I Broke My Wrist As A Kid, And Now It’s Starting To Hurt Again! Why?

I got another email from a Rescue Fan that asked about pain in the wrist that has recently become very bad.  He had injured the scaphoid bone in his wrist as a teenager, got a cast, took it off prematurely and then just recently began to really feel pain, numbness and discomfort in the same area.  I emailed him back and then thought there may be other’s with the same question due to the popularity of this type of injury. Here’s my email back to him.  I hope it helps.

Dear _____

I’m sorry to hear that you’re going through so much discomfort.  I looked up your injury and though nothing has told me anything you didn’t already know about this type of injury I’m including a video that may help refresh your memory.

In regards to the injury causing more problems.  You are always welcome to request a second opinion and may even want to find a good “sports medicine” Ortho Doctor.  It could be a number of things causing the pain but one reason is due to the possibility of developing “traumatic arthritis”, it could be Simple immobilization in a cast will not lead to healing of the bone. This scaphoid bone is particularly prone to this for several reasons: there is the possibility of the fracture being missed at the initial injury leading to a delay in treatment; secondly, the bone has a poor blood supply. The fact that it is inside the joint and is constantly being bathed by synovial fluid also contributes to the development of a nonunion. A nonunion, in other words, is a failure on the part of the patient’s bone to complete the healing process. A “false joint” occurs at the nonunion since the ends of the broken scaphoid are attached to ligaments at each end of the bone, further separating the fracture and preventing healing(http://www.arthroscopy.com/sp04013.htm). This can only be verified via thorough investigation by a qualified physician. In the mean time, rest, ice, elevation when possible and maybe even a splint of some sort can help to immobilize while on the way to the doctor to get to the bottom of the issue.

I hope this helps and I hope you’ll let me know what you find out.

Best Wishes,


Lindsey Vonn Super G Skiing Accident Medical Breakdown



In this episode of RoyOnRescue, I take a look at the details of the recent Lindsey Vonn skiing accident and what mechanism of injury caused the serious knee injury she suffered. Watch actual footage of the accident while I comment on how the crash caused her injuries. Then, discuss what steps you might take to minimize further damage and what you would do as the rescuer on scene prior to air evacuation.

Football Helmet Removal During Emergencies

In this episode, Roy answers a question that came in regarding how to remove a football helmet if a person may have a neck injury.  Roy explains that only when the person’s life depends on it, should a helmet be removed before professional rescue personnel arrive.  If the person’s life depends on a rescuer being able to remove the helmet, then it should be removed following a few guidelines.  Be sure to watch this episode of RoyOnRescue to learn when and how a helmet should be removed during an emergency.

When Is It Safe To Return To Work or Sport After A Concussion?

Hello Everyone,

I had a person email this question and I thought it may be a good refresher for everyone on a very common accident and injury that effects many different age groups and many different people.

Below is the question and the answer follows below that.

Dear Roy,

I had an injury yesterday playing baseball I ran into another player. I don’t really remember what happened.  I was told I hit my head on his chin and on the way down, my chin hit his knee, and then hit my head on the ground. I was knocked out. When I woke,  I didn’t know what happened and could not move or talk for about a minute.  Then, when I went to get up, my legs collapsed.   So I went to the emergency room for  a CT scan.  No bleeding to the brain,  but had an extreme headache.  Now the next day,  head still hurts and my neck is sore but not as bad. the ER doc said everything looked fine, but could not really say if I have a concussion or not.  He said I have the “symptoms”.  I guess my question is,  when should I go back to work?  The doc only took me off for a day but I am still in pain.

Hello J—-,

Concussions can be very tricky. They may not show up on CT or Xray and you can really feel lousy for a while after the initial accident. If you don’t feel capable of returning to work, it’s always best to allow your body the ample time required to heal prior to putting your body back in a stressful situation. However, that’s the perfect case scenario. It’s pretty common that those of us who work, may have to return to work prior to feeling 100%. If this is the case and you cannot get your doctor to write a letter for additional recovery days for your employer, make sure you watch your signs and symptoms and listen to your body. If you become dizzy, nauseated, develop a headache etc., these can lingering signs of a concussion but may not be serious enough for you to be hospitalized. But if you handle heavy equipment or must be at your best to stay safe, keep others safe, or do the level of job required of you, this should probably be communicated to your professional health care provider and see if an extra bit of recovery time could be allowed.

It’s never any fun getting a “Konk On The Melon” and even less fun dealing with the lingering side effects while duty is calling the patient back to work.

Keep an eye on your symptoms and as most any health care provider would tell you, if your symptoms worsen, you become more painful and not less painful over time, if you have numbness, tingling, have a seizure, headache increases, get more dizzy not less dizzy or have a decreased level of consciousness, 911 should be called and you should be seen in the Emergency Room.

Other wise, if the symptoms don’t get worse but get better though are still lingering a few days, it may be within normal recovery expectations and you simply need to take it easy and allow yourself to recover.  If you are ever in doubt, don’t hesitate to contact your medical professional and let them know what your symptoms are and see if they want to reassess the situation.

I found a well laid out guideline for definitions and signs and symptoms from a website and I’ll pass the information on to you along with the link for credit to the referenced website.

Sports Concussion

It’s more than just a bump on the head

MYTHS about sports concussion…

1. Concussion is a minor brain injury with no long-term effects

2. If you weren’t knocked out, then you didn’t have a concussion

3. Having multiple concussions is common in sports and no cause for concern

4. Symptoms of a sports concussion will always clear up, usually in a few days

5. If there’s no visible injury, everything’s okay

6. You should play through the pain—get back in the game!

FACTS about sports concussion…

1. Twenty percent of all concussions are sports-related

2. A concussion doesn’t always knock you out

3. Having one concussion increases your chances of having another

4. Symptoms of a concussion can last hours, days, weeks, months, or indefinitely

5. Concussion can cause disability affecting school, work, and social life

6. Returning to contact or collision sports before you have completely recovered from a concussion may lead to more serious injury and can increase your chances of long-term problems

What is a concussion?

Concussion is a mild traumatic brain injury that occurs when a blow or jolt to the head disrupts the normal functioning of the brain. Some athletes lose consciousness after a concussion but others are just dazed or confused. Concussion is usually caused by a blow to the head, but can also occur due to whiplash.

How can you tell when an athlete or person gets a concussion?

Sometimes, but not always, the athlete will be knocked out. In cases where there is no obvious loss of consciousness, the athlete may appear to be confused or disoriented (such as running in the wrong direction), and may not remember things that happened before or after the concussion, such as what period it is or the score of the game. Often, the athlete will describe some symptoms of a concussion, such as headache, dizziness, nausea, or blurred vision. It is also common for athletes to describe feeling “fuzzy” or “foggy” after concussion, and to have problems with balance or coordination. For this reason, and also because symptoms can sometimes worsen rather than improve, careful observation of the athlete after concussion is especially important.

What is post-concussion syndrome?

Post-concussion syndrome is a term that describes the physical, cognitive, and emotional symptoms that are caused by concussion and which can last for a varying amount of time after injury. Some symptoms show up right away, but others may not appear or be noticed until the next day or even later. Likewise, some symptoms might resolve fairly quickly, but others—especially fatigue—can persist much longer. The number and severity of symptoms, the speed of recovery, and the impact of symptoms on day-to-day functioning will be different for each athlete.

Physical Symptoms…

* headache
* neck pain
* nausea
* lack of energy and constantly feeling physically and mentally tired
* dizziness, light-headedness, and a loss of balance
* blurred or double vision and sensitivity to light
* increased sensitivity to sounds
* ringing in the ears
* loss of sense of taste and smell
* change in sleep pattern especially waking up a lot at night

Social and Emotional Symptoms…

* mood changes including irritability, anxiousness, and tearfulness
* decreased motivation
* easily overwhelmed
* more impulsive and disinhibited
* withdrawn and wanting to avoid social situations

Cognitive Symptoms…

* feeling ‘dazed’ or ‘foggy’
* difficulty concentrating and paying attention
* trouble with learning and memory (especially for recent events)
* problems with word-finding and putting thoughts into words
* easily confused and loses track of things
* slower in thinking, acting, reading, and speaking
* easily distracted
* trouble doing more than one thing at a time
* lack of organization in everyday tasks

How long does it take to get better?

Most people do recover completely from a concussion, usually in a matter of days. However, it can take up to a year or longer for some athletes to recover, and in some cases the symptoms won’t go away. Recovery may be slower in those who have already had one or more concussions, and in those who have a history of learning disability or attention disorder.

When it is safe to return to play after concussion?

There are several guidelines for return to work/play after concussion.  All of these share some common principles:

1. An athlete who has suffered a concussion should be removed from competition immediately and monitored for post-concussion symptoms

2. An athlete should not return to play before he or she is completely symptom-free at rest and after exertion for a specified period of time, which varies based on the athlete’s history and the severity of the concussion.

3. Athletes who have a history of one or more previous concussions should be treated more cautiously (not returned to play as quickly) than those who have suffered their first concussion

4. When in doubt, sit them out!

How can you tell when an athlete is symptom free?

An athlete should only return to competition when it is clear that there are no lingering symptoms of concussion. Unfortunately, because concussion is an invisible injury, and because athletes may minimize or not recognize persistent post-concussion, symptoms, this can be a tricky matter. Also, symptoms may sometimes go away, only to come back after physical or mental exertion.

Most often, return to play decisions are made without the benefit of neuropsychological testing and are based on observation and player report of symptoms. Neuropsychological testing provides the coach or team physician with information that can help to take the guesswork out of concussion management and return-to-play decisions. Using a battery of tests of memory, reaction time & processing speed, we can provide specific information regarding the severity of injury and a standard for evaluating recovery from injury. It is of benefit for athletes to receive baseline assessment prior to or at the beginning of the athletic season to allow for within-subjects analysis of scores following an injury.

I hope this helps J—- and I hope you feel better real soon.

Thanks for the question.

Best Wishes,

Roy, RoyOnRescue.com

16 Year Old Dies Suddenly On Basketball Court!

In this episode, Roy talks about a terrible tragedy where a 16 year old athlete made the winning shot, was greeted by teammates on the basketball court and suddenly collapsed in sudden cardiac arrest. Later it is revealed that the young man had a not so un-common condition. Learn how to recognize symptoms surrounding this condition, how to respond to an emergency that arises from this condition and how to detect it before it may be too late.
Our hearts go out to the family and friends of this young man. May God bless and comfort them all.

RoyOnRescue Team

How Do I Know If It’s A Fracture or A Sprain?

Hello Again,

A great question came in about how to tell if an injury is a fracture or a sprain or strain. This is a great question. In some cases it’s very easy to tell that a fracture is present. Like… bone sticking out of the skin! But if it’s not and there isn’t any deformity, it can be tricky. Check out this video blog for a more in-depth look on how to tell if the injury is something that needs medical attention or if it’s minor and can be managed right at home.

To read a bit more about the specifics, feel free to browse this link.
Fractures Vs. Sprains and Strains

Best Wishes,

Roy, RoyOnRescue.com


Impact Sports and Rib Injuries!

Hello Everyone,

In this royonrescue blog entry I wanted to address a particularly familiar problem associated with sports of all kinds but especially common with high impact sports and the new uptick of people getting into Martial Arts, Judo, Brazillian Jiu-Jitsu and MMA.  For anyone who has been involved in any of these sports you know that it takes a lot of time, energy, work, determination and discipline to get to a point where you’re not just trying to get into shape but trying to improve your game.  All the months and years of training hard, working out and testing your skills all to have them come to a screeching hault when your fell a rib “pop”.   This term “popped  a rib” is coined for the explanation of any type of injury having to do with the rib cage but is mostly found in the anterior or posterior region of the lower rib cage, ie. floating or hanging ribs.  These are the ribs that are low and out to the sides of the abdominal region.  They are called hanging or floating due to the fact that they are not connected to the sternum and only the spine.  Because of this feature they are usually very flexible and can take a lot of pressure.  When a person gets hit hard, leans over a railing wrongly or maybe takes a punch, kick or a knee on stomach from another sparring partner or teammate, they can damage the rib causing everything from dull to severe pain.

Now when I say from dull to severe I mean from the scale of pain everthing from .5-10 on the scale.  Some of this depends on the severity of the rib fracture and some of it depends on if it is an actual rib fracture or if it’s a muscle or cartilage injury.  The pain can be only sensitive to pressure or additional bumps or it can hurt when a person breaths but either way, when the injury is present it definitely makes itself known and can really screw up sleep, let alone your normal training routine.

Because I couldn’t find a lot of good advice or explanation all in one location, I thought I’d add my two cents to the whole thing and maybe help someone out.

Question:  Is a rib fracture dangerous?

RoyOnRescue Reply:  It is not usually a dangerous injury unless the rib is fractured completely and sharp bone end punctures an organ or muscle. If the rib is broken from a wrong movement it is probably not as potentially dangerous as when it’s broken from a severe force.  Severe force strong enough to break a rib high up in the chest cavity may be strong enough to cause trauma to lungs, heart or other parts of the body.   At it’s worse here’s what trauma.org says about rib fractures:  Fractures of the lower ribs may be associated with diaphragmatic tears and spleen or liver injuries. Injuries to upper ribs are less commonly associated with injuries to adjacent great vessels. This is especially true of a first rib fracture, which requires a significant amount of force to break and indicates a major energy transfer. A fracture of the first rib should prompt a careful search for other injuries. Note also that the rib cage and sternum provide a significant amount of stability to the thoracic spine. Severe disruption of this ‘fourth column’ may convert what would otherwise be a stable thoracic spine fracture into an unstable one.(http://www.trauma.org/index.php/main/article/399/)Normally the biggest complication is that it impairs breathing deeply which can lead to respiratory infections or pneumonia and it’s hard to rest lying on your side or back depending on the location of the injury.

Question:  Do I Have to Stop Training?

RoyOnRescue Reply:  Do you want the true answer or the one I wanted to hear when I hurt my ribs the last time?   Either way, I’m going to give it to you as straight forward as possible.  Usually there isn’t much therapy for a broken/bruised or strained rib injury.  If it hurts or makes it hurt worse with activity, stop the activity and give the injury time to heal.  Usually 6-8 weeks has been the consensus from my research.  If you can tolerate the workout without reinjury then you may be able to keep training.  If it seems to make it worse and you are re-injuring the rib, you may need to stop and give it the time required.  If in doubt, talk to your medical professional for advice.  As for me, I train as long as I can tolerate it and try to not re-injure the same problem injury.  If I do, I take time off.

Question:  How Can I Treat The Inury to Help Healing?

RoyOnRescue Reply:  Most research is going to tell you to rest as much as you can, drink lots of water and stay hydrated and try not to re-injure the same site.  Cold packs applied to the area being careful not to place directly against the skin will help to decrease swelling and help aid the healing circulation.  Some say that an ace wrap around the injured area of the chest may help support the area to decrease movement and pain.  And of course most people will take some form of analgesic or non-steroidal anti-inflammatory medicine like Aspirin or Ibuprofen.  Please refer to your doctor for prescriptions that would apply to you and be careful of allergies.

Question:  How Do I Know If I Need To See A Doctor?

RoyOnRescue Reply:  If you have any problem with Airway, Breathing or Circulation, Shock or Shock symptoms, internal pain that is increasing with or without moving, numbness or unable to move any part of your body, headache that is increasing or not going away, chest pain that is severe or for any reason you feel like you should see a doctor, it is always a good idea to be seen.  Better to be safe than sorry and find out that you ignored an internal injury with severe bleeding or other complications.  If the rib injury is causing any life threatening problems, call 911 immediately.

So to all my fellow rib injuries out there, I hope you feel better sooner than 6-8 days let alone weeks, don’t do what ever you did the first time to get hurt and get well soon.

I hope this helped and if you have any other questions or comments for RoyOnRescue.com be sure to email them to:  royonrescue@gmail.com

Until next time, go fourth and rescue,

Best Wishes,



How to Hit Your Head on Pavement at 17MPH and Survive!

Imagine riding your road bike and as you near a curve in the bike trail hitting speeds of around 17 miles per hour your front tire instantly goes flat.  Now you’re trying to corner on a metal rim sliding across the pavement which has as much traction as an ice skating rink.   This is exactly what happened to Tom Monett, cycling enthusiast, big mountain skier, hiker and mountain climber.  As Tom’s bike slid out from underneath him, he didn’t have enough time to catch himself let alone think about what was about to happen.  As his head hit the pavement, and his ribs began to break, his wisdom to ride with personal protective equipment most likely made the difference between life and death.  Watch this episode of royonrescue to see the full interview and hear his story about surviving a high speed cycling crash.


Warning!  Video contains graphic pictures of injuries and accidents.

Video Gallery of Actual Bike Accidents

“Head and Shoulders, Knees and Toes…”

A student emailed a question regarding the Head to Toe exam.  Though this is normally performed as a secondary survey in a more advanced setting, I do think there are times where knowing how to check a person for other injuries is a good idea.  Take a look at the video blog and I hope this helps.
Best Wishes,

Coaching Sports, Injuries and Liability

BaseballI would like to pass on a quick informational about injuries and liability when it comes to coaching and organized sports.   I found the following outline very helpful when it came to the part about how to put a proactive risk management policy together.  Whether your sports organization is volunteer or paid, a healthy risk management program is always wise.

The following is specifically on how to deal with training, injuries/illnesses and return to play, but the website has a lot of really great advice.  I’ve included the link below or you can click on the hyperlink in this paragraph.

Sport Specific Techniques – Coaches should always follow the accepted practices for teaching sport specific techniques. Certain drills and other methods that are standard for each sport should be followed. Coaches should be involved in continuing education to learn about the advances of teaching techniques. It is especially important that instructions key in on the more hazardous areas of a particular sport such as avoiding a wild pitch, tackling techniques, etc.

Safety Rules and Procedures – Safety rules and procedures should be reviewed before and during every practice and game. They require constant reinforcement with special emphasis on the purpose and intent of the rules and the types of injuries they are meant to prevent. Any rule changes dealing with safety should be reviewed with all coaches during the pre-season with an emphasis on the types of injuries they are meant to prevent.

Sports Injury Care

Sports injury care consists of two basic elements – prevention and recognition/treatment. Youth sports administrators (RMO’s and Coaches) must understand the importance of both elements.

1) Prevention – Consists of pre-participation screening, strength training, conditioning, and awareness of the nature, cause, and mechanism of sport specific injuries.

2) Recognition and Treatment – Once the coach realizes that the injury has occurred, the magnitude must be assessed and appropriate care initiated.

Consent to Treatment – Health care providers can’t lawfully render treatment to a patient without consent. When a minor is involved, consent must be obtained form a parent or legal guardian. In life threatening situations, the law assumes that consent is given. However, once the patient has stabilized, consent must be obtained for further care. Having a “consent form” on file my provide some protection against a parent’s claim that emergency care was not authorized and can help to overcome apprehensions of health care providers about rendering treatment before lawful consent is obtained. Also, such consent forms should list if the athlete is allergic to any medications and should specify who should be notified in the event of an emergency.

First Aid and CPR – All coaches should be certified in basic first aid and in CPR. The coach should not exceed the scope of his training in administering first aid. The purpose of first aid is merely to stabilize the situation by preventing it from worsening. Once the situation has been stabilized, all other treatment should be provided by a doctor.

Emergency Medical Plan – Should be developed with the assistance of local doctors, hospitals, and EMS. The Emergency Medical Plan must be tailored differently for each community because of differing availability, response times, etc. Coaches should be specifically trained how to activate the Emergency Medical Plan.

The plan should be in writing and readily available and should cover the following elements:

  • Who calls EMS?
  • Who stays with injured athlete?
  • Where is nearest phone?
  • What phone number to call?
  • Where is the nearest treatment facility?
  • Where is the ‘consent to treat’ form?
  • Does the athlete have any medicine allergies?
  • How to notify parents?
  • How to initiate crowd control?
  • Who meets EMS and the guides them to the injured athlete?
  • Who accompanies the injured athlete for treatment?
  • Who supervises the team?
  • Who provides proof of insurance?

An alternative Emergency Medical Plan should be formulated when traveling to other facilities.

Return To Play – Once an athlete has suffered an injury, the decision regarding the appropriate time to return to play should be made by a doctor. The coach should not put pressure on an athlete to return too early and the instructions of the doctor should always be honored.

Visit the Sports Insurance and Risk Management Website for Risk Management Outline