Authors: Jenna Little and Ella Bonner
Winter comes with the excitement of the holidays, snow, and winter activities, but it is also a time of increased falls often resulting in injuries. While some are avoidable, others are not. It is important to stay educated on how to best prevent falls from occurring such as wearing proper footwear and slow, small walking. Additionally, knowledge about the structures that make up our bodies helps us understand injuries when they occur. It is also beneficial to understand the potential injuries we risk obtaining by falling such as injuries from falling on an outstretched hand (FOOSH) or shoulder dislocations and subluxations. These injuries are often unavoidable, but just remember that physical therapy is there to help you when an injury occurs!Â

Cold weather in the winter can be fearful or nerve-wracking for populations like the elderly or individuals more susceptible to injury. The winter comes with naturally dangerous circumstances like slippery ice and large chunks of snow that increase the risk of falling. These conditions can lead to traumatic injuries depending on the intensity of impact, the body part, age, and overall health of the individual. Injuries that may occur include wrist fractures, dislocated shoulders, rotator cuff injuries, torn meniscus, and hip fractures. When falling, oftentimes one's first instinct is to catch themselves with their hands, which can lead to more injuries.
Three main bones make up the shoulder: the humerus, the scapula, and the clavicle. The scapula, also known as your shoulder blade, is a flat and triangular shape located on your upper back which contains the acromion, coracoid process, and glenoid cavity. The clavicle (collarbone) is a bony attachment that forms the shoulder girdle. It meets at the sternum and the acromion on either end. Lastly, the humerus is the upper arm bone, consisting of a head, neck, greater and lesser tubercles, and a shaft. The ball, or head, of the humerus, sits in the glenoid cavity of the scapula to form the glenohumeral joint. These bones have elastic cartilage to allow shock to be absorbed and allow for easy movement of the joint.Â
Three types of bones make up our hand: the phalanges, metacarpals, and carpal bones. The phalanges are made up of 14 bones which form the fingers of both hands. The pointer finger to the pinky all have three phalanges, distal, middle, and proximal. Alternatively, the thumb only has two phalanges, the distal and proximal. Then, there are the five metacarpal bones, the middle hand bones commonly known as the knuckles. Lastly, the 8 carpal bones form the distal portion of the wrist allowing for grasping and holding objects. These bones are connected to two long bones in the arm: the ulna and radius, creating the forearm.Â
The elbow is a hinge joint and comprises three bones: the humerus, ulna, and radius. The humerus creates the top of the elbow joint. The bottom of the humerus widens and has bony protrusions on either side called the medial and lateral epicondyles. The ulna is one of two of the forearm bones which is a larger bone that articulates with the humerus and is on the inner side (medial) of the elbow joint. The radius is the second of the two forearm bones which is smaller in size and located on the outer side (lateral) of the elbow joint. As the forearm bones articulate with the humerus, it allows the forearm to rotate, performing forearm supination and pronation.

A FOOSH injury is an injury to the hand, wrist, arm, and/or shoulder that occurs when an individual falls and out of instinct, catches themself with their arm stretched out. The injury is wide-ranging from just a normal bruise to a fracture or dislocation. These injuries can occur from falling during a sport, tripping over anything such as a hole in the ground, rock, or even your feet, or especially in the winter, from ice making the ground slippery. The method of treatment depends on the type of injury that occurred. For instance, bruising can go away on its own with time while a fracture, in most cases, needs to be placed in a cast or sling. If not treated properly or the injury is severe, surgery could be included in the plan of treatment, as well as physical therapy. A common and severe injury that can occur because of falling on an outstretched hand is a radial head fracture. This is when the bone just below the elbow is fractured and can cause pain in the wrist and elbow. It is important to get treated for FOOSH injuries as soon as they occur as they can later cause bad circulation in the arm or arthritis if left untreated.Â
A shoulder subluxation occurs when the humerus bone, which is the upper arm bone, comes only partially out of its socket. Alternatively, a shoulder dislocation is when the humerus bone is completely out of its socket. Both are considered concerning injuries and should be consulted for medical attention after occurrence. Even if symptoms of either injury can go away on their own, there could be muscle or ligamentous damage that can further lead to instability in the shoulder. Having an unstable shoulder can increase the chance of a subluxation or dislocation reoccurring.
Anterior dislocations are the most common types of shoulder dislocations and are the most severe. These occur when the arm is held away from the body (abducted) and rotated outwards (externally rotated). This is the type of dislocation that is most associated with FOOSH injuries. When being examined for the injury the individual will often hold their arm out and rotate externally. On the other hand, a posterior dislocation only happens a small percentage of the time and is caused when a strong force acts on the front (anterior) of the shoulder when the arm is rotated inwards (internally rotated). When being examined, the injured arm will not be able to rotate in the other direction or may go unnoticed for multiple sessions.
In physical therapy, the best way to treat an injured shoulder either from dislocation or subluxation is to start with simple and general movement of the shoulder to keep the shoulder joint flexible. During regular treatment, most shoulders are held in a sling so the tissue, ligaments, and cartilage can heal correctly. Therefore, physical therapy can help with gentle movement to positively counteract the firmness and stability of the sling. Once the shoulder has begun to heal, stretching can be added to the plan of care to work with recovering the motion of the shoulder socket. Later in the therapy, shoulder strengthening exercises will be added and prescribed to build stability in the socket so the patient is back to their prior level of functioning and hopefully prevent another dislocation or subluxation from occurring.Â
While falls can be inevitable at times, there are multiple ways to prevent them as much as we can! To start, it is important to have proper footwear such as boots, tennis shoes, or anything that has a grippy bottom. Avoid wearing things like slippers or flats that tend to have a flat, soft bottom. Taking your time walking outside is also important, leave enough time, maybe even extra to walk to your destination safely. If there are handrails available, use them! If in an extremely icy walkway, take small steps. It is safer to keep the center of gravity of your body as close to underneath you as possible.Â
Overall, injuries are more common in the winter due to weather conditions and have a wide range of extremes. It is essential to remain cautious and use one's discretion when out in snowy and icy weather. Individuals who are at a greater risk of falling should know and understand the methods of preventing injuries. Being realistic about the risks of the weather and one’s overall health is crucial in staying safe and taking preventative measures. Regardless of the injury, there are various ways physical therapy can help anyone get back to their prior level of functioning and activities of daily living.Â
Resources:Â
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