treatment without consulting a physician, and even if they do, the fracture may go unnoticed, and the treatment may not be followed up adequately. Leaving it untreated for an extended period, ranging from months to even longer, can lead to the bone becoming immobile or non-union. Some individuals may experience complications due to the fractured area compressing nerves or tendons, resulting in a weakened or absent little finger grip.   Image 3 shows a CT scan image indicating the fracture line of the Hamate bone (indicated by an arrow).   Prevention: • Golf club handles should be appropriately sized for the hand, and the grip should avoid pressing against the glove near the Hamate bone, particularly for slightly smaller left hands. • Proper grip techniques and studying correct swing mechanics should be practiced to prevent hitting the ground. • Regular hand strengthening exercises should be performed, such as squeezing hand springs or tennis balls. • Wrist flexibility exercises involving diagonal movements from the palm side to the pinky finger side (cocking - uncocking) should be practiced. • Wrist exercises using dumbbells should be incorporated.   Image 4 shows front arm muscle management using weight lifting, wrist flexion, wrist extension, and wrist rotation.   Recommendations for Golfers:   • When injured, it is advisable to cease playing golf. If there is a tender area, grip instability, abnormal movements, such as a loose grip or weak golf swings, it is recommended to consult a physician. If the condition does not improve within a week, it is advisable to seek a second medical opinion for accurate diagnosis and appropriate treatment. Normal X-ray examinations may not detect fractures and may require specialized X-ray views, such as the Carpal Tunnel View, or a CT scan to identify bone fractures. • The initial treatment for a fracture is immobilization for 6-8 weeks using a cast. • If left untreated for more than a month or if the fractured bone does not respond to immobilization, surgical intervention is often necessary to remove the affected bone.   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital From Golf Lover's Magazine Healthy Tips

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Training Tips for Golfers

Training Tips for Golfers   How can a golfer improve their strength and avoid injuries through practice? In order to enhance their golf skills and minimize the risk of injuries, golfers can make three key adjustments. These adjustments include changing golf clubs, modifying their swing technique, and improving their physical fitness. The advancements in technology have greatly contributed to the development of better golf clubs, golf balls, and related equipment. As a result, golfers today can hit the ball farther compared to a decade ago. The study of swing mechanics, the utilization of scientific sports tools, medical research, and high-speed video recording have improved the understanding and development of golf swing techniques. Moreover, these advancements have also contributed to better injury prevention and risk reduction.   It is crucial for golfers to understand the significance of practice intensity in order to maintain physical fitness and prevent injuries. The human body's tissues can adapt to the forces exerted upon them. In 1982, a German biomechanics physicist named Julius Wolff studied the changes in bones following the application of external forces. It was found that bones become stronger and denser in response to such forces, a phenomenon now known as Wolff's Law. Conversely, if bones do not experience these forces, they may become weaker and less dense. Subsequent studies have shown that other types of connective tissues, such as tendons and ligaments, undergo similar changes.   Figure 1 illustrates the changes that occur in connective tissues when subjected to different forces. The force applied to various tissues in the body, such as tendons and ligaments, varies depending on each individual's daily activities. These forces can range from minimal to moderate, up to significantly high, such as those experienced by athletes in activities like running and jumping. The graph demonstrates the magnitudes of forces applied. If the forces are too low, it can lead to muscle weakness, decreased tendon strength, and fragile bones. However, individuals who engage in regular physical activity, including golfers who consistently move their bodies, maintain tissues within the normal range without weakness or excessive strength.   To increase the forces applied during training beyond those experienced in daily life, the body's tissues undergo adaptations. These adaptations involve micro damage at the cellular level, which stimulates the body's remodeling response. This response triggers tissue growth and repair. The more micro damage present, the greater the body's adaptive response, requiring more time for recovery and remodeling. Consequently, these adaptations lead to increased bone size and strength, as well as muscle growth and enhanced strength. However, excessive forces can result in tissue tears and injuries that surpass the cellular level. Examples of such injuries include bone fractures and tendon ruptures.   Force and frequency:   Figure 2 illustrates the relationship between the magnitude of force and the frequency at which it is applied, resulting in injury. Sometimes, the force exerted does not arise from intensity or accidents, but rather from repetitive actions of minimal magnitude. While this may not directly cause injury, frequent and continuous repetition can lead to injuries. These repetitive injuries occur when a small force repeatedly acts upon a specific area of tissue, resulting in overuse injuries. Three factors contribute to such injuries: the magnitude of force, the frequency of repetition, and the duration of rest for tissue adaptation. This type of injury is commonly found among skilled golfers, such as shoulder and elbow injuries.   Summary for golfers:   Golfers should find opportunities for regular exercise, whether at work, on the golf course, or by climbing stairs instead of using elevators. If walking is difficult, golf carts should be avoided to maintain the strength and condition of bones and muscles. Gradually increasing and consistently maintaining exercise intensity will improve your physical strength. If you experience pain or fatigue, it is important to rest. If symptoms subside within 1-2 days, your condition will improve. However, if there is no improvement or if symptoms worsen, it is advisable to seek medical attention. When practicing golf, if you frequently drive with full-force swings, you should limit the number of repetitions to avoid experiencing pain. It is recommended to alternate with shorter swings of less than 100 strokes. Intensive training is necessary for those striving for excellence, but it should be done correctly and gradually, focusing on strengthening the muscles involved in the swing. Additionally, it is important to learn injury prevention techniques.   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital From Golf Lover's Magazine Healthy Tips

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To What Extent Do You Practice Golf?

To What Extent Do You Practice Golf?   How diligently do you practice golf, Pro Uan (Pro Nanthawat Siriporn) called me at the hospital and asked for my assistance in writing a piece for Galaxy Golf. He asked me if I'm available this evening to go practice golf at the railway field, to help him analyze his swing and discuss work matters. After finishing my work, I hurriedly met Pro Uan and bought six trays of golf balls. We stretched and warmed up, then began practicing continuously until we were drenched in sweat. Pro Uan was incredibly kind and offered me his guidance, saying that my swing was improving. After exhausting ourselves, Pro Uan asked me to help him with some writing to provide knowledge for golfers. He even generously offered me a free golf lesson and invited me to watch another one. I gladly accepted his offer with utmost gratitude.   In the following content, I will take you deep into the sport of golf, which is a fascinating and highly challenging game:   It appears to be a very simple game, just hitting the ball with a golf club into the hole from a distance of only 3 to 4 feet, but it can still be missed. Some golfers can hit the ball over 300 yards. How is that possible? Some players achieve a hole-in-one... a fluke (I don't want to admit it, but I've done it twice). Some people practice a lot, playing three times a week, yet they still struggle with consistent ball striking.   How should one practice like a pro? From Thongchai Jaidee’s book “On The Path To The Stars”:   At the age of 13, using discarded golf club pieces attached to bamboo, he played with friends after school, shining a flashlight on the club to see the ball when hitting. Once he had his own golf bag, he practiced every day, Saturday to Sunday, from morning till night. He underwent intense military training, running and exercising every day, which instilled discipline in his practice. He became a pro golfer seeking excellence.   We are proud to have the first Thai player to participate in The Masters at Augusta on April 6, 2549, and the first Thai player to complete all four Major tournaments, exemplified by half-Thai golfer, Tiger Woods.   In the book "Tiger Woods: How I Play Golf," while others may be able to beat him in golf competitions, no one can surpass him in terms of intense practice. As the world's number one golfer, fluent in English, he was asked if he still needed to practice that hard. He replied that he was the last person on the practice range yesterday and returned to the same question: "To what extent do you practice golf?"   The answer is:   It depends on where you start. Where do you want to go?   If you aspire to reach your highest desired level, you must not allow other golfers at that level to practice harder than you.   I leave you with this quote: "Think far, go far."   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital From Golf Lover's Magazine Healthy Tips

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Bones That Golfers Should Know

Bones That Golfers Should Know   Greetings! The author has previously discussed the concept of "living bones," which are studied at the cellular level and require the assistance of a microscope for examination. Now, let us delve into the understanding of bones visible to the naked eye, specifically their significance in the sport of golf.   Within our bodies, we possess 206 bones, divided into two categories: the axial skeleton and the appendicular skeleton. The axial skeleton consists of 80 bones, while the appendicular skeleton comprises 126 bones, which form the arms and legs.   The axial skeleton component that golfers should familiarize themselves with is the spine, which consists of 26 bones. It's worth noting that the skull bones and facial bones, despite their presence, hold no importance in the golf swing.   The majority of spinal bones share a similar structure, including:   The body, which is a thick, round disc located at the front. The upper and lower surfaces of the body serve as attachment points for spinal cushions. This particular section of the spine carries the weight.   The vertebral arch, a curved bony structure located at the back of the body, enclosing the spinal canal.   Processes, which are protrusions extending from the vertebral arch. There are seven of them, serving as articulations between adjacent spinal bones and attachment points for muscles, aiding in the movement of the spine.   The cervical spine, or neck region, consists of seven bones. The first and second cervical vertebrae differ from the other spinal bones. The first cervical vertebra, known as the Atlas, resembles a ring without a body, while the second cervical vertebra, called the Axis, has a protrusion from its upper part known as the Dens, which resembles a tooth and extends into the ring of the first cervical vertebra.   Approximately 60% of head rotation occurs at the first and second cervical vertebrae. If you tilt your head down, you can rotate your head approximately 45-50 degrees by rotating it on the first and second cervical vertebrae. On the other hand, if you extend your neck and lift your chin, you can rotate your head 80-90 degrees, allowing your chin to touch each shoulder. This additional 40% of head rotation occurs on the third to seventh cervical vertebrae, collectively. Due to the structural nature of the cervical vertebrae, when swinging a golf club, it is advisable not to hunch over and look at the ball, but rather to extend the neck and lift the chin. This action aids in rotating the neck involving the third to seventh cervical vertebrae, allowing for maximum torso rotation.   The external thoracic vertebrae, numbering 12 pieces, are larger and stronger than the cervical vertebrae. However, due to the attachment of the rib bones to the 12 pairs of thoracic vertebrae, the movement of the external thoracic vertebrae is limited.   The lumbar vertebrae, consisting of 5 pieces, are the largest and strongest. They allow for significant movement, especially in bending forward and backward positions.   The sacrum, composed of 5 fused vertebrae, does not have any movement.   The coccyx, consisting of 4 fused vertebrae, also lacks movement. When the coccyx forcefully hits a hard surface, such as when falling, it may fracture or bend.   The curvature of the spine:   In a normal spine, when viewed from the back, it appears straight. However, when viewed from the side, it shows four natural curves. The neck and lower back curve forward, while the thoracic and sacral regions curve backward. In a fetus in the womb, the spine is initially curved. After the baby starts lifting its head and crawling, the spine curves forward. When the baby learns to stand, the lumbar spine curves forward. As for the external thoracic and sacral regions, they retain their original backward curvature.   The curvature of the spine enhances strength, promotes balance, and reduces impact during walking or running. When swinging a golf club, it is advisable to bend at the hip joints rather than arching the lower back, as it can cause improper curvature of the lumbar spine and restrict rotation. Additionally, it increases pressure on the lumbar cushion, potentially leading to back pain or even nerve compression if the cushion is severely distorted.   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital From Golf Lover's Magazine Healthy Tips

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How Do Muscles Work In The Golf Swing?

How Do Muscles Work In The Golf Swing?   In my previous discussion on golf training, I emphasized the importance of tailoring your practice to suit your individual physical condition. Even if you have a great golf swing or invest in expensive equipment, it won't guarantee improved performance if you've already sustained an injury. The control of the golf swing lies in the hands, specifically in the grip of the golf club, which extends from the wrist, elbow, shoulder, and torso.   Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital, explains the workings of muscles in the golf swing.   In golf training, it is crucial to adapt your exercises to suit your physical condition. Once an injury has occurred, no matter how good your golf swing is or how many high-priced accessories you purchase, they won't magically enhance your golf game. The control of the swing resides in your hands, which grip the golf club and extend from the wrist, elbow, shoulder, and torso.   The body's movements are controlled by the brain through the central nervous system. This allows you to consciously control muscle movement as well as the automatic nervous system, which controls muscle function without your conscious effort. Examples of these muscles include the cardiac muscles (heart muscles) and smooth muscles found in the digestive and circulatory systems. You cannot voluntarily slow down or stop your heart from beating, and if you reach the age of 70, your heart will have beaten approximately three billion times without ever pausing. If your cardiac muscles stop resting, it means you won't have the opportunity to play golf anymore.   Figure 1 depicts the muscle fibers of the body under the influence of mental power.   The muscles under your voluntary control are the striated muscles, such as the muscles in your arms, legs, neck, and back. If you don't train them properly, these muscles will not work in harmony. Within the golf swing, multiple sets of muscles work together in a coordinated and sequential manner. They don't contract simultaneously, and if you imagine all the muscles being stiff and tense at once, it resembles the physical condition of a deceased person within 3 to 4 hours up to 24 hours, where muscle fibers are tightly adhered due to the lack of energy supply to the muscle cells. The muscle fibers cannot relax until the proteins begin to break down naturally. Only then can the muscle fibers detach from each other.   If you are excessively excited or overly focused, your muscles will tense up, and you won't be able to control your swing properly. For example, during the downswing before impact, your left elbow should extend using the triceps brachii muscle. If you contract the muscles on the front side of your elbow, the biceps brachii muscle, your left elbow will flex, causing you to mishit the ball or miss it entirely.   Image 2 showcases the biceps brachii muscle and the triceps brachii muscle.   The golf swing involves a continuous transfer of force from the arm to the wrist and ultimately to the golf clubhead. The muscles must generate force by initiating the rotation of the left arm before exerting the force that controls the wrist. During the downswing, it is important not to strike downwards from the top. Instead, the left shoulder should rotate downward until the right elbow reaches hip level, utilizing the triceps brachii muscle to control the wrist and deliver force to the clubhead at the point of impact (see Images 3 and 4).   Most amateur golfers tend to start their swing by striking downwards from the top, resulting in a lack of force transmitted to the clubhead and causing the clubface to open, resulting in a slice.   Image 3 illustrates Tiger Woods during the downswing, generating force and transferring it to the clubhead. It begins with the rotation of the torso and left arm before accelerating the extension of the right arm and wrist while maintaining body weight.   Image 4 demonstrates that the force generated by the rotation of the left arm initiates first and then decreases. The force that accelerates the clubhead through the wrist begins after the initial muscle group and progressively increases until it passes the impact zone.   To generate force through the contraction of the muscles, you must utilize a chain reaction. If you tense too much or rely on the muscles we use in our daily lives, such as striking downwards with the arm without coordinating the movement with the legs, torso, and shoulders, it not only fails to generate a continuous force but also affects the swing plane.   In conclusion, here are some key points for golfers:   Proper grip of the golf club is crucial because your hands are the only link between you and the club. If you are unsure, seek guidance from a golf instructor to ensure correct positioning. Additionally, practice on your own until you are confident that when you address the ball, the clubface and target line are perpendicular, even after the backswing and during the slow downswing when the clubface should still be aligned with the target line. Practice your swing, starting with accelerating the clubhead towards the impact zone when your right elbow returns to hip level and your hand is ready to strike. For golfers who struggle with distance, direction, or are new to the game, it is advisable to seek instruction from a golf professional rather than solely relying on self-practice.

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Injury to the Fingers

Injury to the Fingers   An injury to the fingers was brought to the attention of the writer by a 27-year-old professional golfer. The golfer complained of severe pain in the left index finger, making it impossible for them to play golf for the past two months. The injury occurred due to excessive golf practice, leading to pain in the middle joint of the finger. The golfer had already visited a doctor twice, and the finger seemed to be functioning normally when extended, but it would hurt again when gripping the golf club for practice. This has made them reluctant to practice, fearing they won't be able to compete. The writer considers this a matter of great importance, as the golfer is a skilled professional golfer and an alumni of the national team, Class A, who successfully passed the first round of the Singapore Tour with a score of 7 under par, including 6 birdies and 1 eagle at the Bright Resort course. It is essential for them to receive proper treatment to recover and be able to participate in international competitions. Finger injuries related to sports, especially golf, are generally not severe and may not receive immediate comprehensive treatment, or some golfers may perceive them as insignificant because they can still move their fingers and perform normal activities, albeit with some discomfort. However, these injuries can easily result in pain and swelling.   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital   Injury to the Fingers   Injury to the fingers refers to a condition where there is a fracture in the bones, causing significant abnormalities in finger movement. This condition is not commonly seen in golf players and often does not pose problems in terms of diagnosis and treatment, as the symptoms of pain, swelling, and abnormal movement can be clearly identified through X-ray examination. The commonly overlooked issue is the invisible injuries that cannot be detected externally. If no abnormalities are found in the X-ray examination, it becomes difficult to make a clear diagnosis. However, if the condition does not improve within 1-2 weeks, it is necessary to consider other possible causes of the injury that may have been overlooked. If not properly treated from the early stages, it will be challenging to treat the injury and hinder golf performance. The injury to the middle joint of the finger (proximal interphalangeal joint) is composed of three joints:   The joint at the base of the finger The middle joint of the finger And the joint at the tip of the finger   The movement of the middle joint allows flexion and extension but does not allow lateral movement or rotation. This is due to the structure of the finger joint and the collateral ligaments that provide stability to the joint, allowing it to move only in flexion and extension. In golf, when the left index finger grips the golf club while swinging, excessive pressure from the club handle can cause a tear in the collateral ligament on the side of the finger. This may result in pain and swelling, with other subtle abnormalities that may not be easily discernible. X-ray examination may not reveal any abnormalities. Resting for 3-4 days usually allows normal movement again, making the diagnosis relatively challenging and often leading to inadequate treatment. Consequently, if pressure is applied to the index finger again, the ligament tear can worsen, causing swelling in the finger joint, and preventing the golfer from playing golf.   Diagnosis:   There is pain and swelling in the middle joint of the finger. Pressing on the side of the finger where the collateral ligament is located causes pain. Check the stability of the side of the middle joint of the finger. If there is a complete tear, the pain will be worse, and the joint may dislocate. An X-ray may not reveal any abnormalities. If there is suspicion, the finger should be examined in a specific position to check for possible ligament tears.   Treatment:   In the acute phase, it is advisable to rest and avoid movement of the index finger. If there is significant swelling, apply cold compresses for the first 4-6 hours until the swelling subsides. Buddy taping the index finger to the middle finger to prevent lateral movement of the joint for approximately 2 weeks. If there is a significant tear and the joint is swollen, immobilize the finger to prevent movement. The duration of immobilization depends on the severity of the ligament tear and may take 1-3 weeks. If pressing on the torn area does not cause significant pain and the joint stability is good, gradual movement or buddy taping can be initiated to prevent joint stiffness.   In chronic cases where the finger starts to deviate and the joint remains swollen after 4-6 weeks of untreated symptoms, treatment becomes challenging. The outcome of treatment may not be as successful as in the initial stages.   Apply a finger splint to keep the finger in a normal position, especially at night. When practicing golf, use a grip aid to prevent increased joint deviation. Use a grip aid that holds the finger on the side where the ligament is torn. Avoid lateral pressure on the index finger. Recommend finger range of motion exercises to prevent joint stiffness and strengthen the finger muscles. If after 4-6 weeks of comprehensive treatment, there is still pain, swelling, and joint instability, surgical intervention may be considered to repair the torn collateral ligament in the finger joint.   Recommendations for golfers:   If an injury occurs in the hand, and after resting and treating for 1-2 weeks, there is still pain, swelling, tender points, abnormal finger bending or stretching, or the inability to play golf normally, it is necessary to seek proper medical examination and treatment. Some injuries, such as a fracture of the hook of the hamate bone or scaphoid fracture (wrist bone at the base of the thumb), torn collateral ligament, or initial finger dislocation, may not show any abnormalities initially. If you, as a golfer, still have abnormal symptoms and no improvement within 1-2 weeks after the injury, you should consider the possibility of these difficult-to-diagnose injuries.

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Golf Injuries

Golf Injuries   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital   Golf is a widely popular sport, greatly influenced by live broadcasts of major tournaments on television almost every week. The increased prize money and the rise of young Superstar players, such as Tiger Woods and Mitchel Wie, have created an iconic image for aspiring youth who seek them as role models. This has led to the promotion of golf among children from a young age, as well as attracting those who become interested in playing golf later in life or after retirement.   Compared to other contact sports or high-speed competitions, golf seems relatively safe and free from danger or injuries. However, there are risks and injuries that may be overlooked. Reports from our country and numerous international journals indicate the following:   Injuries or dangers unrelated to a golfer's swing: Fatal accidents caused by being hit by a golf ball, struck by a golf club, or being pierced by broken golf shafts. Fatal lightning strikes. Fatal collisions with golf carts. Fatal falls after being hit by a golf ball. Risks from sun exposure, leading to reports of skin cancer found in 51 professional female golfers, 142 amateur female golfers, 4 professional male golfers, and 11 amateur male golfers.   Injuries from golf swings have various causes among golfers:   Excessive practice or competition. Improper swing technique. Insufficient physical preparation before playing golf. Poor pre-existing health conditions. Golfers who pass away during play due to transportation to hospitals or deaths occurring in multiple hospitals. Injuries that persist from previous treatments.   Injuries among professional golfers Most injuries among professional golfers, not including issues with incorrect swings, occur due to excessive practice or competition, with approximately 80% of injuries affecting the back and wrists. Other commonly affected areas include the right elbow, shoulder, and knees. Injuries among amateur golfers Amateur golfers can sustain injuries in almost all parts of the body, depending on which area of the swing is overly utilized. Common injuries include the back, elbows, wrists, shoulders, knees, and neck, respectively. Additionally, severe injuries have also been reported, such as fractures in elderly female golfers' spinal bones. Newly learning golfers, 18 cases (average of 8 weeks of golfing), had 15 cases of rib fractures and 3 cases of right-sided rib fractures, mostly occurring in ribs 4, 5, and 6, in positions that are relatively towards the back.   Preventing potential harm to others:   Store and secure golf clubs in a safe place, preventing children from playing with them unsupervised. When teaching children to play golf, adults should provide guidance and ensure safety precautions. When standing, maintain a distance of at least four club lengths from someone who is swinging a golf club and avoid moving ahead in the direction of the golf ball.   The Problem of Golf Injuries   Excessive practice or competition. Previous injuries leading to recurring injuries. Most commonly found in the back, wrists, elbows, shoulders, and knees. Injuries may not be severe but can affect performance and increase the risk of further injuries.   Recommendations:   Prior to every practice session or competition, warm up the body and stretch the muscles adequately. Engage in muscle-strengthening exercises to improve endurance and resilience, such as running and weightlifting. Correct swing mechanics to reduce the risk of injuries and improve golf performance by seeking guidance from a golf instructor. Choose appropriate golf clubs and footwear. When injured, refrain from playing and consult a physician for accurate diagnosis and proper treatment from the beginning. Before returning to play, ensure full recovery from injuries and strengthen the muscles.   Preventing Hazards While Playing Golf Dangers that may arise from sunlight, dehydration, injuries from being struck by a golf ball, hazards from animals on the golf course, or lightning. Recommendations:   Golfers should protect themselves from sunlight by using sunscreen, wearing hats, and long-sleeved shirts. Stay hydrated by drinking an adequate amount of water before and after playing, and drink water during the game without waiting to be thirsty. If continuous sweating occurs for more than an hour, consider drinking a sports drink with electrolytes. Familiarize yourself with the rules of golf etiquette. Before swinging the golf club, ensure that no one is standing too close, which could pose a danger from the club's swing. Wait until it is certain that players in the group ahead have moved out of range. Golfers should avoid entering areas that are potentially dangerous due to animals or poisonous insects. In the event of lightning, immediately stop playing golf and leave the course.   References: Farrally, M.R., & Cochran, A.J. (1998). Science and Golf III. Human Kinetics. Jobe, F.W., & Schwab, D.M. (1991). Golf for the mature athlete. Clin Sports Med, 10(2), 269-282. McCarroll, J.R., & Gioe, T.J. (1982). Professional golfers and the price they pay. Physician SportsMed, 10(7), 64-70. McCarroll, J.R., Retting, A., & Shelbourne, K. (1990). Injuries in the amateur golfer. Physician SportsMed, 18(3), 122-126.

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Skin, The Most Amazing Organ

Skin, The Most Amazing Organ   By Dr. Virayut Chaopricha Orthopedic Surgeon at Vibhavadi Hospital   Several professional golfers have achieved success in both domestic and international competitions. Many amateur golfers have also received consecutive trophies. Congratulations to all of you. Those who have not yet achieved their goals, keep developing. "We will not fail if we do not give up." I encourage and support all golfers who are determined to continuously improve their skills. Over the past two years, I have presented frequent injuries from golfing, and many readers and golfers have shown great interest. Many of you have come from different provinces to meet me and have received advice. You have recovered well and returned to playing golf. One potential danger that arises from playing golf in a sunny and hot country is the issue of skin. However, no golfer has consulted me about skin issues. Most of them seek help from dermatologists, which is the correct approach to receive the best treatment. I would like to provide information about skin for the benefit of all golfers and to prevent potential risks. The skin is the largest organ in the body, covering an area of approximately 2 square meters and weighing about 4.5-5 kilograms. The average thickness is 1-2 millimeters, with the thinnest skin being around the eyes at approximately 0.5 millimeters and the thickest on the soles of the feet at about 4 millimeters. The skin consists of two layers of tissue:   Epidermis: The outermost layer. Dermis: Located beneath the epidermis. The subcutaneous layer (hypodermis) is not considered part of the skin. It is a fatty layer, and in this layer, women have more thickness than men, approximately 8 percent more. This leads to women having softer skin than men, and some areas may have increased fat deposits, such as the abdominal area, hips, and legs. The epidermis consists of 4-5 layers.   In the lowermost layer of the skin, the epidermis undergoes continuous division and pushes old cells upward. The skin cells produce keratin, a protein within the cells that provides resilience and waterproofing. At the same time, the cells lack blood supply and become dead cells that shed every day.   The epidermis consists of four types of cells:   Keratinocytes: Predominant cells, accounting for 90%. Melanocytes: Pigment-producing cells, accounting for 8%. Langerhans cells: Cells that help defend against infections. Merkel cells: Cells that transmit sensory information to nerve cells.   The dermis is composed of collagen fibers, elastic fibers, blood vessels, muscles, nerve fibers, and various specialized nerve receptors. These receptors perceive sensations such as touch, pressure, heat, and cold, and transmit feelings of pain.   The functions of the skin:   It wraps and covers the body, maintaining its shape, and provides protection against diseases and ultraviolet (UV) light from the sun. It regulates water loss because the uppermost layer of skin consists of dead cells and a coating that prevents water from seeping through. The body controls its temperature at 37 degrees Celsius through the workings of sweat glands. It senses various sensations such as heat, cold, touch, and pain. It synthesizes melanin, which darkens the skin after exposure to sunlight. It synthesizes keratin in the outermost layer of the skin, which sheds daily. It synthesizes vitamin D from the small amount of UV light received, leading to changes in the liver and kidneys and aiding in the regulation of calcium levels. This is essential for children to prevent weak bones and for adults to promote bone strength. It plays a role in conveying meaning when there are changes in emotions. For example, blood vessels contract when startled, resulting in pale face and cold hands. When angry, blood vessels dilate, causing a flushed face. The muscle contractions in the facial muscles, which attach to the skin, can express various emotions such as smiling, furrowing eyebrows, anger, joy, and sadness.   Since the skin performs multiple functions and works together with other parts of the body, such as hair, nails, sebaceous glands, and subcutaneous fat, to maintain the body's normal state, it can be considered as one system of the body called the Integumentary System. Taking care of the skin is crucial for maintaining good health and is a significant aspect of the beauty and cosmetic industry. It involves preserving and enhancing the skin's appearance, making it look younger, as well as treating conditions like acne, freckles, age spots, and other sun-related damages.   Excessive exposure to sunlight can lead to skin cancer. Reports have shown that there are approximately one million cases of skin cancer in the United States each year. Among them, 78% are Basal Cell Carcinoma, a cancer that originates from the lowest layer of the epidermis and usually does not spread. 20% are Squamous Cell Carcinoma, a cancer that arises from the flat cells of the epidermis and may spread. 2% are Malignant Melanoma, a cancer that originates from melanocytes, the cells responsible for producing the pigment melanin. Malignant Melanoma can be life-threatening as it spreads rapidly. Early diagnosis and complete surgical removal yield the best treatment outcomes. The key characteristics of Malignant Melanoma are: A - Asymmetry: The shape is irregular and not symmetrical or round. B - Border: The edges are undefined, wavy, or not well-defined. C - Color: The color varies within the same lesion, displaying different shades. D - Diameter: The diameter is larger than 6 millimeters. This differs from the normal appearance of moles (Nevus) and Malignant Melanoma. Normal moles are round, have a consistent color, sharp borders, and are smaller in size.   Additionally, reports have been published in various international journals indicating the presence of skin cancer in both amateur and professional golf players.   Recommendations for golfers:   Avoid sun exposure during peak hours of intense ultraviolet (UV) radiation, specifically between 10:00 AM and 3:00 PM. If necessary, wear long-sleeved shirts, use a wide-brimmed hat, and carry an umbrella for shade. Use sunscreen regularly with a sun protection factor (SPF) of 15-28 when playing golf in moderate sunlight for short durations, not exceeding 2 hours. If playing golf for more than 2 hours, use a higher SPF that corresponds to the sunscreen's ability to protect against UV radiation, measured as a multiple of the minimum erythema dose (MED) - the amount of UV radiation needed to cause skin reddening. SPF = MED of sunscreen used MED without sunscreen If there are any abnormal skin conditions, especially growths resembling moles that are rapidly growing or large in size, it is advisable to promptly consult a physician. Hydration is crucial. Drink water before, during, and after playing golf to prevent dehydration. If you experience excessive thirst, it indicates that your body is already dehydrated. Cleanse and dry moist areas of the skin, such as between the toes, to prevent fungal infections. Hands are prone to harboring disease-causing pathogens. They can pose a significant risk if these pathogens spread to other areas, such as the eyes, leading to eye inflammation, or if you handle food while playing golf, it can result in foodborne infections.

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