The Treatment of “RIPS” on the Hands
by Larry Nassar, DO, ATC

The treatment of rips has become a part of gymnastics folk lore through the years. There are many treatments that have been tried and sworn to be effective through the years. For example:

• Preparation H or other hemorrhoid ointments have been used to reduce tissue swelling and some have a topical anesthetic to help numb the rip.
• Bag Balm which is a veterinary balm applied to cows' utters because they have a tendency to crack/split. Bag Balm is used to help treat fresh rips or as a hand conditioner to prevent rips.
• A small balloon taped over the rip may help. The friction generated between the bars and the tape causes the balloon to rub against its inner surfaces and prevents friction between the balloon and the rip.
• Tuff Skin (a taping base) sprayed onto a fresh rip, has been reported to help heal rips - this is not recommended.
• Another fairly common treatment is soaking the freshly ripped hand in a 10 percent bleach in water solution-this also is not recommended.
• The old standby is covering the hands with a hand lotion, vitamin E or aloe vera at night while sleeping and protecting the bed sheets by wearing gloves or socks over the hands. Please, use a non-perfumed hand lotion since the perfume is alcohol based.
• Gibson (1-800-275-5999) sells DAT Sticks which is a series of three balms: a callous stick used prior to workouts to promote toughening of calluses, a condition stick which is used at night to keep calluses smooth and pliable; and a rip stick used to help heal fresh rips.
• The company, 10.0 (1-800-241-9249), sells Spenco “Rip Kits” which contains “2nd Skin” (a hydrogel dressing) to help prevent and protect rips. The kit also contains pressure foam pads and adhesive knit. 10.0 also sells a “skin freeze” which is a spray that will cool down hot hands to reduce skin irritation.
• Dunlap makes a skin protector called “Compeed” which can be used in practice to protect the fresh rip and also helps to heal these rips. This can be found in many sporting-goods stores and bicycle shops.
• Neoprene rubber wrist bands are used to prevent rips on the wrists from dowel grips.
• G.A. Deitch (717-697-3107) makes a lanolin protective glove which is worn underneath the regular grip as an “undergrip.”
• Of course the tape grip made out of white trainer's tape to protect a rip is a standard, but I recommend using Johnson & Johnson Elastikon elastic tape instead
  Trimming calluses (with a “Pyrex Corn and Callus Shaver”) is important to help prevent rips from occurring.
• DuoDERM and Nova Derm sterile occlusive dressings and Op-sight and Bioclusive transparent moisture vapor permeable hypoallergenic viral barriers.
  

Recommended Treatment For Rips

Prevention of infection is the first thing to consider when treating a rip. I have seen improperly-treated rips develop cellulitis (blood poisoning) and required intravenous (IV) antibiotics for treatment of the wound. The most important thing to do after a rip occurs is to wash the hand with warm water and a mild soap. The latest medical research shows that soap and warm water is more effective in treating wounds than using Betadine (providone iodine) or hydrogen peroxide. Hydrogen peroxide should not be used as a general wound cleaner unless recommended by a physician. It has been determined that hydrogen peroxide is too caustic for the wound and destroys healthy cells and can actually delay healing. Betadine has also been shown to be too strong and can damage cells when applied to a would. Betadine is still used as a pre-operation skin preparation and is used for cleaning wounds in the Emergency Room prior to suturing lacerations. However, the Betadine is diluted with sterile water and is rarely used without being watered down. The most effective way of cleaning wounds is by irrigating it well with water and washing it with warm soapy water.

Once the rip has been washed and dried to prevent infection, then a sterile bandage should be applied. The type of sterile bandage depends on the severity of the rip and the cost of treating the wound. The inexpensive way of treating minor rips is by applying a triple antibiotic ointment (Neosporin) to a sterile bandage and covering the wound with this bandage. Change the bandage when it becomes wet.

The most effective way to speed up the healing process is to utilize the expensive bandage protocol. After the wound has been cleaned with soapy water and dried, apply DuoDERM Extra Thin CGF Spot dressing. DuoDERM dressings have a skin contact adhesive layer containing hydroactive particles that interact with fluid produced by the wound. This forms a moist gel which provides a great environment for cell migration, leading to rapid healing. You should not add a triple antibiotic ointment (Neosporin) to the wound when DuoDERM is used because it may actually delay healing. Some studies (Xakellis and Chrischilles) have shown a 46 percent faster healing rate than using gauze bandages. This moist gel protects the wound from re-injury when the dressing is removed. With gauze bandages, the wound dries out and sticks to the dressing and newly formed tissue tears away when the bandage is removed (Tudhope).

DuoDERM dressings present a functional barrier to external contamination with infection rates up to five times lower than gauze bandages (Hutchinson). It can be left on up to seven days in a row before needing to be changed. The gymnast may wash his hands and even shower and keep the dressing in place. With the Extra Thin DuoDERM gymnasts can even swing bars with the bandage held in place by tape beneath the grip. Some gymnasts prefer to use an even thinner viral barrier called Bioclusive or Op-sight while swinging bars. After use on bars, I recommend that the dressing should be changed no matter what type is used. If the gymnast does not swing bars, however, the dressing may remain in place after practice.

DuoDERM is currently used by many collegiate and professional sports medicine staffs for their athletes in a variety of sports. These facilities have the resources to purchase the dressings. Our gymnasts may not have the funds to buy the product. To help reduce this cost, ask a physician to write a prescription for the DuoDERM. Request several refills on the prescription so that more DuoDERM can be used when the gymnasts rips again in the future. Since many medical insurance companies cover the use of DuoDERM the only cost to the gymnast is the prescription co-pay. DuoDERM is available over-the-counter at many pharmacies. A pharmacy connected to a hospital or one which sells hospital supplies is the best source for DuoDERM. Remember to use the extra-thin type of DuoDERM.

No matter what type of dressing used to cover a wound, signs of infection need to be assessed. These signs of infection include: a foul order, pus or yellowish discharge (exudate), redness (erythema), and fever. If these signs develop the wound should be evaluated by a physician for further cleaning and the use of antibiotics.

References

Hutchinson J.J. Prevalence of wound infection under occlusive dressings: A collective survey or reported research. Wounds. 1989; 1:123-124.
Tudhope M. Management of pressure ulcers with a hydrocolloid occlusive dressing. Journal of Enterostomal Therapy. May/June 1984; II:102-105.
Xakellis G.C. and Chrischilles E.A. Hydrocolloid versus saline-gauze dressings in treating pressure ulcers: A cost-effectiveness analysis. Arch Phys Med Rehabil. May 1992; 73:463-469.

This article is reprinted from the May/June 1998 USA Gymnastics magazine.