It’s No Fish Tale – These Uncommon Hand & Upper Extremity Fishing Injuries Can Really Happen!

Located on the Gulf of Mexico and home to hundreds of lakes, it’s no wonder that the Texas coast is the playground to fishing enthusiasts far and wide.

Barracuda

unhook stingray2But even the seasoned sportsman can fall victim to some unlikely fishing injuries affecting the hand and upper extremity. In fact, fishermen (and women) put themselves in danger every time they come into contact with marine life – unpredictable behavior/aggressive and often forceful nature of a catch, prevalence of less commonly treated bacteria, unsanitary tools/equipment, poor wound care – all contributing to some common and not so common injuries that hand specialists see in a region like the Texas Gulf Coast.

Some common fishing injuries and conditions with which a Texas hand surgeon is all too familiar include:

fillet_2Many of these common injuries and conditions are treated non surgically and follow the same treatment protocol as any other patient with the same diagnosis – regardless of the cause.

Uncommon Hand & Upper Extremity Fishing Injuries and Conditions

Though there is very little that surprises a hand specialist practicing in “sportsman’s paradise,” an unusual injury associated with fishing will occasionally make its way to a Texas medical clinic.

Some of these uncommon injuries and conditions include:

  • Sting Ray Laceration
  • Fish Bite / Impalement
  • Fish Handler’s Disease / Bacterial Infection
  • Lodged Fish Bones, Fin Spine 

Unlike other injuries that break the skin, these types of fishing injuries are particularly concerning.  Fish and other marine life carry bacterial infections within their bodies, as well as on their skin, which can affect humans if certain precautions are not taken immediately. Some types of bacteria found in marine life are not commonly seen and do not respond to conventional antibiotics frequently used for infections.

Additionally, some marine life such as the Sting Ray utilize defense mechanisms that require special attention when used against a fisherman.

Sting Ray Laceration
While many sting ray injuries involve an inadvertent encounter between a foot or other lower extremity and a sting ray’s barb, some have occurred to the hand or wrist while trying to remove a sting ray from a fishing net or line.

These types of lacerations require more than bandaging.  Not only do sting ray barbs pierce like a weapon, all sting rays are armed with at least one serrated venomous spine at the base of their whip-like tail.  Short-tail sting rays have two tail spines: a slender spike in front of a large, jagged bayonet (1).

In addition to possible damage to muscle, tendons and nerves that can occur from the physical impalement of a sting ray barb, its venom is comprised of many different substances that can cause tissue to break down and die.
Some of the symptoms that Sting Ray venom can cause include:

 

  • Immediate and severe pain radiating up the affected limb
  • Bleeding and swelling in the affected area
  • Sweating
  • Faintness, dizziness and weakness
  • Low blood pressure
  • Salivation, nausea, vomiting, diarrhea
  • Headache
  • Shortness of breath (2)

 

Medical attention is recommended for all sting ray injuries.  Minimally, the wound will be cleaned with warm water to remove the venom and a tetanus booster given if it has been more than five years since the last tetanus booster. Tetanus prevention is required if the patient has never had a tetanus vaccination.  Antibiotics may also be required, and depending on the severity of the injury and amount of damage sustained (often the result of the delay in seeking treatment), surgical intervention to repair soft tissue damage and/or a period of rehabilitation may be required to restore strength to the injured limb (2).

Fish Bite and Impalement
While not every fish injury comes with a venomous double blow, the high risk of bacterial infection and soft tissue damage can be just as serious.  Many fish have sharp teeth, tails and pointed features that can easily break the skin.  Wrestling the unwilling catch onto the boat or beach can leave some sportsmen a bit worse for the wear.

 

Aside from the bacterial concerns that come with marine life, the forceful impact from a sharp feature of the fish can result in soft tissue damage that may require surgical repair and/or months of rehabilitation to restore hand and upper extremity function – as the hand alone is comprised of approximately 34 muscles, 120 known ligaments, and 50 nerves!

 

These types of deep puncture wounds or lacerations in the hand are also at high risk of infection and should be monitored closely.  A delay in the appropriate treatment can lead to complicated tenosynovitis and horseshoe abscess.  Additionally, marine life bacterial infections resulting from Mycobacterium marinum (M. marinum) do not respond to some conventional antibiotic treatment such as amoxicillin (3).

Fish Handler’s Disease
Not every fishing-related Mycobacterium marinum infection is the result of an obvious injury/wound.  A condition known as Fish Handler’s Disease can impact those frequently handling fish and generally affects the hands.  Any inconspicuous cut or small opening on the skin can allow the bacteria to enter the body.  The bacteria’s inability to proliferate in the warm body confines it to the affected area.

 

Common symptoms include swelling, tenderness, and bluish-purple spots. Fish Handler’s Disease is treated with special antibiotics used specifically for this type of bacterial infection.  Recovery can take months.

Lodged Fish Bones, Fin Spine
Occasionally in the handling of fish a fish bone or fin spine can lodge in the hand. Though this may not be painful or immediately worrisome to the injured party, these types of injuries are concerning.  Such injuries often leave residual fragments of foreign organic matter in the soft tissue, which can cause secondary infections such as Staphylococci and Streptococci (4).

 

Typically, x-rays are used first to try and identify a foreign body in the tissue, though are not always successful in doing so.  An MRI may be indicated to identify fine fin spines and tiny bones lodged in the body’s tissue. The surgical removal of the foreign body is important.  Failure to seek and remove the foreign body may lead to persistence of infection (4). Multiple surgical procedures may be required, and the patient is put on antibiotics to prevent infection. Physical therapy may be required after surgery to regain mobility of the hand.

 

If this type of injury goes untreated it can result in permanent disability and hospitalization for infection. Though the area may look as if it has healed, but is still tender, swollen, discolored, or abnormal in any way, individuals are urged to see a hand specialist.

 

Prevention and Precaution
Understanding the unique aspects of the marine life occupying the waters you’re sporting and utilizing protective gloves and garments while fishing can go a long way in injury prevention.  As the largest organ of the human body, our skin serves as a protective barrier.  When any area is compromised, our entire body is compromised. Individuals with other health conditions, such as diabetes or immune deficiency disorders should be particularly cautious and consult a hand specialist for proper wound care.

If not addressed properly, even seemingly minor fishing injuries can result in serious infection, lingering weakness or permanent disability – inhibiting participation in the sport you love.

 

References

 

How Your “Musculoskeletal Mindset” Can Impact Injury Risk at Work

While the study of orthopedics has traditionally placed emphasis on the physical influencers impacting our bones, tendons, ligaments and other surrounding soft tissue comprising the musculoskeletal system, new research now spotlights the increasingly important role of workplace “psychosocial” factors on musculoskeletal disorders (MSD).Tired man being overloaded at work

According to the Canadian Centre for Occupational Health and Safety (CCOHS), a workplace psychosocial factor is defined as “a non-physical aspect of the workplace that is developed by the culture, policies, expectations and social attitude of the organization.” [1]

Basically, psychosocial factors umbrella the different emotional responses to the demands placed on workers while performing their job –  including frustration, dissatisfaction, depression and despair. The resulting stress induces physiological responses that can contribute to the development of musculoskeletal disorders.

New research reported by the CCOHS identifies some physiological responses to psychosocial factors, including:

  • Increased blood pressure, which in small joint spaces can increase pressure on tendons, ligaments and nerves.
  • Increased fluid pressure over a prolonged period of time can also increase pressure in joints and on surrounding soft tissue as well as the carpal tunnel.
  • Reduction of growth functions can reduce production of collagen and consequently the body’s ability to heal or recover after performing work functions.
  • Over time a decreased sensitivity to pain can prompt workers to work beyond their body’s physical capacity, predisposing it to injury.
  • Increased muscle tension can increase pressure on and around the joints and may cause excessive use of force during certain activities and movements.
  • The body’s heightened state of sensitivity may overburden the musculoskeletal system by prompting a person to lift more, work faster, etc.

It is difficult in our current healthcare environment to directly attribute “workplace psychosocial factors” as a cause of workplace MSD, because of the many other factors that contribute to such disorders/injuries (biomechanical, etc.). Increasingly, though, evidence and newly published scientific research studies are helping to spotlight the role that these factors play, and the link between “stress induced physiological changes” and musculoskeletal disorders.

Additionally, a growing number of research studies are reporting a link between emotional disorders (anxiety, depression) and medical and surgical complication rates, lower patient satisfaction scores and readmission risk in joint replacement patients. [2,3]

There will likely be much more research on these topics in the coming years.

This new information underscores the importance of identifying and addressing psychological stressors and our response to them, as they are proving to have a significant impact on not only the cardiovascular but also the musculoskeletal system – two vital contributors to overall health and well-being.

 

References

  • Canadian Centre for Occupational Health and Safety (CCOHS), cchos.ca , https://www.ccohs.ca/oshanswers/psychosocial/musculoskeletal.html .
  • Wood TJ, Thornley P, Petruccelli D, et al. Preoperative predictors of pain catastrophizing, anxiety and depression in patients undergoing total joint arthroplasty. J Arthroplasty. 2016 Dec;31(12):2750-2756.
  • Gold HT, Slover JD, Joo L, et al. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplasty. 2016 Nov;31(11):2385-2388.

 

 

What Spring and Summer Mean to Our Musculoskeletal Health

Spring has finally arrived and time isn’t the only thing jumping forward.  Our enthusiasm for the outdoors is renewed and our activity schedule is ramped up.  From the slopes to spring sports, new plantings and training for one of the biggest bike rides in Texas, the potential for overuse injuries is particularly high this time of year – following less active winter months.

Some of the musculoskeletal injuries and conditions most commonly seen in the spring and summer months include:

  • Skier’s Thumb
  • Friction Blisters
  • Allergy-Related Muscle Fatigue / Joint Pain
  • Carpal Tunnel Syndrome
  • Golfer’s Elbow

Skier’s Thumb

Though the skies and poles are packed away, signs of a common injury following an active ski season may linger a bit longer.  Skier’s thumb, also known as Texter’s Thumb skiers-thumb gardening cycling MLB: Oakland Athletics at Chicago White Sox golfing tennisamong millennials, refers to injury of the unlar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MP) joint.  This occurs when the abnormal pulling of the thumb, such as that from a fall or harsh pull while affixed to the ski pole/hoop, causes a forced abduction or hyperextension of the proximal phalanx of the thumb. If unaddressed, this injury is further exacerbated by the repetitive use of the injured thumb in texting.

Friction Blisters

While the most common concerns during baseball season include pitch count and the stress that excessive pitching and throwing has on a player’s elbow and shoulder over the course of a baseball season, these generally occur mid to late season following many practices and games.

A lesser known injury often occurs as the season gets started and impacts pitchers in particular – friction blisters.   The repeated trauma created between the baseball seams and the fingers of the pitching hand, predominately at the tips of the index and long fingers, can result in friction blisters.

Friction blisters, which are the result of repetitive friction and strain forces that develop between the skin and various objects, are also common this time of year among those increasing gardening efforts and tennis players hitting the court.

Friction blisters form in areas where the “stratum corneum” and “stratum granulosum” are sufficiently robust such as the palmar and plantar surfaces of the hands and feet [1].

 

Allergy-Related Muscle Fatigue / Joint Pain

With the vibrant colors of spring come seasonal allergies and a host of symptoms that can sometimes make involvement in many of these long-awaited activities a challenge.  While pollen allergies most commonly cause nasal congestion, a runny nose, a sore/scratchy throat and itchy eyes, they can also cause hives, itchy skin, chronic cough, mood changes and body aches/muscle and joint pain. After exposure to pollen, the body reacts to it as a foreign invader by releasing antibodies and natural chemicals called histamines. Histamine is a substance that causes inflammation in the body. Sometimes allergies can advance to bronchitis and mimic flu-like symptoms, including a low-grade fever, body aches and muscle fatigue which can make everyday activity and exercise more challenging if unaddressed. Continuing to train or play while the body fights to overcome allergy challenges can predispose the musculoskeletal system to injury.

 Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is one of the most common overuse conditions seen in hand and upper extremity orthopedic care.  In the spring and summer, it is often the result of new activity excessively engaging the hand and wrist such as gardening and cycling. It is generally the result of irritation and swelling, which 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.  This nerve becomes irritated in the compressed tunnel and can cause numbness, pain, tingling and weakness in the thumb, index and middle fingers.  CTS can come on quickly and command attention or linger with varying degrees of pain that becomes gradually more intense over time.

Another hand and wrist condition, Handlebar Palsy, also known medically as ulnar neuropathy, is an overuse or repetitive stress condition that affects cyclists, though generally after completion of a long, competitive ride.  It is the result of direct pressure 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.

 

Golfer’s Elbow

While the greens are rarely bare in Houston, golfing tournaments really ramp up in the spring and so too do one of the most common overuse conditions associated with the sport – Golfer’s Elbow.  Also known as medial epicondylitis, Golfer’s Elbow affects the muscles and tendons on the inside (medial) portion of the elbow. The repeated activity of swinging the golf club places strain on the elbow, irritating and inflaming the tendons and muscles at the elbow joint.  This inflammation can cause pain on the inside of the elbow, as well as in the forearm and wrist.

 Preventing Injury

Easing into new activity gradually and preparing appropriately can reduce risk of overuse injuries and conditions.  Strengthening muscle groups equally and stretching sufficiently both before and after activity are key, particularly after less active winter months.

Ensuring proper equipment (cycling and other ergonomic gloves and tools) and products (moisturizing to reduce calluses and blister risk) can protect the parts of the body most vulnerable to some of these spring activities and sports. Behavior/activity modification can also help to distribute stress to different parts of the body, reducing repetitive impact on one particular area.

While allergies are often unavoidable, antihistamines and corticosteroids can reduce symptoms and improve performance.  Understanding the associated muscle fatigue and joint pain will help you modify activity accordingly to avoid injury.

Periodically resting and refraining from the activity causing pain can help restore limb strength and prevent more serious injury or damage to the affected area.

 References

[1] McNamara AR, Ensell S, Farley TD. Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management. Am J Orthop. 2016 March;45(3):134-36.

Baseball Fit – Preventive Exercises for a Winning Season

As weather warms and winter sports wind down, attention turns to the promise of a new baseball season and the championships ahead.

Now is the time to begin preparing.High School baseball

At the core of a successful team are strong players – physically strong, well rested and well conditioned.

Baseball is one of the few sports played almost daily throughout the entire season.  For young players beginning in little league, this amounts to a lot of plays by high school.  The frequency of repetitive stress injuries in youth baseball have increased over the years, particularly with the rise in special “elite” teams and extended seasons. This is most evident in young pitchers, on which much research has focused and for which Pitch Count guidelines have been developed.

Although baseball is not considered a contact sport, injuries can result from contact with the ball and other players, as well as poor form/technique, or an awkward movement during a play.

Some of the most common baseball injuries include:

  • Injuries in the shoulder and elbow (Little Leaguer’s Shoulder, Little Leaguer’s Elbow)
  • Knee injuries
  • Muscle pulls
  • Ligament injuries
  • Fractures (Finger, Distal Radius/Wrist)
  • Concussions 

While some injuries resulting from collision with another player are getting hit by the ball cannot be avoided, exercise can aid in reducing risks or preventing many repetitive stress related injuries.

Repetitive injuries are the result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones and joints), which are not given adequate time for proper healing. They are sometimes called cumulative trauma, repetitive stress or overuse injuries.

To avoid such repetitive stress conditions and muscle fatigue, players should have a dedicated fitness program – ideally one that is also specific to the position they play.  This should include overall strengthening and endurance, along with specific exercises to equally strengthen the muscles of the limb(s) most used. Such fitness programs should also include stretching and rest between play.

Exercise programs should also be age appropriate. Young, developing players are encouraged to build strength through resistance rather than weights. Involvement in other seasonal sports such as swimming and running can also provide excellent overall strengthening and endurance.

Strength and Conditioning Exercises – Upper Body

As a throwing sport, exercises for baseball concentrate heavily on the upper body – arms and shoulder. Core strength is also essential for pitching velocity, hitting power and running speed.

The key to any exercise program is the balanced/equal strengthening of muscle groups. For the upper body, this includes triceps/biceps, trapezius, rotator group, and deltoids.

Some Effective Arm, Shoulder and Core Exercises Include:

  • Resistance bands – These can be effective in building arm and shoulder strength. (View video on how these bands are used in exercise programs.)
  • Push ups – Traditional push ups are very effective in building upper body strength (arms, shoulders, back and core/abdominal muscles).
  • Pull ups – Using your own body weight/strength these work on the biceps, upper shoulder and back, upper abdominals and obliques.
  • The Plank – strengthens the core, lower back and oblique muscles. (View video demonstration of the Plank.)

Exercises to Improve Leg Strength

Lower body strength and conditioning is as important as upper body training for young athletes. Leg strength impacts throwing velocity, bat speed/force and running speed.

Squats, lunges and running are among the most effective ways to strengthen the lower body.

Stretching

Stretching is a very important part of an exercise program for athletes in any sport. During exercise and play muscles contract. When muscles contract, they produce tension at the point where the muscle is connected to the tendon. Stretching helps lengthen, relax and restore muscles to their natural state.

Stretching following activity is as important as stretching while warming up before practice and play.

Some easy, yet effective stretches include:

  • Elbow Pulls – Raise the right arm as though asking a question and drop the forearm behind the head though leaving the elbow in the air. Pull the elbow to the left with the left arm until you feel the stretch, hold briefly then repeat several times. Do the same on the opposite side.
  • Cross Body Arm Pulls – Straighten your right arm and pull it across the front of your body, cradling the forearm and elbow with the left hand, pull the arm towards the left across the body until you feel the stretch. Hold the stretch briefly, then repeat on the opposite side.
  • Shoulder Stretch – Lay face down on a floor mat and stretch arms overhead to form a “Y,” with palms facing down on the floor. With forehead on the ground, retract shoulder blades while lifting arms off the ground (still outstretched). Hold for a couple of seconds while squeezing the shoulder blades together. Be careful not to “shrug” the shoulders up. Return to starting position and perform several sets of 10 repetitions. To work the back a little differently, perform this same exercise with the arms straight out to your sides, forming the shape of a “T.”
  • Runner’s Lunge – Position into a deep lunge on your right leg, drop the knee of your left leg and lean forward over the right quad until you feel the stretch, hold for several seconds. Repeat on opposite leg.
  • Hamstring Stretch – Stand flat on the floor with feet a little less than hip width apart. Lean forward and place palm of your hands flat on the floor just in front of your feet, hold for several seconds.

TOP PREVENTION TIP

Resting is as important as any of the components in a successful training program.

Track and Field Hand & Upper Extremity Injuries and Conditions

As track season sprints past, we begin to see some common overuse injuries and conditions in these athletes.  While the vast majority of those seen in track and field affect the lower body, there are several common hand and upper extremity injuries and conditions seen in throwing events such as the javelin, shot put, hammer and discus.

Between weekly practices and weekend competitions, overuse injuries and conditions in throwing events account for most upper extremity injuries in track and field. These overuse conditions often affect the rotator cuff and shoulder labrum. Overuse conditions are those resulting from the repetitive use of a particular limb/joint(s) and are frequently seen in baseball, swim and tennis as well.

Other track and field injuries include ulnar collateral ligament (UCL) tears of the elbow (also known as a Tommy John injury) and thumb.  Also metacarpal (hand) fractures are seen resulting from repeated stress on the small bones of the hand.

Rotator Cuff Injury

There are four tendons and muscles that make up what is known as the “rotator cuff,” providing coverage around the shoulder joint at the top of the humerus. The rotator cuff holds the arm in place and allows it to move with the broad range of motion we demand not only in everyday activity but also in many throwing sports. This broad range of motion, though, predisposes the shoulder to injury.  Repetitive stress on the rotator cuff can cause partial tears and swelling in the tendons.  A “high impact” stress, such as the powerful force required in these track and field throwing events, may cause one of the tendons to pull away from the bone or tear.rotator cuff injuries cropped

Rotator Cuff Injury Symptoms and Diagnosis

While most rotator cuff injuries can be slow to develop – producing nagging pain in the shoulder and arm, shoulder weakness and difficulty lifting the arm overhead – sometimes they can be quite sudden. In this case, athletes may feel a “pop,” followed by strong pain and a weakened arm.  An orthopedic specialist will assess the injury initially with a physical examination and review of the activity leading up to the injury.  This may be followed by a shoulder x-ray, MRI and/or arthrogram.  Treatment depends on the severity of the condition and will include a period of rehabilitation therapy. Conservative, nonsurgical treatment is often considered initially.  Surgery may be indicated if shoulder instability persists or there is a complete rotator cuff tear.

Shoulder Labrum Tear 

Another common track and field throwing injury is a shoulder labrum injury.  Among the most commonly diagnosed shoulder labrum condition in athletes involved in throwing sports is known as a SLAP (superior labrum, anterior to posterior) tear. The labrum works to keep the arm bone in the shoulder socket. When the ring of firm tissue that helps to make the shoulder more stable becomes stressed, it can result in a SLAP tear, compromising shoulder stability.    Often damage to the labrum occurs in those athletes who are also suffering from rotator cuff injury or weakness.slap-tear-1

SLAP Tear Symptoms and Diagnosis

Some of the common symptoms associated with SLAP disorders include a popping, clicking or catching in the shoulder during throwing activity, aching pain and feeling of weakness.  Beyond a physical examination, a diagnosis may include an MRI and/or an arthrogram.  Occasionally minimally invasive arthroscopy may be used to confirm a tear.  If a tear is confirmed, the surgeon may choose to repair it at the same time.

UCL (Ulnar Collateral Ligament) Injury

Ulnar Collateral Ligament (UCL) injuries of the elbow frequently occur in javelin as a result of the throwing motion and stress on the elbow.  Also known as a Tommy John injury, it is similar to the stress placed on the elbow in baseball.

The elbow is basically a “hinge” joint allowing not only bending and straightening but also rotation from palm up to palm down.  Several important ligaments in the elbow joint facilitate this range of motion, connecting the bones (ulna, radius, humerus) and forming part of a lubricating joint capsule.UCL of elbow

Two of the key ligaments for elbow joint stability  include the lateral collateral ligament and the UCL, which is also known as the medial collateral ligament because of its location on the elbow (inside).

When overuse of the joint (force on the soft tissue exceeds that of the structure’s tensile strength), such as in a throwing sport like javelin, places stress on the UCL, tears can develop.  The ligament stretches and lengthens to the point that it can no longer hold the bones tightly enough during throwing activities.

UCL Injury Symptoms and Diagnosis

Athletes suffering from this type of overuse condition may experience pain along the inside of the elbow, which is worse during the “acceleration phase” of throwing.  There may also be swelling, reduced range of motion and feeling of instability in the elbow.  Throwers may also have tingling or numbness in the “pinky” and ring fingers and experience difficulty throwing.

Diagnosis includes a physical examination, x-ray and an MRI.  Treatment is initially conservative and may include rest, ice and anti-inflammatory medications, along with physical therapy to strengthen surrounding muscles and compensate for the injured UCL.  Following this, or in more severe cases, a UCL reconstruction may be indicated. Also known as Tommy John surgery (named for the Los Angeles Dodgers’ pitcher who first underwent the surgery), the procedure entails taking a tendon from another area of the patient’s body and replacing the injured UCL with it.

Metacarpal (Hand) Fracture

While less common than overuse injuries and conditions, hand fractures can result from the repetitive stress and force placed on the small bones of the hand.

With a total of 27 bones in the hand (14 phalanges, five metacarpal, eight carpal), more than half of the bones making up the entire upper extremity,metacarpals fractures are inevitable in sports placing extreme and repeated stress on the hands.

One such fracture is known as a metacarpal fracture, which affects the bone at the base of the finger closest to the wrist.

Metacarpal Fracture Symptoms and Diagnosis

Metacarpal fractures will cause immediate pain and possibly visible deformity. The injured finger(s) may swell, and there may be some bruising.

A physical examination and an x-ray Metacarpal hand fracture repairwill identify the location and severity of the fracture.  Treatment is determined based on whether the fracture is “stable” or “unstable” and the extent of injury.  More severe cases may require surgery and internal fixation (K-wires or plates and screws), followed by a period of splinting and hand therapy.

Prevention and Treatment

Understanding that adequate rest between practices and events is as important as the training will help reduce the likelihood that an overuse condition will result in a tear or stress fracture. Maintaining balanced strength and conditioning of opposing muscle groups is also an important prevention component.

When symptoms are addressed early, the injury often responds well to conservative treatment.

Texter’s Thumb – A Modern Day Malady?

While science explains how changes in our daily physical activity result in changes in our physical state, current culture seems to dictate the terms we use to identify these changes – reflecting what’s going on in the world around us.

Technology use gives new name to repetitive stress condition.

Technology use gives new name to repetitive stress condition.

In early hunting days (1955), Gamekeeper’s Thumb was coined by an orthopedic surgeon who repeatedly diagnosed Scottish gamekeepers with a thumb condition seemingly associated with the manner in which they killed small animals – and carried their game home in a leather thong attached to their thumb and draped over their shoulder.

Over time it became more commonly referred to as Skier’s Thumb – as similar damage occurred to skiers falling against a planted ski pole.  Our affection for the slopes boosted the popularity of the new terminology.

Similarly today’s activities have resulted in a new way to incur a long established condition – and the terminology associated with the diagnosis will provide future generations with some insight into the culture of our day!

Known as “Texter’s Thumb,” (also BlackBerry Thumb and Gamer’s Thumb),
de Quervain’s Disease or Syndrome is a painful inflammation of the tendons (fibrous connective tissue attaching muscle to bone), which control thumb movement and extend to the wrist (tenosynovitis).  The inflamed and swollen tendons and their coverings rub against the narrow tunnel through which they pass – causing pain at the base of the thumb which may extend to the lower arm.

Today's Texter's Thumb is  actually de Quervain's Disease.

Today’s Texter’s Thumb is actually de Quervain’s Disease.

Historically, this condition has also been called washerwoman’s sprain, mother’s wrist and mommy thumb.

Considered a repetitive stress injury (RSI), de Quervain’s Disease is often the result of repetitive activity/grasping – which results in irritation of the tendons and other soft tissue in the thumb.  The condition may also be caused by a direct blow to the thumb and inflammatory conditions such as rheumatoid arthritis.

In the activity of texting, it is thought that the problem is not caused by the tip of the thumb pressing the keys on a phone, but rather the frequent traveling of the thumb over the keyboard. The thumb joint is not meant to move rapidly in this manner – the confined space adding insult to injury.

Symptoms of Texter’s Thumb

Common symptoms of Texter’s Thumb (de Quervain’s syndrome) include swelling and pain that can run from the tip of the thumb to the wrist and into the forearm. This pain is primarily present when the wrist is flexed or turned – as well as when forming a fist or grabbing. There can also be pain when direct pressure is applied to the area.

Diagnosing Texter’s Thumb

To diagnose de Quervain’s, a physical examination and discussion of lifestyle and activity is assessed.  A Finkelstein test may also be performed.  This entails placing the thumb against the hand, making a fist with fingers closed over the thumb and then bending the wrist towards the little finger.  Pain with this maneuver is a positive test.

Finklestein's Test may be used in diagnosing de Quervain's.

Finkelstein’s Test may be used in diagnosing de Quervain’s.

Generally, this type of injury is treated conservatively and entails refraining from texting for a while (activity modification) and resting the affected thumb(s). Non steroidal anti inflammatory medication (NSAIDs) may also be prescribed and a splint that incorporates the thumb may be indicated.   When pain persists despite rest and refrain from the activity causing the condition, a steroid injection may be recommended. In chronic or severe cases, surgery to release the pressure in the compartment is performed – followed by rehabilitation therapy to regain strength. If untreated, the synovial sheaths will continue to thicken and degenerate. This can result in permanent damage and loss of grip strength and chronic pain.

 

Hand and Wrist Pain in Exercise – Can Make it Hard to Power Through

Hand and wrist pain in exercise can affect men and women, young and mature alike.  From weightlifting and exercise machines to pushups, injuries and conditions can result from the repetitive stress of the activity or the sudden frequent exposure (training in an off season, sudden increase in weights or repetitions, new exercise program, etc.).

Powering Through

Exercise Impact on the Hand & Wrist

The hand and wrist conditions most commonly associated with these types of exercise regimens is tendinitis. Other less common injuries include stress fractures of the wrist.

If not addressed, pain and restricted hand and wrist function could hinder proper form during the activity and cause more serious injury.

Tendinitis – Symptoms and Diagnosis

Tendinitis is the inflammation of the tendon resulting from micro-tears that occur when the “musculotendinous unit” (muscular and tendinous tissue and its ability to be stretched) is severely overloaded with a excessive or sudden tensile force (resistance of a material to a force tending to tear it apart).

It can also be associated with Tendinosis, which is the degeneration of the tendon’s collagen in response to chronic or repetitive overuse.

Symptoms can vary depending on the area affected.  When affecting the fingers, symptoms can be similar to those experienced with trigger finger – catching or locking when bent.

Occurring where a tendon attaches to bone, other symptoms of tendinitis include:

  • Pain and/or tenderness in the hand or wrist when lifting weights
  • Possibly mild swelling

Tendinitis is confirmed upon physical examination and discussion of patient history.  It is generally resolved by resting and refraining temporarily from the activity causing the strain.  If this does not resolve the condition, anti inflammatory medications and hand therapy exercises may be recommended.  Only in extreme cases of tendon damage is surgery considered.

Stress Fractures – Symptoms and Diagnosis

A stress fracture is an overuse injury which occurs when muscles become fatigued – unable to absorb added shock therefore transferring the stress overload to the bone.  This can cause a tiny crack in the bone and is called a stress fracture.  While stress fractures are most commonly seen in the lower extremity, they can occasionally occur in the wrist when subjected to excessive strain or repetitive stress activity such as increasing the amount or intensity of an activity too rapidly.

A stress fracture can sometimes be confirmed on an x-ray, though may not be visible for several weeks despite the pain.  If necessary, a computed topography (CT) scan or magnetic resonance imaging (MRI) may be indicated to confirm the fracture.

Among the most effective treatments for a stress fracture is rest from the activity that caused the fracture for approximately six to eight weeks.  Resumption of activity before proper healing can result in a more serious fracture and potentially chronic problems.

Reducing Risks

There are a number of things that those engaged in weightlifting or related exercise program can do to reduce these types of hand and wrist injuries and conditions.

  • Build up gradually to increased weight and reps
  • Wear wrist guards or protective gloves (minimizing pressure and providing wrist assist)
  • Taking breaks to rest the hands and wrist
  • Using proper technique/form  

Learn more about common hand and wrist injuries and conditions. 

 

 

Handlebar Hazards

Repetitive Stress Hand & Wrist Conditions Affecting Cyclists

As training begins for the upcoming MS150, we thought we’d talk about some of the common overuse, or repetitive stress, hand and wrist conditions affecting cyclists.  By discussing some of these conditions and ways to reduce your risk, hopefully we can ensure pain free cycling and play a hand in many successful rides.

How Repetitive Stress Occurs
Avid cyclists competing year round in weekend rides and races tend to experience various types of overuse strains and stress associated with such a sport – nearly one-third of these

Hyperextended Wrist

affect the hand and upper extremity.  Despite the best equipment and preventive measures, the jarring vibration of a rough terrain, handlebar hand positioning for hours at a time or tense ride into the wind 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

Hyper Flexion of Wrist

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  CTS is the result of irritation and swelling, which 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 neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  It is the result of direct pressure 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 it may result in numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications can generally resolve this condition.

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

Reducing Your Risks
Decades of cycling enthusiasts have contributed to an array of preventive cycling gear and recommendations for reducing a fellow cyclist’s risk for such conditions.  These include everything from basic and specialized gel cycling gloves to additional handlebar padding and 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, along with frequent adjustments to grip and position on the handlebars, should reduce risk for carpal tunnel syndrome and handlebar palsy.

Figures source:  http://www.hughston.com/hha/a_15_3_2.htm