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.

FIREARM INJURIES -When Things Get Out of Hand

While firearm injuries to the hand and upper extremity represent a small percentage of all firearm traumas, when they happen the injury is often severe.

Frequently the result of mishandling a gun, the damage that both a bullet, the chamber and even the recoil can pose to the small bones and joints of the hand and wrist can be devastating and have a longterm impact.

Scope of Hand & Upper Extremity Problems in Firearm Users Range from Trauma to Repetitive Stress Conditions

From partial limb loss to stress fractures and repetitive stress conditions historically diagnosed in those working in a daily repetitive task, firearm users should recognize the dangers that exist behind the barrel as well.

Trauma – Open Wound

A broadly distributed article on an unfortunate handgun user losing the top half of his ill placed thumb – a result of the powerful vapors escaping from the chamber upon firing – cast a spotlight on the dangers of using certain firearms and the magnitude of damage that can occur to the small bones and intricate network of nerves, tendons and ligaments of the hand.

While this type of injury is uncommon, it is important to know what to do should it happen. Collecting any remains separated from the impacted area could aide a hand surgeon with replantation.  Rinsing the wound with sterile, normal saline and wrapping it if possible is advised just before heading to an emergency center for immediate assistance.

The surgical approach depends on the severity of damage to the tissue and bone. Open wounds like this are always treated with antibiotics, as “skin” is the body’s largest organ and when its protective barrier is compromised in this way and vulnerable to bacteria, antibiotics are used to reduce risk of infection.   If there is damage to the bone, surgery would entail stabilizing the bone.  Then, the tendons are repaired and the blood flow is re-established – with repair of the artery and veins. Potential problems can result from the magnitude of the blast, confounded by the risk of infection.  The expected outcome and long term function of such an injury is often highly variable as it depends on the amount of tissue damage from the accident.  Often times patients are able to regain adequate function despite not having full mobility of the injured extremity during their recovery.

Forceful Impact – Stress Fractures

Sportsmen frequently using what are known as “big-bore” handguns (models with rifle-type cartridges) have increasingly reported problems with their shooting hand – pain, swelling, weakness when shooting – following periods of preparation/practice for an upcoming hunt. This type of pain can stem from damage to the carpal bones of the wrist, as well as the forearm and elbow as a result of the repetitious and harsh recoil impact (much like a worker regularly using a Jackhammer or other such high powered equipment).  In some cases, this can result in a stress fracture.  Stress fractures are most commonly seen in the lower extremity of frequent runners or athletes, but can occasionally occur in the hand and upper extremity when subjected repeatedly to unusual force.

Treatment of stress fractures generally entails rest from the activity and possibly bracing.  Rehabilitative exercises are also effective in strengthening the shooting arm for both overcoming fatigue and reducing risk for more serious damage.

Repetitive Stress Conditions

Conditions like carpal tunnel syndrome and tennis elbow are considered repetitive stress conditions, most often associated with repetitive tasks in work or sports.  They are occasionally seen in the avid sportsman – practicing to perfect their shooting prior to a hunting season or holding the firearm only certain times of the year in a way to which the hand/arm is not accustomed.

These conditions are most often treated nonsurgically with rest and anti inflammatory medication.  Rehabilitation therapy is also frequently used to address these conditions – to restrengthen, stimulate healing and in some cases retrain hand and arm position during tasks identified as triggers. A new procedure known as the Graston Technique® is also an effective therapeutic way to address these types of repetitive stress conditions.  It entails uniquely designed stainless steel instruments and specially trained hand therapists to detect and treat the affected areas of soft tissue irritation.

Long-term Impact

Persistent pain and chronic inflammation can alter the natural mechanics of the affected limb, negatively impacting joints and accelerating joint degeneration – which could eventually result in osteoarthritis if unaddressed.

Reducing Risks

The best way to reduce the risk of firearm or other activity-related hand and upper extremity conditions is to space practices so that adequate time is allowed to rest the “master” hand and arm.  Strengthening exercises will also allow muscles to protect the soft tissue and bones.  Most sports also have protective gear, developed to address some of the most common conditions associated with frequent involvement.  Hunting is no exception, with brakes, grips and shooting gloves designed to reduce the impact of frequent shooting on the hand, wrist and elbow.

When pain is persistent, seeking medical attention will often reduce risk of more serious injury and permit conservative treatment to effectively address the problem and promote a healthier approach to the activities you enjoy.

 

 

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.