Study finds most surfing injuries involve shoulder or knee, surgery usually not required

Over the last few years, surfing has increased in popularity, with about 2.6 million recreational surfers in the United States. Efforts are under way to include competitive surfing in the Olympics. However, the number of reports on surfing-related injuries is limited and does not mirror the trend in popularity, according to researchers at Hospital for Special Surgery (HSS).

Harry “Tate” Greditzer, MD, a radiologist at HSS and avid surfer himself, launched a study to determine the kinds of orthopedic injuries a recreational surfer might sustain and how often he or she required surgery. “The primary purpose of the study was to characterize MRI patterns of acute surfing-related injury at HSS, an urban musculoskeletal hospital,” Dr. Greditzer said. “Secondarily, the purpose was to report the proportion of those injuries that required orthopedic surgical intervention.”

Dr. Greditzer and colleagues found that shoulder injuries were the most common, followed by knee injuries. In the study, 17% of patients needed surgery for any type of surfing injury. The research was published online in the journal Sports Health on November 5.

The investigators noted that previous surfing studies from different regions of the world have described the incidence of injuries along with the type, location, and severity, but the results have been highly variable. Most prior studies have also utilized imaging modalities that are readily available in an emergency setting, but did not focus on high resolution soft tissue imaging modalities such as MRI, as in the HSS study.

HSS investigators conducted a retrospective review of medical records to identify patients with surfing-related injuries who came to HSS for treatment between January 1, 2009 and August 1, 2018. The researchers analyzed the data and reported on the body part injured, diagnosis, and surgical versus nonsurgical treatment.

The search yielded 109 patients with surfing-related injuries who had MRIs. A total of 90 patients came to HSS within six months of their injury and were included in the final analysis. The median age was 36, with patients ranging in age from 12 to 66. Three-quarters of the patients were male.

Acute surfing injuries were diagnosed with an MRI in 72% of study patients. The following injuries were reported:

Shoulder: 46% of surfing injuries

Knee: 28%

Foot or ankle: 9%

Spine: 6%

Elbow: 6%

Other (rib fracture; muscle strain or muscle laceration): 5%

“Although prior studies have shown that injuries related to surfing are primarily found in the head or lower extremities, our study found upper extremity injuries to be more common,” said Peter Fabricant, MD, a pediatric orthopedic surgeon at HSS and study author. “The majority of upper extremity injuries occurred at the shoulder with anterior shoulder dislocation being the most common diagnosis. Of the presenting knee injuries, a torn medial collateral ligament was the most frequent.”

Only 17% of all the surfing injuries required surgery at HSS. This percentage may overestimate the number of surfing injuries in general that require surgery, the study authors noted. Tertiary care referral centers such as HSS tend to see a greater proportion of serious injuries requiring surgery.

The study authors noted that the overall diagnostic quality provided by MRI helps to elucidate the most serious soft tissue surfing injuries. However, the exclusive use of this imaging modality for diagnosis was a limitation of the study, as it would not account for other musculoskeletal surfing injuries that do not require an MRI.

“When compared to other extreme sports, surfing seems relatively safe,” said Dr. Greditzer. “However, it’s important to keep in mind that our study looked at recreational surfers. We did not include professional surfers, so the patients in our study were not able to generate as much speed, get barreled, or launch into the air like a professional or amateur can, where the potential for injury is much higher.”

Dr. Greditzer, who has been surfing for more than 20 years, commented on injury prevention for beginning surfers. He says being a good swimmer is the most important attribute for anyone thinking of taking up the sport. He also recommends that beginners take a few lessons to learn the basics and use a soft foam surfboard to start.

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HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the tenth consecutive year), No. 3 in rheumatology by U.S. News & World Report (2019-2020), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2019-2020). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In addition, HSS will be opening a new facility in Florida in early 2020. In 2018, HSS provided care to 139,000 patients and performed more than 32,000 surgical procedures, and people from all 50 U.S. states and 80 countries travelled to receive care at HSS. There were more than 37,000 pediatric visits to the HSS Lerner Children’s Pavilion for treatment by a team of interdisciplinary experts. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is the world’s leading provider of education on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. http://www.hss.edu.