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.

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