Sports injuries to the upper extremity. How to recognize and deal with some common problems

Rehabilitation of basketball injuries

Basketball is one of the most popular sports in the United States and throughout the world, and therefore represents one of the most common sources of sports-related injuries. Basketball injuries should be managed by the same general rehabilitation principles as other sports injuries. Additionally, the clinician should be aware not only of general sports injuries but of those injuries most commonly seen in basketball players. By maintaining knowledge of the most common basketball injuries as well as their diagnosis and treatment, the clinician can help to optimize the athlete's return to play and enjoyment of the sport.

Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand

Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses common overuse injuries of the wrist including tendon injuries such as de Quervain's syndrome, subluxation of the extensor carpi ulnaris, and the common dorsal carpal impingement syndrome. The main focus of this section is the discussion of traumatic injuries to the hand in the athlete. Included is a discussion and review of fractures of the phalanges and metacarpals, common proximal interphalangeal joint injuries, and thumb carpal metacarpal and metacarpophalangeal joint injuries. Emphasis is placed on more common injuries seen regarding diagnosis, indications for non-operative versus operative treatment, and time to return to athletic competition.

Injuries to the upper extremity in ice hockey: analysis of a series of 760 injuries

BACKGROUND

Injuries to the upper extremity are common in ice hockey.

PURPOSE

To investigate the mechanisms, types, and severity of upper extremity ice hockey injuries in patients in different age categories.

STUDY DESIGN

Retrospective cohort study.

METHODS

We analyzed 760 consecutive upper extremity injuries in Finnish ice hockey players reported to an insurance company during 1996.

RESULTS

The overall injury rate of upper extremity injuries was 14.8 per 1000 player-years; 70% occurred during games. Of the 861 injury types, 32% were contusions, 28% sprains or strains, and 27% fractures. Checking or other collisions with players caused 76% of the injuries to the shoulder (170 of 223), 55% of the injuries to the elbow (35 of 64), and 45% of the injuries to the distal extremity (213 of 473). Of the 561 injuries with known severity, 38% were major. The injury risk increased significantly with age, from players younger than 12 years to players 25 to 29 years of age. The injury profile among 15- to 19-year-old players was similar to that of adult players.

CONCLUSIONS

Injuries to the upper extremity are relatively serious because of the high number of shoulder injuries and fractures. The frequency of injuries increased with age. A considerable proportion of upper extremity injuries was caused by body checking.

Upper-extremity tendinitis and overuse syndromes in the athlete

Overuse injuries are the result of repetitive microtrauma to the musculotendinous unit. Treatment protocols are based on the stage of the inflammatory process that is active at the time of diagnosis. Control of the inflammatory response with rest, elevation, and ice is the treatment objective during the inflammatory stage. Prevention of further injury is the primary treatment goal throughout the proliferative phase. Once the inflammatory process has reached the maturation stage, rehabilitation can begin with flexibility exercises, isometric contractions, and a slow return to strength training. Surgical decompression is frequently necessary if chronic inflammation causes fibrosis of the fibro-osseous tendon sheaths. Anomalous muscle bellies and tendinous interconnections can be contributing factors to overuse syndromes. Properly structured training programs and rehabilitation regimens can prevent tendinitis and overuse syndromes.

Epicondylopathia humeri (EPH) and peritendinitis humeroscapularis (PHS): evaluation of radiation therapy long-term results and literature review

BACKGROUND

The effectiveness of radiotherapy (RT) for degenerative inflammatory disorders has been clinically documented in historical studies, but long-term follow-up and assessment with objective criteria are still not available.

PATIENTS AND METHODS

From 1986 to 1991, 200 consecutive patients with symptomatic epicondylopathia humeri (EPH, n = 104) and peritendinitis humeroscapularis (PHS, n = 96) were referred to our clinic. All patients were refractory to conventional therapy prior to irradiation. One hundred fifty-six patients with 192 sites (due to bilateral symptoms) received a full treatment course and were available for long-term follow-up, i.e. 83 patients with 93 elbows and 73 patients with 89 shoulders. The treatment response was evaluated with regard to pain symptoms grouped into five categories (pain at strain, pain at night, persistent pain during daytime, pain at rest and morning stiffness) and four grades (none, mild, moderate and severe) and with regard to established orthopedic scores (Morrey score and Constant and Murley score). The analysis was performed before and 6 weeks after RT and at last follow-up. All joints received two RT series applied in three weekly fractions (EPH, 6 x 1 Gy (total 12 Gy); PHS, 6 x 0.5 Gy (total 6 Gy)). The second RT series started 6 weeks after the first RT series. The minimum follow-up was 1 year for both groups and the mean follow-up reached 4 years (range 1-8 years).

RESULTS

Fifty elbows (43 patients) and 44 shoulders (39 patients) achieved complete pain relief in all pain categories; 24 elbows and 28 shoulders substantially improved, i.e. had only minor symptoms. Thus, 74 elbows and 72 shoulders responded to RT. Nineteen elbows (17 patients) had surgery after RT due to persisting symptoms or subjective dissatisfaction; 17 shoulders (12 patients) were non-responders and five of those were operated on; seven elbows and one shoulder were completely free of pain after surgery. The mean Morrey score improved by 18 points (from 78 to 96) and the mean Constant and Murley score improved by 48 points (from 18 to 66). Two cases worsened according to the Morrey score and one case worsened according to the Constant and Murley score. Bi- and multivariate analysis revealed two factors with negative prognostic value on treatment outcome, i.e. EPH, long symptom interval prior to RT and long-term immobilization with plaster (P < 0.05) and PHS, long symptom interval prior to RT and lack of pain intensification during the first RT course (P < 0.05) were poor prognostic factors.

CONCLUSION

RT is highly effective for refractory EPH and PHS. Structured pain scores and quantitative orthopedic scores are important for evaluation. Prognostic factors for outcome can be established. Due to minimal side effects and low costs, RT represents an excellent treatment compared to conventional methods of treatment and surgery in the chronic disease.

Imaging in sports medicine: hand and wrist

Sports-related injuries of the hand and wrist include lesions of the bones, joints, ligaments, tendons and muscles. In many cases, radiologic imaging procedures are indispensible for the depiction, localization and accurate diagnosis of these lesions. This article reviews the role and potential of current imaging modalities such as conventional radiography, fluoroscopic examinations, arthrography, computed tomography (CT), ultrasound, and magnetic resonance (MR) imaging for the diagnostic work-up of typical osseous and soft tissue injuries in sports medicine.

[Epicondylopathia humeri. The indication for, technic and clinical results of radiotherapy]

BACKGROUND

The efficacy of radiotherapy for degenerative-inflammatory disorders is well known, but so far long-term observations and reliable assessment of symptoms according to objective criteria and scores for validation are still missing.

PATIENTS AND METHOD

From 1986 to 1991, 104 patients with refractory epicondylopathia humeri were irradiated. 85 patients or 93 elbows (due to double-sided symptoms) were documented in long-term follow-up according to objective criteria. All patients had received intensive therapy. Pain symptoms were quantified in "categories" and "grades" prior to and 6 weeks after radiotherapy and at last follow-up. In addition, the elbow score of Morrey et al. [36] was used for long-term evaluation. The onset of pain symptoms was acute in 41 and chronic in 52 cases. The mean symptom duration prior to radiotherapy was 16 months. Pain was mostly triggered off during professional (46) or sportive activities (23) or spontaneously (11). Fifty-one patients were severely disabled in professional or sportive activities. The involved elbow(s) received 2 radiotherapy series of 6 x 1 Gy (total 12 Gy) with 3 fractions per week; the second radiotherapy series was started 6 weeks after the first series. Mean follow-up was 4 +/- 2 (1 to 8) years.

RESULTS

Forty-three patients (50 elbows) achieved "complete pain relief (CR)" in all pain categories: 59% elbows with pain at strain had "complete pain relief", 79% with pain at night, 84% with permanent pain, 80% with pain at rest and 81% with pain at initiation or morning stiffness. Nineteen elbows gained "major pain relief (PR)", i.e. had minor symptoms (maximum grade 1) in all categories. Thus, a total of 69 (74%) elbows responded to radiotherapy. Seventeen patients (19 elbows) were operated because of persistent symptoms or dissatisfaction in long-term follow-up; 7 of those became completely free of symptoms. The Morrey-Score improved by a mean of 18 points from 78 prior to radiotherapy to 96 points at last follow-up. According to the Morrey-Score only 2 patients became worse in long-term follow-up. Two parameters indicated a negative prognosis in multivariate analysis: long symptom duration prior to radiotherapy and immobilisation with plaster (p < 0.05).

CONCLUSIONS

Radiotherapy for refractory epicondylopathia humeri is highly effective. Long symptom duration and long-term immobilisation by plaster are negative prognostic factors for treatment outcome. Due to the low side effects and treatment costs, radiotherapy is a good therapeutic option in comparison to conventional treatment methods and surgery in the chronic stage of epicondylopathia humeri.

Overuse syndromes of the upper extremity in interpreters for the deaf

Fourteen of 80 interpreters (18%) for deaf students at a national center on deafness sought medical care for painful conditions of the upper extremity; 11 others (14%) had less severe or transient symptoms. The conditions were brought on by repetitive use and were relieved by rest. All represented overuse syndromes. Tendinitis, fasciitis, synovitis, and nerve entrapment were encountered most often. Conservative treatment (eg, physical therapy, splinting, medications) was of little or no value. Only rest relieved symptoms. Surgery was rarely indicated. The most reasonable approach to treatment would, therefore, seem to be prevention. Suggested methods for avoidance of pain include limiting the duration of interpreting sessions, technique modification, and resistance exercises to increase endurance.

Stress fracture of the finger in a bowler

A 28-year-old semiprofessional bowler was seen initially with pain in the right ring finger that was aggravated by bowling and relieved by rest. He had localized tenderness of the middle phalanx; x-ray films revealed a stress fracture. The fracture healed with restriction of activity and he was able to gradually resume bowling. Although rare, stress fracture should be considered in the differential diagnosis of finger pain in a patient with a history of overuse.