Nutrition in Combat Sports

224 R.R. Wroble
38.7% of wrestlers had a permanent ear deformity. Approximately one fourth of
those with deformity incurred their injuries while they were wearing headgear. In
an early study of high school wrestlers, only 2 of 49 coaches (4.1%) required their
wrestlers to wear headgear (Acksel 1966 ). Estwanik and Rovere found that 88% of
high school wrestlers wore their headgear in less than 50% of practices. Estwanik
et al. (1980) documented that 70% of hematomas they treated occurred while headgear
was not being worn. In the few studies that documented ear injuries as percentage
of total, these have comprised from 1.7% to 24.6% of the total number of
wrestling injuries (Konrad 1951 , Patacsil 1955 , Estwanik et al. 1978, 1980 , Lorish
et al. 1992 , Requa and Garrick 1981 , NCAA 1993a, b , Roy 1979 , Snook 1982 ,
Brown 1951 , Acksel 1966 , Wroble 1996) .
Historically, treatment has been apparently ineffective for several reasons. First
and most unfortunately, is that some wrestlers regard the “cauliflower ear” as a
mark of distinction that identifies them immediately as a wrestler. Second, treatment
may be avoided because of anticipated pain. Third, a wrestler may shy away
from treatment for fear of being told he needs to take time off.
Treatment goals include: restoring the normal appearance and pliability of the
ear, early return to wrestling activity, and low recurrence rate. The acute hematoma
requires prompt needle aspiration by or under direct supervision of a physician. We
must emphasize the strict use of aseptic techniques. Should infection arise in the
subperichondrial space, cartilage necrosis with loss of a portion of the external ear
may ensue. Approximately 2–3 cc of blood can be aspirated from the typical acute
hematoma. It is routinely sent for aerobic and anaerobic culture and sensitivity.
A 1-in. 19-gauge short bevel thin-wall needle works well. It provides a large inner
diameter, which seems less apt to clog and allows removal of more viscous fluid.
Many methods have been described to prevent reaccumulation of fluid.
Contemporary techniques use different types of suturing over materials including
dental rolls and different silicone materials (Schuller et al. 1989b , Dimeff and
Hough 1989 , Eichel and Bray 1978 , Kelleher et al. 1967) . Our preference is the
through-and-through suture technique over silicone sheeting described by Lane
et al. (1998) The principal advantage of this technique is allowing the wrestlers to
return to participation within 24 h. Antibiotic ointment and a short course of oral
antibiotics are used immediately after the application. Sutures are left in place for
14 days with frequent rechecking for any signs of infection. More complex cases
require referral to an otolaryngologist for open debridement of the ear. Infection is
a more serious scenario and requires immediate intervention.
13.4.2 Upper Extremity
13.4.2.1 Shoulder Injuries
Shoulder injuries account for 3.5–24% of all wrestling injuries in prospective studies.
The shoulder is injured by three principal mechanisms. When being thrown to the
mat from a standing position, a wrestler may attempt to brace his fall with his