Cowboy Casualties and the Rigors of Rodeo Life

While the Houston Livestock Show and Rodeo has come and gone, the rodeo athletes who kept us captivated as they rode, roped and wrangled their way across the arena for the duration are on to a new city – and not even half way through their rodeo season.

The life of a rodeo athlete, many true cowboys at heart, is one of unyielding dedication and physicality.

Those who have participated since youth in rodeo events have built both strengths and vulnerabilities to the ongoing rigors of rodeo life. Proper mental and physical conditioning are key in avoiding serious injury.Rodeo Quote

While many of the injuries commonly associated with these athletes include concussions and fractures, others are the result of ongoing strain placed on the same limbs, ligaments and joints day in and day out for months at a time.

Many rodeo athletes begin in their teens, tie-down roping calves before progressing to adult wrangler, bull or bare back rider.  The years of hand and upper extremity strain predisposes this athlete to tendonitis in the hand, wrist, elbow and shoulder. Known as a repetitive stress or overuse condition, without proper treatment it can cause chronic inflammation, joint instability and eventually the early onset of arthritis.

Recognizing early signs of tendinopathic injuries and conditions and establishing an effective treatment program is key.

Tendonitis

Tendonitis (also spelled Tendinitis) is the inflammation of the tendons and other soft tissue connecting muscle to bone.  It is most often caused by repetitive movement, placing strain on the tendon and negatively impacting the affected area over time.  It may also occur following a sudden more serious injury such as a fracture or dislocation.

Tendonitis can affect different parts of the body.  Some of the commonly diagnosed upper extremity tendinopathies include Tennis Elbow, Golfer’s Elbow, deQuervain’s Tenosynovitis, Pitcher’s Shoulder and Swimmer’s Shoulder – named after the repetitive motion and sport implicated.  Though, many other activities and types of sports can result in one of these types of tendinopathies as well.

Among rodeo athletes, wrist tendonitis and tendon damage is particularly common, both as a result of the repetitive stress on the wrist and fractures and other trauma this athlearthritis_tendinitis_elbow_strainte sustains.

Symptoms

Symptoms of tendonitis may include;

  • Pain and swelling
  • A feeling of friction as the tendon moves
  • Warmth and redness about the affected area
  • A lump that develops along the tendon
  • Difficulty moving

A tendon rupture may result in a gap felt in the line of the tendon and would manifest with weakness or lack of function of that muscle.

 

Tendinosis

Tendinosis is often referred to as “chronic tendonitis” and is damage to a tendon at a cellular level.  In fact, “osis” represents a pathology of “chronic degeneration” without inflammation.  Key identifiers include disrupted collagen fibers within the tendon, increased cellularity and neovascularization.  This condition is thought to develop from micro tears, repeated injury and increases the risk of tendon rupture. While pain associated with this condition may be addressed similarly to that of tendonitis, emphasis is on stimulating collagen synthesis and breaking the cycle of tendon injury.

Extensor Carpi Ulnaris (ECU) InstabilityWrist Tendonitis

The ECU tendon of the wrist attaches the ECU muscle to the bone and is responsible for straightening and rotating as well as gripping and pulling movement in the wrist and hand. While this tendon normally slides over the forearm (near the little finger), held in place by the retinaculum (ligament-like structure), damage to the area can cause it to slip in and out of place (sublux) or dislocate completely.

Treatment

Treatment for and recovery from a tendinopathic condition will depend on the type and severity.  While minimally invasive corticosteroid injections have proven effective in relieving pain, rest from the repetitive activity contributing to the condition is also indicated.  Stretching and strengthening exercises are also proving effective.

In severe cases, or when the tendon becomes displaced and nonsurgical treatment fails to resolve the problem, surgical intervention may be indicated.  Surgical intervention may include repair of the retinaculum, tendon lining (tendon sheath), or tendon – or to replace the tendon if it is torn.

Prevention

While many injuries in the life of a rodeo athlete cannot be avoided, damage can be reduced by staying fit and strong overall.  Strength and flexibility, combined with periods of rest and other activities involving different muscle groups will help reduce risk of injury and the impact of a tendinopathic condition.

According to long time rodeo professional and bareback rider Cody Goodwin, “every ride is like getting in a car wreck.”

“You have to be in pretty darn good shape, which is why I jog four miles every other day and lift weights every other day – to develop lean muscle mass,” said Goodwin.

“I take good care of my body, so that I can, at my age, continue to compete with 20 and 25-year-old riders,” added the 41-year-old rodeo veteran.

Dr. Korsh Jafarnia is the hand and upper extremity specialist at UT Physicians / Memorial Hermann IRONMAN Sports Medicine Institute (Memorial City and Texas Medical Center locations), 713.486.1700.

Summer Sideliners

Common summer injuries of the hand, wrist and elbow

As we hike, bike, raft and climb our way through summer adventure, mishaps are bound to happen.  Some of the most common we see include wrist fractures, tennis elbow syndrome and cuts and lacerations to the hand.

Recognizing and treating mishaps that may occur while maximizing these brief few summer months can make a difference in how ready we are for all that awaits us in the fall.

Wrist Fractures

The wrist is susceptible to injury, often used as a first line of defense to break a fall, shield us from impact and soften a blow.  The wrist is comprised of eight small carpal bones, two forearm bones (radius and ulna) and four articulations or joints – which allow the wrist to bend and straighten, move from side-to-side and twist with a broad range of motion.  A force to the hand and wrist may result in a fracture of any one or several of these bones.  While a fracture to one of the smaller carpal bones may only be visible on x-ray, more common distal radius fractures are usually evident – crooked or deformed in appearance.  A wrist fracture may cause pain and swelling and should be immediately addressed.

Tennis Elbow Syndrome (Lateral Epicondylitis)

Though named for the sport frequently causing the condition in tennis players, Tennis Elbow Syndrome is in fact most often caused by everyday activity and diagnosed in those who have never played tennis.  Affecting the outside (lateral) portion of the elbow, tennis elbow syndrome is considered an “overuse” condition.  It is the result of strain placed on the muscles and tendons that attach to the bone.  Also caused by trauma, tennis elbow syndrome can cause pain with gripping, lifting and grasping.

Cuts and Lacerations

Cuts and lacerations to the hand are very common during the summer months as our hands are integral in most outdoor activity and projects. Tendon lacerations are also often the result of trauma to the hand or fingers.  Tendon lacerations may affect either the flexor or extensor tendons.  These types of lacerations often also result in other deep structure damage and require surgical repair.  The cut ends of a tendon must be brought back together in order for the cells inside the tendon to begin the healing/repair process.  Preventing infection in an open wound is also a primary concern with these types of injuries.

 

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 3 (Trigger Finger)

This is the last part of a three-part series on unexpected hand and wrist conditions experienced during pregnancy.  We have focused in this series on three of the most common conditions expectant moms may experience, Carpal Tunnel Syndrome, de Quervain’s Tendonitis and Trigger Finger.

Last month we discussed deQuervain’s Tendonitis and the non invasive ways in which we address the condition – and prior to that Carpal Tunnel Syndrome.  In this last part of the series, we focus on Trigger Finger.

Any one of these conditions may be prompted in expectant moms as a result of the hormonal changes, increased blood flow and water retention and swelling in the body during pregnancy.

Trigger Finger is a disorder characterized by snapping and locking of the flexor tendon of the affected finger or thumb. The term Trigger Finger comes from the unlocking of the finger, in which case it pops back suddenly as if releasing a trigger.

Trigger Finger is the result of inflammation of tendons connecting muscles of the forearm to the finger and thumb bones.  This connection permits movement and bending. While in most cases the inflammation is the result of a repetitive or forceful use of the finger or thumb, medical conditions causing a change in tissues – such as pregnancy – may also prompt Trigger Finger.

One of the early symptoms of Trigger Finger is soreness at the base of the finger or thumb, followed by painful clicking or snapping when flexing or extending the affected finger.  Occasionally there may be swelling.  Periods of inactivity may make this worse, though eases with movement.  In more severe cases, the affected finger or thumb may lock in a flexed or extended position – and forced to straighten.  Joint stiffening may eventually occur.

Diagnosing and Treating Trigger Finger

Diagnosing Trigger Finger is done with a physical examination of the hand and assessment of the symptoms.

Treatment for Trigger Finger is generally conservative and may include:

  • Avoiding activity that aggravates the affected finger or thumb
  • Anti-inflammatory medication
  • A steroid injection into the tendon sheath

If conservative treatment is unable to resolve the condition, a minimally invasive surgical procedure to release the tendon sheath may be indicated.  Expectant women are advised to wait before considering surgical treatment as often times the condition is resolved following pregnancy – when the body resumes normal function.

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 2

Last month we discussed several unexpected hand and wrist conditions associated with pregnancy – the first in a series of blogs on this subject.

We focused first on one of the most common pregnancy related hand and wrist conditions, Carpal Tunnel Syndrome – discussing the symptoms and common treatment options available to expectant moms.Pregnancy related hand conditions

This month we’re discussing another common hand and wrist condition women may experience during pregnancy and following childbirth, deQuervain’s Tendonitis.  Like Carpal Tunnel Syndrome, deQuervain’s can develop as a result of the musculoskeletal changes, hormonal fluctuations, pregnancy related fluid retention and nursing – all of which can place stresses on the tendons.

DeQuervain’s Tendonitis affects the tendons around the base of the thumb and results when these tendons become irritated – causing the lining around the tendon, known as synovium, to become inflamed.  Tendonitis actually means “swelling of the tendons.”  Tendons are responsible for attaching muscle to bone.

The main symptom of deQuervain’s Tendonitis is pain and tenderness along the thumb side of the wrist, which may radiate down the thumb or up the forearm when rotating the wrist, grasping things or gripping.  The swelling may also place pressure on nearby nerves, causing numbness in the thumb and index finger.  The pain may be gradual or arise suddenly.

DeQuervain’s Tendonitis is generally easily diagnosed in the physicians office after a physical examination and discussion of patient history.  Patients are then asked to perform a series of hand movements and discuss the level of discomfort and area of pain and tenderness.Parts of the hand and wrist affected by deQuervain's Tendonitis

Treating deQuervain’s Tendonitis
Treatment for deQuervain’s Tendonitis is generally nonsurgical and may include:

  • Resting the thumb and wrist with the support of a splint
  • Anti-inflammatory medication 
  • A steroid injection into the tendon compartment
Look for the final part of this series on Unexpected Pregnancy Related Hand & Wrist problems next month when we talk about Trigger Finger.

Unexpected… Pregnancy Related Hand & Wrist Problems

Pregnancy, while one of the most exciting times of a woman’s life, can also present a few physical challenges – affecting parts of the body new moms-to-be may not expect.

During pregnancy women are not only adjusting to changes in the body necessary to create new life, but also other less expected changes resulting from the musculoskeletal challenges and overall physical demands pregnancy places on body function.  These demands come from added weight of carrying the baby as well as the reallocation of nutrients from mom to baby, hormonal changes and pregnancy-related fluid retention.  

It is this type of physical impact to seemingly unrelated areas of the body like the hands, wrist and elbow that takes most expectant women by surprise.

While problems in these areas might be expected after the baby is born – as extended holding in unusual positions, feeding positions, pushing of strollers and other unusual hand and upper extremity movements place stress on the hands, wrist and elbow – there are actually a number of hand and upper extremity pregnancy-related conditions women may experience.

Such conditions include carpal tunnel syndrome, deQuervain’s tendonitis, trigger finger and general swelling and tingling in the hands and upper extremity.

This article is one in a series focusing on pregnancy related conditions, beginning with carpal tunnel syndrome, as it is one of the most common hand and wrist conditions affecting pregnant women.  While often categorized as a “repetitive stress” condition – which affects those performing a repetitive tasks resulting in irritation and inflammation – it is often also commonly associated with pregnancy.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the compression of the median nerve passing through the narrow carpal tunnel of the wrist.  Increased fluid generated during pregnancy can cause the same inflammatory/compressive effect of repetitive stress generally associated with carpal tunnel syndrome. 

Carpal tunnel syndrome is most often experienced in the third trimester when fluid retention is at its highest.

Symptoms of carpal tunnel syndrome may include pain, tingling and numbness in one or both hands. It is traditionally addressed nonsurgically with behavior modification, rehabilitation exercises and bracing.  If bracing and activity modification do not alleviate the problem, a steroid injection may be given and usually resolves the problem within a day or two.  Patients infrequently will need surgery if the carpal tunnel syndrome is related to pregnancy.

Basal Joint Arthritis (Arthritis of the Thumb)

Basal joint arthritis (also known as Basilar Joint arthritis) affects the base of the thumb, known as the basal joint or carpometacarpal (CMC) joint.  It is, in fact, the range of motion permitted by this joint that most distinctly separates the hand movement of humans within the animal kingdom – as it’s function and wide range of motion is unlike any other.

Bones which comprise the basal joint of the thumb.

The basal joint, or the CMC joint, is an interesting joint consisting of the small bone of thewrist known as the trapezium and the first (metacarpal) bone of the thumb.  This joint allows the thumb to reach a unique range of motion – permitting not only up and down movement but also the ability to span across the palm and achieve a “pinching” position.

This type of arthritis of the thumb results when the cartilage, which cushions the meeting point of the bones comprising the joint, deteriorates.  In the absence of sufficient cartilage, the bones are allowed to rub together during movement – causing pain at the base of the thumb and in severe cases deformity as the thumb collapses into the palm.

Pain may hinder many daily activities when the basal joint is irritated during such activities as turning knobs, opening lids, and writing.

It is one of the most common forms of arthritis of the hand, and it is thought that those suffering from a previous fracture or dislocation which affected the joint may be at higher risk for developing basal joint arthritis. Those suffering from osteoarthritis may also suffer from this type of arthritis.

Diagnosing Basal Joint Arthritis

The first steps in diagnosing this type of arthritis may include a physical examination, a discussion of patient history, and review of the pain and limitations experienced. A grind test and an X-ray may also be used to help confirm the diagnosis.

Treating Basal Joint Arthritis

There are a number of nonsurgical treatments for less severe cases of basilar joint arthritis, including:

  • Hand Therapy, which includes: therapeutic hand splints to support the thumb and wrist during rest; posture modification exercises to reduce joint irritation during certain activities; and massage, heat and ice therapy.
  • Non steroidal anti inflammatory medications (NSAIDS) – ibuprofen, aspirin, naprosyn.
  • Injection therapy – such as steroid, viscosupplementation, etc.

More severe cases of basal joint arthritis may require joint reconstruction or other surgical intervention to restore joint stability.

Learn more about this type of arthritis and other conditions affecting the hand, wrist and elbow.

 

 

 

 

XIAFLEX® Injection Therapy for Dupuytren’s Contracture

Dupuytren’s Contracture is a condition that affects the hands – and while the exact cause is unclear, there are a number of factors that can increase an individual’s risk.

The condition causes the tightening of fibrous tissue in the palm of the hand – between the skin of the palm and underlying flexor tendons of the fingers.  As the condition progresses, these rope like cords contract and begin to pull one or more fingers inward towards the palm making everyday activities more challenging.

While the exact cause of Dupuytren’s is unclear, risk factors include a genetic predisposition and those suffering from other diseases such as diabetes, cirrhosis and epilepsy.  Though, many sufferers are affected by none of the above.

Symptoms of this condition develop gradually and may go unnoticed.  Patients may first develop a tender lump in the palm of the hand, though associated pain may eventually subside. The condition is generally diagnosed upon physical examination.  Signs of Dupuytren’s include the inability to completely flatten the hand (palm down) on a flat surface, dimples in the palm and puckering over lumps in the palm may be evident.  In more advanced cases, fingers may be curled inward and difficult to straighten.

When Dupuytren’s Contracture is mild to moderate no surgical intervention is required.  Though in advanced cases, it may be necessary to surgically remove the fibrous cords which are pulling the fingers inward.

Until recently, traditional open surgery was the only option available to address the tightening, movement restricting cords to restore normal hand function.

While the innovative and less invasive needle aponeurotomy reduced for many over the past few years the need for more invasive traditional surgical intervention, another even less invasive procedure is gaining attention and showing much promise.

XIAFLEX® injection therapy is a new treatment for Dupuytren’s Contracture, which is an FDA-approved injectable collagenase (extracted from clostridium histolyticum).  Injected directly into the cords, XIAFLEX works to dissolve them – breaking down the fibrous tissue.  The injection takes just five minutes in the office.  Over the next 24 hours, the treatment works to dissolve the contracted cord.  Patients then return to the office the following day and the cord is “released” in a simple procedure.  A “popping” sound is often heard as the finger is pushed open and the cord is released.

Rehabilitation and specialized hand therapy, also known as occupational therapy, can help patients restore hand function following a Dupuytren’s Contracture procedure.

Learn more about Dupuytren’s Contracture, Injection Therapy and other common hand injuries and conditions.