The National Federation of High Schools report that about 1,000,000 high school student athletes participate in basketball in the United States (51). The numbers are significantly less for college and professional levels, but basketball is a sport that can be played at the recreational level for many years. Understanding the types of injuries found associated with basketball can help plan for coverage and prevention of injuries. Most injuries are lower extremity, but head injuries are a common occurrence. Studies in the pediatric population show that nonorganized play has a higher prevalence of injuries versus organized play. The most common injuries in nonorganized basketball include closed head injuries, lacerations, and fractures (49).
During a 10-year span (1997 to 2007), 4 million children and adolescent injuries were evaluated at local emergency departments within the United States. Sprains and strains were the most common diagnosis, with the most common injured body region being the low extremities. Adolescents, aged 15 to 19 years, accounted for the majority of basketball-related injuries (50.7%) and were three times more likely to sustain an injury to the lower extremity versus younger children. Younger children, 5 to 10 years old, were more likely to injure the upper extremities and sustain traumatic brain injuries (TBIs), fractures, or dislocations. Boys accounted for three-fourths of injuries and were more likely to sustain lacerations, fractures, or dislocations. Girls were more likely to sustain TBIs and knee injuries (58).
Using the High School Reporting Information Online, 100 representative high schools reported basketball injuries in the 2005 to 2006 through 2006 to 2007 seasons (8). High school student athletes sustained 1.94 injuries per 1,000 athlete exposures (AE). This rate is less than football and boy’s wrestling but similar to both football and soccer. Injuries were more common in games versus practices (3.27 game injuries vs 1.40 practice injuries per 1,000 AE) (8). Injuries to the ankle/foot (39.7%), knee (14.7%), head/face (13.6%), arm/hand (9.6%), and hip/thigh upper leg (8.4%) were most common (8). Women sustained more injuries (2.08 per 1,000 AE) versus men (1.83 per 1,000 AE). Women accounted for a greater portion of concussion and knee injuries, while men sustained a greater portion of fractures and contusions.
The National Collegiate Athletic Association (NCAA) Injury Surveillance system provided data on injuries within division I, II, and III men’s and women’s basketball 1988 to 1999 through 2003 to 2004 seasons (2). Lower extremity injuries accounted for 60% of all game and practice injuries. Injury rates during games were two times higher than that of those during practices (2,15). Male basketball players experienced 9.9 injuries during games and 4.3 injuries during practices per 1,000 AE (15). For female basketball players, the game rate of injuries was 6.75 versus 2.84 injuries during practice per 1,000 AE (2). At a division III women’s basketball program, times of increased training loads, particularly the first 2 wk of formal practice and practices following holidays, were found to result in an increased number of injuries (3).
During men’s NCAA games, the common injuries were ankle sprains (26.2%), knee internal derangement (7.4%), patellar injuries (2.4%), upper leg contusion (3.9%), and concussion (3.6%). The common practice injuries included ankle ligament sprains (26.8%), knee internal derangements (6.2%), and patellar injuries (3.7%) (15). In Women’s NCAA games, ankle ligament sprains (24.6%), knee internal derangements (15.9%), concussions (6.5%), and patellar problems (2.4%) accounted for the majority of injuries. In practices, ankle ligament sprains accounted for 23.6% of all reported injuries, whereas knee internal derangements (9.3%) and patellar injuries (4.0%) together accounted for another 13.3%. Upper leg muscle-tendon strains (5.0%) and concussions (3.7%) were other common injury categories (2). When comparing anterior cruciate ligament (ACL) injuries in male and female collegiate basketball, women experienced a higher rate of injury (women, 0.29 (P = 0.04); men, 0.08 (P = 0.002)) (1). A retrospective review of the Women’s National Basketball Association (WNBA) Combine, the screening physical test before going from college to professional basketball, of the 2000 to 2008 seasons was performed. The most common injuries the female athletes had incurred during college were ankle sprain (47.8% of players), hand injury (20.8%), patellar tendinitis (17.0%), ACL injury (15.0%), meniscus injury (10.5%), stress fracture (7.3%), and concussion (7.1%). ACL reconstruction (14.4%) was the most common surgery before entering the combine followed my meniscus surgery (9.9%). The history of ACL or meniscus surgery was similar by position played, by round drafted, and did not affect career length in WNBA (46).
At the professional level, the pattern of high rate of lower extremity injuries stays true, accounting for 65% of all injuries. WNBA players experience a higher game-related injury rate at 23.9 versus NBA at 19.3 injuries (per 1,000 AE). Lateral ankle sprains (LASs) were the most common diagnosis in both leagues (14).
In the adult population in the ambulatory setting (20 to 59 years old), the annual visit rate for a basketball-related injury was 3.2 (95% confidence level, 2.6 to 3.9) per 1,000 patient visits. The majority of these patients were treated in their primary care physician’s office setting. Sprains and strains to the lower leg and ankle region and fractures of the hand, wrist, or fingers were the most common injuries. Women have a low rate of visits (0.8/1,000) than men (5.7/100) pertaining to basketball-related injuries (24). In patients 15 years old or older, the injury rate for basketball was 1.49 (95% confidence interval (CI), 1.33 to 1.53) in 2003 to 2007, using 1,000 U.S. population. This was the highest compared with football and soccer. When using hours of participation, basketball (2.69 (95% CI, 2.35 to 3.02)/10,000 h) was second to football (5.08 (95% CI, 4.46 to 5.69)/10,000 h) for documented injury rates (11).
Exercise-related sudden cardiac arrest (SCA) is a risk while participating in athletics. In an elementary to college population, SCA is most common in high school population, and 83% of SCA occur to men (17). Within the NCAA student athlete population in 2004 to 2008, cardiovascular-related sudden death was the leading cause of death. Basketball was by far the highest risk sport, with an overall death rate of 1/11,394. Division I male basketball players were at a five and a half times greater risk than female basketball players. Also male African American basketball players were three times more at risk versus white athletes (26). Within a 26-year period, 13 cardiovascular deaths were reported in Minnesota athletes, with basketball being the most common sport (44). Due to the common occurrence in male basketball athletes, it is therefore important to screen appropriately for cardiac disease and to have automatic electronic defibrillator available on the sideline when covering basketball.
Feet and Ankles
The notable features of examination are that the immediate sideline examination is good, but the examination hours later are often wrong for confirming ligament rupture (33). For a solid diagnosis of an ankle ligament rupture, patients must be reexamined 4 to 5 d after the trauma (33). If bruising develops and the athlete experiences pain with palpation, or a positive anterior drawer test is present or both, there is high probability that a ligament rupture exists, which will delay return to play (33). Magnetic resonance imaging (MRI) and ultrasound are useful, but evidence is lacking on added value to examination (33).
The majority of the studies on ankle braces evaluated the effects of the brace on reducing LAS as the primary clinical outcome. The studies’ findings were subcategorized into primary prevention, investigating the role of ankle support in preventing ankle injury in those that were not injured before, and secondary prevention, preventing recurrent injury in those previously injured.
Three meta-analyses (level I evidence) concerning the effectiveness of primary prevention of ankle sprains have been performed. The authors of these systematic reviews agree that the primary prevention of LAS with ankle support is minimal but present (16,25,74). This conclusion is based on a smaller number of studies in high school and college athletes. There is sufficient evidence to support ankle bracing to prevent ankle injuries, but the cost savings from bracing is not confirmed.
Most of the evidence that we have is on semirigid ankle orthoses for the prevention of ankle sprains. Ankle taping has not been found to be superior to bracing by numerous high-quality studies that compared taping with bracing (16,74). There is also consistent evidence now supporting the role of neuromuscular training, but further studies are needed to reach equally strong conclusions (74).
Unlike primary prevention of ankle sprains, the evidence is more convincing for secondary prevention of injury (16,25,74). There is statistically significant evidence, mostly in high school and college athletes, supporting the role of ankle braces or taping in the prevention of recurrent LAS, with ankle bracing being more effective than taping (16,25,74).
Stress fractures are seen in the high school level basketball and beyond, usually seen in the lower leg and foot. Four stress fractures seen in basketball need special attention: fifth metatarsal, medial malleolus, navicular, and anterior tibia (61,65,70,73). These fractures are higher risk stress fractures due to prolonged healing times and nonunion rates. Lower risk stress fractures of the posterior tibia, fibula, and second/third metatarsal fractures are injuries that, with proper unloading, will heal nonoperatively (65). Occasionally they take much longer to heal, and bone stimulator can be helpful to reduce discomfort. The four worrisome stress fractures will often need surgery to stabilize the injury and allow healing. Appropriate diagnosis and management of these higher risk stress injuries is crucial for competitive basketball players.
It has been reported that navicular stress fractures make up approximately 14% of stress fractures (70). Stress fractures of the navicular are seen in basketball due to the impact nature of the sport involving running and jumping. Patients presenting with insidious onset foot pain and tenderness over the navicular on examination should be considered a stress fracture until proven otherwise. Appropriate treatment of navicular stress fractures is critical due to the risk of nonunion because of the poor blood supply within the middle one-third of the bone. Initial radiographs are often negative, and due to the high false-negative rate, further advanced imaging should be ordered to rule out the diagnosis. The percentage of normal radiographs with navicular stress fractures has been reported between 67% and 82% in the literature (43). Several imaging techniques can be considered including MRI, bone scan, and computed tomography (CT) scan, depending on the clinical scenario. MRI and bone scan are sensitive particularly for stress reactions, and CT is useful in evaluating cases of nonunion. There is some debate regarding the treatment of navicular stress fractures. The standard and accepted treatment for stress reactions and nondisplaced stress fractures is cast immobilization and non-weight bearing for a period of 6 to 8 wk (70). Following cast immobilization, there should be a gradual introduction of weight bearing over a period of 2 to 6 wk, then a graded return to activity protocol. Operative management with screw fixation is considered after a period of 8 to 10 wk of immobilization with continued symptoms or nonunion and complete fractures of the navicular.
Stress fractures involving the tibia more commonly involve the posterior medial aspect of the tibia, which are relatively low-risk stress injuries. In contrast, anterior tibial stress fractures are high-risk injuries that are slower to heal with nonoperative treatment. The anterior tibia is the distraction side of the bone, which is the reason for the more prolonged healing time for these injuries (73). Fortunately anterior tibial stress fractures are less common than stress injuries to the posteromedial tibia. Cases can be treated operatively with intramedullary nail placement, with a mean return to sport reported on average 3 to 4 months postoperative (73). The mean time for return to play in the literature in a cohort treated nonoperatively was 12.7 months (59). Nonoperative treatment included activity modification, periods of non-weight bearing, and immobilization.
Medial malleolus stress fractures are rare, accounting for anywhere between 0.6% and 4.1% of stress fractures (40). Again the repetitive jumping makes basketball players a more common population for these injuries (40). Stress injuries of the medial malleolus occur due to increased axial and torsional forces through the area. The typical location of these injuries is at the junction of the medial malleolus and tibial plafond. Radiographs should be performed initially; however false negatives have been reported 70% of the time (40), and radiographic evidence may not be present for 2 to 4 wk. Therefore follow-up imaging with MRI or bone scan is recommended when there is clinical suspicion. Treatment nonoperatively includes activity modification or walking boot immobilization until pain free with walking. If pain is experienced with walking while immobilized, a period of partial weight bearing may be necessary. Nonimpact activities such as biking or swimming can be considered if able to be done without pain to maintain fitness levels. After a period of rest or immobilization for several weeks, patients can then be progressed through a graded return to activity protocol with an average return to sport in 6 to 8 wk (65). A longer treatment regimen has been reported with a period of 4 to 5 months of nonoperative treatment, then followed by a return to sport protocol (40). If patients fail the nonoperative treatment with continued pain or nonunion, surgical treatment is then indicated. Surgical treatment is indicated also when a fracture line is noted on radiographs and with displacement. In a retrospective review by Lempainen et al. (40), all surgically treated patients achieved clinical healing with 9 out of 10 patients returning to their prior level of sport participation postoperatively. In their study, patients were treated with open reduction and internal fixation (ORIF), followed by partial weight bearing for 4 to 6 wk. Athletes were then progressed to nonimpact training and allowed to return to running at 3 months after surgical fixation (40).
The Jones fracture involves the proximal fifth metatarsal at the metaphyseal and diaphyseal junction (18). Surgical treatment with intramedullary screw fixation is the mainstay of traditional Jones fractures in competitive athletes due to the long period of nonoperative treatment and risk of nonunion. These fractures are prone to nonunion and slow healing due to the so-called “watershed area” or area of poor vascularity (18). Stress injuries of the proximal fifth metatarsal can be successfully treated with nonoperative management. However operative treatment in high-level athletes is preferable due to the physical demands of sport, the desire to return to sport as quickly as possible, and risk of reinjury. Union rates have been reported in the literature at 96% with screw fixation compared with 67% with nonoperative treatment (61). Stress fractures of the proximal fifth returned to sport in 12 wk with operative treatment in comparison with 24 wk in those treated nonoperatively (61).
Of all injuries in basketball, one of the more aggravating and difficult to treat is blisters of the foot and ankle. Some basketball players are more prone to developing blisters (10,76). These athletes probably have more plantar pressure and plantar shear force (76). Blisters, if not cared for properly, can become infected and lead to more serious problem like cellulitis (9,35). Staphylococcus aureus infections are common in athletic facilities, and extra care should be taken to reduce exposure. It is important to educate the athlete on properly cleaning and covering the blister (9,35).
A blister on the heel of an athlete who is running constantly, jumping, and changing directions can be very painful. Clinical experience suggests draining intact blisters and maintaining the blister roof results in the least patient discomfort and may reduce the possibility of secondary infection (35). Finding the best way to reduce the friction and make the athlete comfortable can be very challenging. There are many different remedies on the market for doing this, but the authors find that sometimes, a combination of several of these methods helps more than just one remedy alone. Data show that a polypropylene with a cushioned sock helps reduce blisters (7,72). A gel pad that is applied to the blister and kept in place by a band-aid or elastic tape can be helpful (9). A lubricant stick product that runners use to prevent blisters provides an invisible barrier to the area of friction (22). When taking care during basketball, one needs to be aware of the proper treatment after the formation of a blister, the risks that are secondary to blisters, and identifying the source of the blister to avoid future incidence.
Thigh and Knee
The mechanism for an ACL injury can be either contact or noncontact. Most commonly, about 70% of all ACL injuries are noncontact injuries (64). These occur secondary to a landing or side-cut motion of the lower extremity (32). The way in which the lower extremity responds during athletics can be affected by different factors. Some of these variables may be proprioception, neuromuscular control, and knee valgus to name a few. Use a clinical screening tool that can be implemented easily by physicians or athletic trainers to identify athletes at increased risk for ACL tears and that could then implement a prevention program to reduce the ACL injury rate. The Landing Error Scoring System, Functional Movement Screening and 3D motion analysis are a few tools that have been used in an effort to identify “at risk” athletes. This can be a challenge on any level, but on the college level, it can be especially challenging because bad habits and poor techniques are developed as adolescents. It is the role of the athletic trainer and team physician to recognize and correct these less than desirable habits and deficits. This can provide the athlete the best possible chance to have a healthy and successful career. When looking at the neuromuscular training programs and effects on ACL injuries, one can evaluate the numbers needed to treat (NNT) and relative risk reduction (RRR), and they are preventive of injury (21). Pooled NNT was 89 (95% CI, 66 to 136) individuals performing a neuromuscular prevention program to prevent one ACL injury in a competitive season (21). The pooled RRR was 70% (95% CI, 54% to 80%) among individuals who participated in the training program (21). ACL injuries can be prevented at the high school level with an integrated warm-up program (37).
Implementing these programs can be difficult, but it is not unrealistic. Adding prevention exercises to the strength and conditioning workouts, and during the first 10 to 15 min of the warm-up, is an excellent way to get the team to work together, recognize the errors, and have constant feedback on the quality of the exercises (21,63). Programs like FIFA 11+ has been shown to decrease injuries in basketball (41). Often times, the authors will use a mirror in the athletic training room so that the athlete can identify the movement issues and work to correct these themselves. The athlete frequently requires feedback from the athletic trainer or the strength and conditioning coach to correct poor technique (67). Incorporating specific injury prevention exercises into summer training, preseason training, prepractice warm-ups, lifting sessions, and postseason is an ideal plan to maximize the efforts of prevention (67).
Rupturing the ACL is a very mentally traumatic event (52). This injury not only can end potentially a season for an athlete but also requires an invasive surgical procedure that requires long-term rehabilitation. The recovery process can take up to 10 months before returning to full activity. It is important for the athletic trainer to monitor constantly the mental well being of the injured athlete (45). If the athlete is not doing well mentally, then a referral is made to the team physician or sports psychologist. The authors recommend focusing on maximizing the time in rehabilitation, keeping the athlete involved and interested by setting goals, and reducing the monotony of the rehabilitation process by being creative. In an athletic setting, it is easy for rehabilitation to take 3 to 4 h at a time. Trying to accomplish everything in a single rehabilitation session can be lengthy and may start to discourage the athlete (52). Focus on the main goals first, then the rest of the rehabilitation will fall into place. This keeps the rehabilitation process from becoming too lengthy in the beginning. During the first month, setting goals is a great way for the athlete to see the progress they are making and to continue to work hard to achieve the treatment goals (38). Goal setting is easy in the first month of rehabilitation because everything is new and a challenge for the athlete. The second month is much more challenging for the practitioner, and the athlete can become bored and frustrated. Creativity and being engrossed in the rehabilitation with the athlete is very important during this time.
Meniscus surgery is the second most common surgery of college women basketball players entering the WNBA (46). The injury did not vary by position (46). Lateral meniscus are more common than medial meniscal tears (60% lateral) (77). Young athletes seem to have a different ratio from professional athletes (60% medial) (69). Time to return to play for NBA players was about 6 wk ± 30 d (77). About 80% of players were able to return to play at previous level (77).
Meniscal tears are common, and whenever possible, meniscal tears should be repaired surgically (48). Meniscectomy leads to a significant increased risk of osteoarthritis (48). Although rare, players with meniscal transplants have been able to return to basketball (case series reports about 75%) (12). The authors, anecdotally, find that using an unloader brace is useful with meniscal transplant.
Patella tendinopathy is a common problem in basketball. Even in high school players, it is reported that 7% of basketball players had current patellar tendinopathy on clinical grounds (11% in men, 2% in women) (13). In older nonelite players, it is described that 12% of players have patella tendinopathy (79). Many of these injuries cause discomfort but do not prevent play and thus do not make many injury surveillance systems. This is noted by the much lower injury prevalence rate in the NCAA injury surveillance system that only records injuries that miss a game or practice (2,15). Therefore looking at time missed from practice and games will underestimate the number of athletes that will require treatment for patella tendinopathy.
The repetitive load to the patella tendon complex in adolescent and middle school athletes (boys, 12 to 15 years; girls, 8 to 12 years) (20) will cause Osgood-Schlatter syndrome at the tibial tuberosity. The prevalence is similar to patellar tendinopathy. Osgood-Schlatter syndrome is a traction apophysitis of the tibial tubercle due to repetitive strain on the secondary ossification center of the tibial tuberosity (20). Over 90% of patients will respond to nonoperative management. The disease is self-limited, and while residual deformity may remain, symptoms will disappear, coinciding with closure of the apophyseal plate (4).
The treatment for patella tendinopathy should start with eccentric loading exercises, which are 60% to 70% successful (62), and provide poor success in-season while an athlete is continuing participation. Other treatments with varying level of evidence and success like hyaluronan (50), extracorporeal shock wave therapy, sclerosis of neovessels (29,30), and arthroscopic surgery after failed nonoperative treatment (56) have been described. The use of a patella strap is a common treatment option for patella tendinopathy without clinical studies to support or refute its use. Osgood-Schlatter syndrome being an apophysitis is treated with relative rest, and correction of improper strength and flexibility deficits. Early sports specialization has been associated with overuse injuries, like Osgood-Schlatter syndrome (42).
Thigh contusions are common injuries in basketball. The thigh is probably the most common location for muscle contusions. When the muscle is damaged, repair, not regeneration, occurs. Early treatment with knee flexion to 120° is very important. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be detrimental to the healing if used for more than 48 to 72 h, and glucocorticosteroids should be avoided (66). This is followed by range of motion exercises and advancement of activity.
Acute phase of rehabilitation
After 24 h, the brace is discontinued, then active pain-free range of motion and stretching several times a day are started. Cryotherapy should be used and NSAIDs taken until 48 to 72 h (66). Crutches are continued until pain-free knee flexion is equal to the uninjured side.
Subacute phase of rehabilitation
The athlete should be able to perform the activities needed for their sport, and they should be required to wear a basic thigh pad modified with a ring-shaped pad to prevent recurrent trauma to the area of the contusion, for the remainder of their season (5).
Return to sport should not be allowed without (5) the following:
- pain-free knee flexion,
- quadriceps size and firmness equal to the uninjured side,
- regaining the mobility and agility unique to their specific sport,
- wearing a basic thigh pad modified with a ring-shaped pad to prevent recurrent trauma to the area of the contusion for the remainder of their season.
Early proper treatment is key to success. Ultrasound is useful for diagnosis and following progression (36). Complications of myositis ossificans and compartment syndrome need to be considered with thigh contusions.
Among pediatric and high school basketball injuries presenting to emergency departments (55,68), finger sprains and finger fractures were the second and third most common diagnoses. Among the 12- to 17-year-olds, women sustained a higher rate of finger sprain injuries at 7.9% compared with men at 6.5%. Male high school basketball players fractured their hand/finger frequently at 24.8%, while female high school basketball players fractured their hand/finger at 40.5% (68). Boys sustained a greater proportion of their fractures during general play (16.8%) versus girls (5.9%). In addition, girls were noted to sustain a greater proportion of fractures while receiving passes (19.1%) compared with boys (6.9%) (68).
A mallet finger occurs with forced flexion of an actively extended distal interphalangeal (DIP) joint, which in basketball is most often the result of the ball jamming the fingertip. As long as the joint is stable and without evidence of subluxation, it can be splinted in extension, full time, and the player can return to sport. An unstable joint will require surgery, typically 6 wk of stabilization with a Kirschner I wire, after which the player can return to sport, protecting the joint with taping or splinting for another 6 wk (54). Proximal interphalangeal (PIP) joint dislocations occur with hyperextension of the PIP joint with axial loading. In basketball, this can occur during steals. Return to play can be immediate after a closed reduction of a dorsal dislocation, taking care to buddy tape the fingers. However volar dislocations will require splinting in full extension for approximately 6 wk. Metacarpal fractures most often occur during fouls or dunking in basketball. Stable metacarpal fractures typically require 3 to 4 wk of splinting; however, athletes can return to play within 1 to 2 wk using a hand-based splint, depending on their level of comfort.
There have been case reports of avulsed fingers and thumbs due to dunking in basketball. Digits may be caught in the netting, with possibly an increased risk if they are wearing a ring that could be caught, and as the player drops to the ground, their digit may remain in the net upon decent, or be nearly fully degloved (31,57). This injury represents an emergency that requires immediate transportation to an emergency department equipped to handle a digit amputation. Gently clean the amputated part with water (preferably saline). Cover it in gauze wrap and put it in a watertight bag. Place the bag on ice but do not put the amputated part directly in ice. You could further damage it (31,57). The time to return to play can be extensive and would depend on the severity of the injury.
Head and Face
Basketball being a contact sport, blunt or penetrating eye injury is likely to occur (28). Common injuries include eyelid lacerations, abrasions, eyelid or periorbital contusions, and corneal abrasions, and less commonly, orbital fractures can be seen (78). About 90% of sports-related ocular injuries are considered preventable (53).
Ocular injuries have a rate comparable with ACL injuries. Over a 14-year period, ocular trauma was documented in 0.16 injuries per 1,000 AE in NCAA men’s division I, II, and III basketball games (28). Women basketball players were less likely to sustain ocular trauma during competition in one division III college study (78). Most of the injuries would not prevent return to play and therefore are missed on injury data collection of an injury that prevents participation in one game or practice. Most injuries are corneal abrasion or lid contusion (53). About 5% have some permanent loss of vision (53).
Nail length may be a contributing factor to corneal abrasions particularly in women’s basketball (28). Most heal in 24 to 72 h and rarely progress to corneal erosion or infection. Contact lens wearers may experience dry eye and irritation from travel, so consider having saline available for use (75). Eye patching and topical mydriatics are not recommended (75). Initial treatment should be symptomatic, consisting of foreign body removal and analgesia with topical NSAIDs or oral analgesics; topical antibiotics can speed recovery. All patients including contact lens wearers should be reevaluated in 24 h and again three to 4 d later even if they feel well (75). The functionally one-eyed, or monocular, athlete should take extra precautions (28). Eye protection has helped to reduce the number and severity of eye injuries (28).
Traumatic iritis and hyphemas are caused by blunt trauma to the eye. They require urgent assessment by an ophthalmologist as they may result in permanent visual impairment (53). Small hyphemas can be treated usually on an outpatient basis. Most treatment plans consist of elevating the head at night, wearing a patch and shield, and controlling any increase in intraocular pressure. Other injuries that require an immediate referral to ophthalmology is a sudden decrease or loss in vision, pain on eye motion, photophobia, diplopia, proptosis, halos, flashes, or floaters (60).
Mouthguards are often purported to prevent concussions. A meta-analysis by Knapik et al. (34) looked into both biomechanical impact studies as well as those measuring direct clinical outcomes. In this analysis, 14 studies were reviewed and were found to have variable methodological approaches as well as variable statistical significance. The author concluded that the studies consistently showed strong evidence for the use of mouthguards in the prevention of orofacial injuries, with an overall increase risk (1.9 times) for orofacial injuries when mouthguards are NOT worn. The role of mouthguards in preventing concussion, however, was not significant, based on the studies that were available up until 2005. These conclusions were reached also by a review done by Benson et al. (6) in 2009 where 17 trials were considered for review. The results highly supported the advocacy for the use of mouthguards in collision sports to prevent dental/orofacial injuries but not for the prevention concussions. The use of mouthguards is already justified in collision sports for the prevention orofacial injuries and should be used by all contact/collision athletes.
Concussions are a common place in basketball (27), with girls basketball having a higher rate of concussions than boys basketball (27). The arenas are usually noisy even for high school games, so we recommend proper concussion evaluation be done in the locker room or athletic training room. We recommend using an instrument like the SCAT3 (23) for evaluation of the initial concussion.
Approximately 80% to 90% of concussion symptoms resolve in a 7- to 10-d period (47), although the recovery period is often longer in children and adolescents (19). Gessel et al. (19) noted that 30% of girls basketball players took 3 wk or longer, and 20% of boys basketball players took 3 wk or longer to return to play. Of note, almost 30% of both girls and boys basketball players return within a week of injury. Cognitive rest for the first 48 h is the mainstay of treatment (27,47). Initiating of 10 mg·kg−1 of eicosapentaenoic acid and docosahexaenoic acid (DHA) per day in a 2/1 ratio or 10 mg·kg−1·d−1 of DHA alone seems to be sufficient if started right after a concussion for treatment of concussions is still controversial and further testing in humans is needed (71).
Once asymptomatic of concussive symptoms, then return to play is a graduated process as outlined in multiple consensus statements (27,47): light exercise, followed by shooting drills, followed by team drills, no defense (such as North Carolina drill), then full practice with proper monitoring. The authors have found the graduated exercise test as described by Leddy et al. (39) to be a useful tool in return to play. Each individual will have a different return to play course with concussion versus the other injuries seen in basketball.
Basketball is a sport played by many people both organized and nonorganized leagues. When planning to cover basketball, physicians and athletic trainers need to plan to prevent injuries and treat injuries. Prevention of ankle sprains, ACL injuries, dental injuries, and SCA needs to be in the preseason plans through proper screening and implementation of preventive plans. During the season, the person caring for a basketball team needs to be prepared to care for common basketball injuries described in this article.
The authors declare no conflicts of interest and do not have any financial disclosures.
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