Vitamin D and a COVID Link?

Several years ago we featured a blog discussing the rise in Vitamin D deficiency and the corresponding rise in certain injuries and diseases, including an increase in the number of fracture cases in younger Vitamin D deficient patients.

Over the years scientific research has identified a visible link between Vitamin D deficiency and increased risk of fracture, diabetes, cardiovascular disease and cancer [1, 2].  Testing Vitamin D levels of our fracture patients is now common practice in our clinic.

While the widespread deficiency identified in adolescents, young and middle-aged adults and elderly alike has itself been called a “pandemic,” new studies are now also showing the important role that adequate Vitamin D levels may play in not only maintaining good health but also accelerating recovery when diagnosed with COVID-19 [3].

Though research is ongoing, according to one recently published report, adults with vitamin D deficiency are at greater risk for severe COVID-19 infection and death. The data presented at the American Society for Bone and Mineral Research virtual meeting showed that the hospitalized COVID-19 group had lower 25-(OH)D levels (mean, 18.2 ng/mL) than the group with mild symptoms (30.3 ng/mL), or the control group (25.4 ng/mL; p < .0001 for both) (Figure 1) [3].

The report indicated that intervention trials are needed to explore whether vitamin D supplementation could prevent respiratory failure in people with COVID-19 or other serious respiratory infections.

The data is among the new information learned almost daily on the novel coronavirus.  And while researchers admit that additional research is necessary to further explore this link and the COVID prevention and recovery implications, most agree that encouraging adequate Vitamin D intake and addressing deficiencies present no downside in the interim.

Figure 1. Mean Vitamin D Levels found in adults with or without COVID-19.



Causes of Vitamin D Deficiency

While studies continue to explore possible causes of the widespread Vitamin D deficiency, a number have already been identified.  Some are the result of societal changes such as increased use of sun blocks/sun screens for fear of skin cancer (limiting unprotected sun exposure) and changes in our diet (processed, nutrient-deficient foods versus nutrient and Vitamin D-rich foods). Both of which have gradually reduced the amount of Vitamin D intake we receive.

 Other possible causes of Vitamin D Deficiency include:

 1.) Obesity

Some studies suggest that a higher BMI leads to lower 25(OH) D. Greater amounts of subcutaneous fat sequesters more of the vitamin and alter its release into circulation.

2.) Naturally dark-skinned individuals

Greater amounts of the pigment melanin in the epidermal layer (resulting in darker skin) reduces the skin’s ability to produce Vitamin D from sunlight.

3.) Certain Medications

Corticosteroid medications such as prednisone (often prescribed to reduce inflammation) can reduce calcium absorption and hinder Vitamin D metabolism. Other weight-loss, cholesterol-lowering and epileptic seizure medications have also been implicated in reduced calcium absorption and Vitamin D levels.

4.)  Age

As we age, our skin cannot synthesize Vitamin D as efficiently. The elderly are also likely to spend more time indoors, leading to inadequate intakes of the vitamin [4,5].


  1. Holick MF. Vitamin D: importance in the preventioin of cancers, type 1 diabetes, heart disease, and osteoporosis.  Am J Clin Nutr. 2004;79(3):362-371.
  2. Holick MF. The vitamin D Deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Aspects Med. 2008;29(6):361-8.
  3. Monostra M. Low vitamin D levels independently associated with severe COVID-19 cases, death. EndocrinToday. Helio. 2020 Sept 11.
  4. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89(11):5387-5391.
  5. Institutes of Health, Office of Dietary Supplements – .
  6. Vimaleswaran KS, Berry DJ, Lu C et al. Causal relationship between obesity and Vitamin D status:  bi-directional Mendelian randomization analysis of multiple cohorts. 2013 –

Dr. Korsh Jafarnia is one of Houston’s leading board certified, fellowship trained hand and upper extremity specialists.  A member of Houston Methodist Orthopedics & Sports Medicine, Dr. Jafarnia is affiliated with Houston Methodist Hospital at Memorial City/Spring Valley.  He also serves as an assistant professor, Weill Cornell Medical College. Call 888.621.4263 for an appointment, or go to to learn more. 

This information is made available for educational purposes only.  It does not serve as a diagnosis in the absence of a consult with a qualified healthcare provided.



The Texas Bowl, Championing Community

Stemming from a rich history that dates to 1959, the Texas Bowl we know today champions community and charitable initiatives – designating the Depelchin Children’s Center as its charitable beneficiary.

A post-season NCAA-sanctioned Division I FBS college football bowl game, the Texas Bowl takes top tier performance off the field to strengthen the Texas communities they call home.

Aside from the direct support provided the Depelchin Center through its ticket sales, the Texas Bowl community initiatives include; the Kendra Scott Gives Back event, Gridiron Legends – honoring epic players in Texas football, Gridiron Legends Golf Tournament, Mr. Football – Player of the Year Award, Day at the Museum, Team Football, Rodeo Bowl, Bowl Buddy and THSCA Tickets – Texas Bowl tickets offered to outstanding coaches through the Texas High School Coaches Association & Coaches Education Foundation.

Together the Texas Bowl has contributed over $1.6 million in financial support to the center and millions of dollars in promotional support, while boosting spirits and empowering children from the Depelchin Center throughout the year – something needed today more than ever before.

The Depelchin Center, which has been a beneficiary of the Texas Bowl since 2006, has served as one of Houston’s leading centers for foster care and adoption services since 1892.  The center is a nonprofit provider of mental health, prevention and early intervention and child welfare services.

Texas Legends

The Gridiron Legends program honors individuals who have made a significant contribution to the game of football in the state of Texas (high school, collegiate or professional). 

The 2020 Gridiron Legends class will be honored on-field during the 2020 Texas Bowl, which is scheduled for December and currently taking names for the Priority Waiting List.

The History of the Texas Bowl

The Texas Bowl played its first game in 2006, replacing the Houston Bowl (2000-2005).  Prior to that, the bowl was called the Bluebonnet Bowl (1959 – 1987).  It has had different title sponsors over the years including AdvoCare (2014-2016), Meineke Car Care (2011 – 2012) and currently Academy Sports + Outdoors (2017 to present).  The bowl game today is officially called the Academy Sports + Outdoors Texas Bowl.

Dr. Jafarnia has recently joined the board of directors of the Texas Bowl – committed to ensuring the success of the organization and vital role it plays in improving community and the lives of Houston kids.

Dr. Korsh Jafarnia plays with golf legend Calvin Murphy in the Gridiron Legends Golf Tournament

Dr. Jafarnia (second from right) with golf legend Calvin Murphy (center) and colleagues at the 2019 Gridiron Legends Golf Tournament.

Learn more about the Texas Bowl, the Depelchin Children’s Center and the center’s current School Supply Drive.






Triceps Tendon Trauma – Rare but Serious

In our last blog we discussed biceps tendon ruptures, which occur when the biceps tendon (located in front of the upper arm) is torn from the bone at the point of tendon attachment – either at the shoulder or the elbow.

In contrast, rupture of the triceps tendon (representing the opposing muscle group to the biceps and located at the back of the elbow) is an injury that occurs most commonly from the forced bending of the elbow during a forceful pushing activity, causing the triceps tendon attachment to separate from the bone.

The triceps muscle tendon is responsible for elbow straightening/extension and strength. A triceps tendon that has ruptured prevents the muscle’s normal function and results in weakness and restricted elbow extension.

Triceps Tendon Rupture Diagnosis

Triceps tendon ruptures are rare, accounting for just 0.8% of tendon ruptures, and therefore often misdiagnosed in the emergency department (1,2).

Symptoms may include:

  • Swelling and tenderness to touch at the back of the elbow (where tendon attaches)
  • Weakness/loss of strength when elbow is extended against resistance
  • Inability to follow through with certain movements

This type of injury generally occurs in a sports-related trauma or harsh impact and are more frequently diagnosed in men aged 30 -50.  They are more likely to occur when the biceps and triceps muscle groups are not equally strengthened and pushed to an extreme.

Additional Risk Factors:

  • Excessive weight/power lifting, body building
  • Systemic illness (hyperparathyroidism, renal osteodystrophy)
  • Anabolic steroid use
  • Local steroid injection
  • Fluoroquinolone use
  • Chronic olecranon bursitis
  • Previous triceps surgery
  • Marfan syndrome (2,3)

If this injury is missed or neglected, the individual/athlete may experience weakness with elbow extension and an inability to support a block in football, lift weights, or perform push-ups.

Triceps Tendon Rupture Treatment

While the severity of the injury will determine treatment, surgery is usually indicated in cases of complete rupture and entails tendon repair using bone suture anchors or bone tunnels. Surgery is then followed by a rigorous rehabilitation program that moves from isometric extension exercises to weight-resisted and eventually throwing exercises.

Delayed repair becomes technically demanding and yields treatment results that are inferior to acute repair (2). Early diagnosis and repair will lead to the best possible outcome.

Preventing Injury

While a triceps tendon rupture caused by trauma may be difficult to avoid, those involved in power lifting and body building should be cognizant of such repercussions from the load sport and affiliated supplements.  Equal training of opposing muscle groups, regular stretching and adequate muscle rest have also been found to reduce risk of many different types of musculoskeletal injuries (4).


  1. Ahn L., Ahmad CS. Triceps Rupture. American Shoulder and Elbow Surgeons,, 2019. Retrieved from
  2. Kocialkowski C, Carter R, Peach C. Triceps Tendon Rupture: Repair and Rehabilitation. Retrieved from
  3. Nikolaido ME., Banke IJ., Laios T., et al.Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment. Case Rep Orthop. 2014; 2014:962930. Retrieved from
  4. Tucker A. Why it Matters if One Side of Your Body is Stronger than the Other – and How to Fix It. Self, 2017. Retrieved from



Biceps Tendon Tears – When Not to Push Through the Pain

From a young age we’ve heard; “no pain, no gain.”  Some even see it as a personal challenge.  And while a youthful body can be forgiving when pushed beyond its limits, an adult one is not.

Pain is our body’s warning to either stop or proceed with caution.  Ignoring this or “pushing through” could come at a cost, particularly as we get older.

As working professionals workouts are less frequent and muscle mass, correspondingly, less sufficient to sustain the same weights and reps.

Additionally, as we age, our musculoskeletal system changes.  Joints, tendons and ligaments are feeling the cumulative effects of decades of activity.  To ensure decades more, we need to be smart in our workout routines and the challenges we’re willing to take on.

One injury we often see in men ages 40 – 60 are biceps tendon tears and ruptures.  This often happens when the biceps tendon experiences chronic wear as a result of lifting excessive weights or participating in aggressive contact sports.  It can also occur in those performing repetitive overhead lifting or work in occupations requiring regular heavy lifting.

The Biceps Muscle and the Difference between a Tear and a Rupture

The biceps muscle is located in the front of the upper arm and helps to bend and rotate the arm. It has two tendons; 1.) the long head and the short head of the biceps, which attach the muscle to the shoulder, and 2.) the distal biceps tendon, which attaches at the elbow/forearm.

The terms biceps tear and biceps rupture are often used interchangeably and occur when the biceps muscle is torn from the bone at the point of tendon attachment, either at the shoulder or the elbow.  A tear could represent either a partial or a complete tear.

Biceps tendon tears most often occur at the long head of the biceps at the upper arm bone.  It rarely occurs at the elbow, unless trauma from a sudden accident occurs.

While biceps tears do not repair themselves and can limit full function of the arm unless surgically repaired, those occurring at the elbow cause greater arm weakness than those occurring more commonly at the shoulder/upper arm.

Indications of a Biceps Tendon Tear or Rupture

  • A “pop” or snap at the shoulder or elbow.
  • Sharp pain in the upper arm.
  • Bruising and swelling in the affected area.
  • Weakness and tenderness in the shoulder or when bending the elbow, rotating the forearm, or lifting the arm overhead.
  • A deformity/bulge in the lower part of the biceps referred to as “Popeye arm.”

Treatment of a Distal Biceps Tendon Tear

Following a physical examination and functional testing, the severity of the injury will be determined.  While physical therapy may suffice for elderly patients with low upper body demands, surgery is generally indicated for younger patients.  This may entail either a nonanatomic repair to the brachialis or, most commonly, an anatomic repair to the radial tuberosity [1].

The surgical approach has evolved from an anterior approach to a two-incision approach and most recently to a single-incision approach with a bone anchor or ENDOBUTTON™.

Advantages of this approach include anatomical reinsertion, flexion restoration and supination strengthening [2].

Preventing Biceps Tendon Rupture

  • Maintain equal strength throughout the arm – biceps/triceps, elbow and forearm – and in the shoulders.
  • Avoid repetitive overhead lifting of excessive weight.
  • Use the entire upper body when lowering heaving objects to the ground.
  • Avoid steroid use and smoking, as they weaken muscles and tendons and inhibit muscle recovery and growth.


  1. Ward JP, Shreve MC, Youm T, Strauss EJ. Ruptures of the distal biceps tendon. Bull Hosp Jt Dis (2013). 2014;72(1):110–119. Article Summary in PubMed.
  2. Tarrallo L, Lombardi M, Zambianchi F, Giogini A, Cantani F. Distal biceps tendon rupture: advantages and drawbacks of the anatomical reinsertion with a modified double incision approach.BMC Musculoskelet Disord. 2018;19:364. Full articles online.


Have an Injury-Free Fourth!

Considered the official kickoff to summer, the Fourth of July is a fun-filled celebration commemorated with outdoor barbeques and festivities.  Unfortunately, too many find themselves in the emergency room over this holiday weekend as a result of firework-related accidents.

While unofficially those at highest risk for firework injuries are adolescent boys, the adult male population are a close second in the highest risk group – according to reports of ER physicians and orthopedic hand specialists….

And it is estimated that over 40 percent of firework injuries occur to the hand, wrist and elbow.

Injuries most commonly occur when an ignited firework seemingly fails to go off, though explodes when handled.  Other injuries occur as a result of the extreme heat many fireworks omit.  Even the unassuming “sparkler” can heat to over 2000 degrees, capable of causing 2nd and 3rd degree burns.

The fireworks most implicated in causing injury include small firecrackers, bottle rockets and sparklers, because they are assumed to be less dangerous.  Individuals mistakenly use less caution when handling these types of fireworks.

Some of the most common hand and upper extremity traumatic injuries resulting from firework-related accidents include:

  • Burns
  • Contusions and lacerations
  • Damage to bones, muscle, ligaments and nerves 

Medical Attention for a Traumatic Firework Injury

It is important to seek immediate attention for a traumatic firework injury, to avoid permanent damage to the hand and wrist.

The hand alone contains approximately 50 nerves, with 34 muscles moving the fingers and thumb, and over 120 known ligaments, 30 major joints, 30 bones and a myriad of connective tendons involved in carrying out our everyday activities.

Long-term hand function is dependent on not only immediate care but proper follow up.  If such injuries are not adequately addressed, permanent nerve and tendon damage can impair hand feeling and movement. And the early onset of osteoarthritis from post-traumatic bone and joint damage can further hinder hand function.

Reducing Risks of Traumatic Firework-Related Injury

While many of the tips for reducing risk of hand injury from fireworks seem common sense, they can be overlooked during the excitement.  They include:

  • Ignite all fireworks with extended lighters.
  • Remain a safe distance from ignited fireworks.
  • Allow sufficient time for fireworks to go off / explode before approaching (and handle previously ignited fireworks with an extended apparatus such as BBQ tongs).
  • Supervise young children holding sparklers, advise teens of the heat hazard of these and other small, seemingly harmless fireworks.
  • Protective glasses and gloves can also reduce risks.

 Have a happy and safe Fourth of the July!

Getting a Handle on Repetitive Stress in Cycling

Hand & Wrist Conditions Cyclists Can Avoid

As cyclists across Texas ready for the upcoming BP MS 150, a two-day bike ride from Houston to Austin, we thought we’d talk about some of the most common overuse, or repetitive stress, hand and wrist conditions affecting cyclists and ways to avoid them to ensure a pain-free ride.hand and wrist repetitive stress in cycling

How Repetitive Stress Occurs
Nearly one-third of the overuse strains associated with avid cyclists competing year-round in weekend rides and races affect the hand and upper extremity. These types of injuries can also affect those who have not adequately trained yet embark upon a 150-mile ride between Houston and our state’s capital.

Despite the best equipment and preventative measures, the constant vibration, griped hand position for hours at a time or tense ride into the wind, up a hill and alongside Interstate traffic can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy, also known as ulnar neuropathy.  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

 Carpal Tunnel Syndrome

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  The result of irritation and swelling, CTS causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. CTS is one of the most common overuse hand and wrist conditions affecting cyclists. When the median nerve becomes irritated in this inflamed and compressed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers – causing discomfort and affecting a cyclist’s ability to even shift gears with the affected hand.  Resting periodically and stretching the hands, changing grip to reduce hyperextension and hyper flexion may help during the ride, but ongoing pain may require treatment – which is generally nonsurgical and may entail night bracing and/or injection therapy.  CTS pain remaining unresolved following nonsurgical treatment may require a minimally invasive Endoscopic Carpal Tunnel Release.

Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuritis or neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  This results when direct pressure is placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.  The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of this nerve can cause numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications generally resolves this condition.

handlebar palsy

Hyperflexed Wrist

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists as well – as the continuous vibration of the motorcycle causes the same type of conditions that long rides and regular bicycling can cause.

Ulnar neuritis in cycling

Hyperextended Wrist

Cycling Tips for Reducing Your Risks
Professional cyclists and medical experts have contributed to an array of preventative cycling gear and recommendations for reducing risks for such conditions.

These include:

  • Cycling gloves – both basic or specialized gel cycling gloves to reduce pressure on the ulnar nerve.
  • Additional handlebar padding.
  • Custom adjustments in handlebar height and overall bike fit specific to each rider.
  • Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion.
  • Frequent adjustments to grip and position on the handlebars during a ride.
  • Hand exercises between rides, such as squeezing an Iso-Ball.

Figures source:


Motorized Mobility Mishaps Increasing on College Campuses

The abundance and popularity of motorized vehicles, like Bird Rides and LimeBikes, on college campuses are changing transportation norms faster than the development of new safety guidelines and regulations. [1] As a result, the number of accidents and injuries related to motorized mobility scooters (MMS) are on the rise.

Students can pick up scooters wherever they’re left and head to class or meet up with friends – with bookbag and cellphone in hand, though without a helmet or operating instructions.  The scooters have no designated travel lane, and buzz alongside pedestrians, cyclists and motorists at a speed of 15 miles per hour. Additionally, the short wheel base and small wheel size of the scooter makes it more unstable than a bicycle and vulnerable to debris or uneven pavement.

And if that combination doesn’t raise the hazard flag up the pole fast enough, these young MMS operators are often distracted by their cell phone as well – continuing to text and check messages while in route…

According to a recently published study, ‘low-energy as well as high-energy crashes involving the motorized mobility scooters may result in serious injuries and sometimes death.’ The study suggests that “awareness by multidisciplinary treatment teams may help to avoid underestimation of injury severity. MMS drivers need to improve their driving skills in order to reduce the number of MMS crashes.” [2]

Orthopedic specialists are seeing an increase in hand and wrist fractures, which include distal radius fractures and boxer’s fracture as well as severe lacerations, concussions and neck injuries – resulting in some undergoing repair surgery over this past winter break before returning for spring semester. [3]

Following a study conducted by the Journal of the American Planning Association on pedestrian and cycling traffic, three specific “danger zones” involving more serious crashes and injuries were identified – campus activity hubs, campus access hubs and through traffic hubs. [4]

Recommendations to reduce risk of accident and injury for this population may also prove effective in reducing risks to the growing MMS operating population.

Students are encouraged to avoid distraction while using an MMS and recognize that its speed and instability can increase risk of injury if safety precautions are not taken.


  1. A Flock of electric scooters suddenly descended on Austin. Now the city is scrambling to regulate them.  Reported in the Texas Tribune (May 1, 2018).  Located online:
  2. Leijdesdorff HA, van Dijck JT, Krijnen P, Schipper I. Accidents involving a motorized mobility scooter: a growing problem. Ned Tijdschr Geneeskd. 2014;158:A7858.
  3. That electric scooter might be fun. It also might be deadly.  Reported on CNN online (October 1, 2018).  Located online:
  4. Loukaitou-Sideris A, Medury A, Fink C, Grembek O, Shafizadeh K, Wong N. Crashes on and near college campuses:  A comparative analysis of pedestrian and bicyclist safety. Journal of the American Planning Association. 2014;80(3):198-217.



Buddy Taping, A Helping Hand in Healing?

Buddy taping is the practice of bandaging an injured finger together with an adjacent healthy one for support.  Serving as a type of splint, the healthy finger is wrapped closely to the sprained, dislocated or fractured finger allowing both movement and a natural position conducive to injury protection.

Buddy taping an injured finger to a healthy one.

Buddy taping is used frequently in sports where finger injuries are common, such as volleyball, football and basketball.  It can serve as a temporary solution to help an athlete through a game or provide the necessary support facilitating recovery of a minor injury.  In some cases, it is also used to help prevent injuries.

As a “quick fix” post injury, buddy taping provides protection to the injured finger and keeps it out of the way so that an athlete can maintain grip and level of performance without causing further injury.

As an injury prevention measure, buddy taping may reduce risk of injury by preventing the fingers from moving past their normal range of motion during a fall or other impact [1].

Additionally, some athletes report increased grip strength when taped and practice buddy taping to provide additional grip strength as well as grip traction, in lieu of gloves, to improve performance.  Though, these perceived benefits have not been scientifically proven.

How Buddy Taping is Performed

Buddy taping is a simple process that can be performed easily with just a few items.  A piece of thin foam or padding the length of the finger is generally placed between the two fingers, a relatively stiff tape from ½ to 1 inch in thickness is placed around the fingers, leaving the joints uncovered to facilitate bending.  This may be applied directly to the fingers or over gloves (football). Depending on the thickness of the tape, one or two layers may be applied.  In some cases, a buddy tape “splint wrap” also known as “buddy loops,” a breathable foam line with a non-slip hex material that grips the skin, may be used.



Buddy taping is intended to provide “temporary” support. While it may remain on several days following an injury, all finger injuries should be assessed by a hand specialist.

Concerns about Buddy Taping

While taping digits together have become common practice, particularly in sports, some research suggests a potential for complications warranting concern and caution among those performing buddy taping to treat finger and toe injuries.

The authors of a recent study reported frequently seen complications such as necrosis of the skin, infections, loss of fixation and limited joint motion.

According to the surgeons included in the study, some of the indications for buddy taping included finger fractures, metacarpal fractures, metacarpophalangeal (MCP) joint injury, proximal interphalangeal (PIP) joint injury and carpometacarpal joint injury of the hand.

While benefit was recognized, concerns remain in low patient compliance and skin injury in the treatment of both finger and toe injuries [2].



  1. Jack Gerard. Why do football players put tape around their fingers?
  2. Sung Hun Won MD, Sanglim Lee MD, Chin Youb Chung MD et al. Buddy Taping: Is it a Safe Method for Treatment of Finger and Toe Injuries?  Clin Orthop Surg. 2014 Mar;6(1):26-31. doi:  4055/cios.2014.6.1.26





Tennis Tournament Level Play Increases Risk of Trauma

Tennis is a physically demanding sport which, in avid players, is most often associated with hand and upper extremity overuse or repetitive stress conditions, such as tennis elbow and other tendinopathic injuries and conditions.  But for those playing competitively with tennis leagues at tournament level play, there is also risk for more serious injury.

Nearly one-third of tennis injuries are the result of a traumatic or acute event, which include:

  • Stress Fractures
  • Muscle Strains

These types of injuries are most common in those players engaged in rigorous training, competitive play and frequent tournament participation.

Stress Fractures

Stress Fractures occur when repeated stress on a limb weakens the muscle.  The overload of stress is then absorbed by the bone to the extent that a small fissure or fracture in the bone occurs. This often affects the olecranon (round bony part of the elbow) or the ulnar shaft and seen in athletes participating in throwing and swinging sports.Stress Fracture of Elbow

Additionally, young players are much more likely to sustain a stress fracture than professional playing adults, because they are training too rapidly and fatiguing the ill prepared muscles surrounding the bone.

Unlike a typical fracture that causes a clear break in the bone, a stress fracture is a slight crack that causes pain.  While most often seen in the lower extremity in runners, they also occur in the upper extremity in competitive level athletes involved in such sports as tennis, swimming and throwing activities [1].

Stress Fracture Symptoms Include:

  • Pain, weakness and or tenderness near the break
  • Slight swelling
  • Pain during activity, which is relieved at rest

Stress fractures are generally diagnosed with a physical examination and possibly an X-ray – though they can be difficult to see with this type of imaging.  A bone scan or MRI may be indicated.

Treating Stress Fractures

Most stress fractures heal with adequate rest from the sport, physical therapy and modification of technique.  If symptoms persist, arthroscopic surgery may be indicated to address bone spurs or remove loose bone fragments.

If a stress fracture is not treated despite increasing pain, it can become displaced, resulting in a more severe injury and predisposing the patient to the early onset of arthritis.

Muscle Strains

The rapid and sudden movements in tennis can result in muscle strain if players are not adequately warmed up and subjected to a rigorous training and play schedule.  A muscle strain, also referred to as a repetitive strain injury (RSI) when seen in athletes and those involved in repetitive tasks, can cause tingling in the hand or arm, loss of sensation and loss of strength [2].elbow_pain

Other symptoms of muscle strain include:

  • Tenderness in the affected muscle or joint
  • Throbbing or pulsating in the affected area

A muscle strain is generally diagnosed with a physical examination, and treatment depends on the severity of the injury.

Muscle strain treatment may include:

  • Anti-inflammatory medication
  • Heat or cold therapy
  • Splints
  • Physical therapy
  • Steroid injections (only when specifically indicated)

Preventing Injury

These types of traumatic injuries can be avoided with appropriate strength and endurance training gradually leading up to more rigorous training sessions.  Proper warm up exercises and stretching are also key to avoiding injury, as with any sport.

In young, growing athletes committed to a single, competitive level sport such as many in tennis, it is particularly important to invest in technique and strength and endurance training, as well as ensure adequate rest for muscle recovery.


 [1] Stress fractures of the upper limb. Sports Med. 1998 Dec;26(6):415-24.
[2] Repetitive strain injury (RSI) explained. Medical News Today. 2018 Jan (last updated).

 This educational information was provided by Dr. Korsh Jafarnia, one of Houston’s renowned orthopedic surgeons and board-certified hand and upper extremity specialists.  He is a member of the faculty at Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital – Memorial City/Spring Valley.

 A Side Note:

An avid tennis player himself, Dr. Jafarnia had an opportunity to check out the Astros 2018 World Series Championship trophy while attending the River Oaks Tennis Club Men’s Clay Court Championship. (Pictured with Reid Ryan, President of the Houston Astros.)

Reid Ryan (L) and Dr. Korsh Jafarnia (R)

Reid Ryan (L) and Dr. Korsh Jafarnia (R)







Digital Disabilities, Repetitive Stress & Our Mobile Devices

Too much time on smartphones and tablets can lead to a host of repetitive stress problems known today as “digital disabilities.” These conditions include; cell phone elbow, texter’s thumb, texter’s neck, iPad hand and selfie elbow.digital_device_overload

Cell phone elbow results when the bent hand holding the cell phone to the ear for prolonged periods of time causes compression of the ulnar nerve.  This is also known as cubital tunnel syndrome, which is neuropathy of the ulnar nerve or “funny bone” nerve.

Cell phone elbow may contribute to another injury called smartphone pinky, which is a condition resulting when the bent elbow (while on a cell phone) causes compression of the ulnar nerve, which also gives sensation to the small finger. Over time, the sensation of the small finger diminishes.

The repetitive movements of our thumbs while texting may lead to texter’s thumb.

Texter’s thumb is a painful inflammation of the tendons that control thumb movement and extend to the wrist.  This causes pain at the base of the thumb, which may extend to the lower arm.

The concern is not the thumb pressing down on the keys of a phone but rather the frequent passing of the thumb over the keyboard, as the thumb joint is not meant to move rapidly in this manner.

Texter’s neck comes from too much time spent on electronic devices, subsequently leading to neck and spine injuries.

Texter’s neck has become a catchphrase describing neck pain and damage from looking down at a cell phone, tablet or other wireless device too frequently and for too long.

Another modern day “digital disability,” iPad hand, causes tendonitis in the hand from having the iPad in one position for a prolonged period of time.

Many of these digital disabilities are seen in Millennials, most notably selfie elbow. In fact, according to studies from the Pew Research Center, Millennials are more likely than other generations to have posted a selfie on a social media site (spending an average of five hours a week taking selfies).

The weight of the phone is not the concern.  The repetition combined with the contortion of the elbow, held in unnatural positions while capturing the selfie shot are actually what pose the problem.

Preventing Digital Disabilities, Repetitive Stress Conditions

There are many preventative measures to prevent damage from overuse of handheld devices, such as hands-free modifications, tablet stands and attachable keyboards.

To reduce the risk of cell phone elbow, use an earpiece, a headset or Bluetooth. To avoid texter’s thumb, a keypad is great. And try taking breaks from texting. Use the audio command on your phone to just give your hands a rest.