Sport Injury

Upper Extremity

Silvia Rakhmadani
 Sport Injury
A ‘sports injury’ can be defined as an injury that
occurs during sporting activities or exercise.
 Injuries to the wrist and hand
Wrist and hand injuries are common in sports
such as boxing, tennis, handball, volleyball, and
similar sports.
 Injuries to the wrist and hand
1. BASEBALL MALLET FINGER
symptoms
There is localised pain and swelling around the distal
inter-phalangeal (DIP) joint, which is difficult or
impossible to extend fully. In chronic cases, pain and
swelling may be absent but the inability to extend the
distal phalanx remains.
• AETIOLOGY
This injury is a rupture of the most distal
insertion of the extensor digitorum tendon at
the DIP joint, often after a direct trauma to the
tip of the finger from, for example, a basketball
or volleyball.
• CLINICAL FINDINGS
There is tenderness on palpation over the DIP
joint. The patient cannot actively extend the
distal phalanx.
• INVESTIGATIONS
X-ray may show a small avulsion fracture of the
dorsal plate that corresponds to the tendon
insertion. MRI or ultrasound may show the
tendon rupture and haematoma.
• TREATMENT
If there is no fracture this injury usually heals by
immobilising the distal phalanx in a ‘mallet
bandage’. If there is a fracture, re-fixing surgery
is usually required.
CARPAL TUNNEL SYNDROME
• SYMPTOMS
There is paraesthesia of the radial three and a half fingers and
pain around the wrist. Often, sleep is disturbed.
• AETIOLOGY
These symptoms are caused by chronic compression of the
median nerve in the carpal tunnel by a hypertrophied flexor
tendon retinaculum.
• CLINICAL FINDINGS
There is tenderness on palpation over the carpal tunnel and a
positive Tinel’s sign. In severe cases there is atrophy of the
thumb muscles.
• INVESTIGATIONS
Nerve conduction test is usually positive.
• TREATMENT
NSAID and physiotherapy including stretching of the flexor
muscles may be sufficient to relieve symptoms. Surgery, with
release of the retinaculum, is required in severe cases.
DE QUERVAIN’S TENOSYNOVITIS
• SYMPTOMS
There is localised, sometimes intense exercise-induced
pain and swelling over the radial part of the wrist. This
is common in racket sports.
• AETIOLOGY
These symptoms are caused by compression of the
abductor pollucis longus and extensor pollucis brevis
by swollen, inflamed or hypertrophied tendon sheaths.
• CLINICAL FINDINGS
There is tenderness on palpation over the radial part of
the wrist and Finkelstein’s test is positive.
• INVESTIGATIONS
Ultrasound investigation or MRI.
• TREATMENT
NSAID and physiotherapy including partial
immobilisation of the wrist with strapping or a brace.
Cortisone injections are often suggested but their side-
effects must be considered. Surgery for release of the
tendon sheaths is indicated in severe or chronic cases.
 Elbow Injuries
• Elbow injuries are common in sports like
boxing, martial arts, tennis, ice hockey,
handball, volleyball and similar sports.
DISTAL BICEPS TENDON RUPTURE
• SYMPTOMS
There is acute pain in the elbow and sudden weakness in elbow flexion.
• AETIOLOGY
This is an acute injury, where the tendon usually ruptures close to the distal
insertion at the radius during an excessive elbow extension or flexion
manoeuvre.
• CLINICAL FINDINGS
Pain and weakness is provoked by resisting elbow flexion. There is often
significant swelling, bruising and/or haemarthrosis.
• INVESTIGATIONS
X-ray should be taken, to rule out fracture of the elbow. MRI verifies the
diagnosis.
• TREATMENT
A complete tear of the biceps tendon at this site usually requires surgical re-
fixation in physically active people. A partial tear may be treated with partial
immobilisation, since surgery can be performed later if healing does not occur.
 GOLFER’S ELBOW
• SYMPTOMS
There is gradual onset of exercise induced pain around the medial epicondyle of
the elbow that is aggravated by hyper-extension.
• AETIOLOGY
This is an over-use type injury of unknown aetiology, often affecting the wrist
flexor muscle origins at the medial epicondyle in racket sports players, javelin
throwers and cricket bowlers. Despite the name, such injury to golfers is rare.
• CLINICAL FINDINGS
There is tenderness on palpation over the medial humerus epicondyle and pain
and weakness is caused by resisted elbow hyper-extension.
• INVESTIGATIONS
X-ray and MRI are normal.
• TREATMENT
Temporary partial immobilisation avoiding hyper-extension may relieve
symptoms. Address aspects such as bowling technique, errors in top spin or
throwing, etc. Cortisone injections may be considered. A soft neoprene type of
brace may decrease symptoms
LATERAL EPICONDYLITIS (TENNIS
ELBOW)
• SYMPTOMS
There is gradual onset of exercise induced pain around the
lateral epicondyle of the elbow aggravated by hyper-
flexion and supination of the wrist.
• AETIOLOGY
This is an over-use type injury of unknown aetiology,
affecting the wrist extensor muscle origin at the lateral
epicondyle in racket sports players.
• CLINICAL FINDINGS
There is tenderness on palpation over the lateral
epicondyle and pain and weakness on a resisted Waiter
test.
• INVESTIGATIONS
X-ray and MRI are normal.
• TREATMENT
Temporary partial immobilisation may relieve symptoms.
Address bowling technique, errors in racket grip or
throwing, etc. Recommend double backhand in tennis.
Cortisone injections may be considered. A soft neoprene
brace may decrease symptoms.
 Shoulder Injury
ACROMIO-CLAVICULAR DISLOCATION
• SYMPTOMS
There is acute onset of localised swelling and pain over the acromio-clavicular
joint with or without immediate deformation.
• AETIOLOGY
This injury can occur after a direct trauma or after a fall on to an
outstretched arm. It is common in rugby, ice hockey or riding and cycling. A
Grade I injury is a partial ligament tear; Grade II, one with added slight
deformation or lifting of the distal clavicle end and easily reducible; Grade III,
a complete tear with significant lifting, which is still easily reducible; Grades
IV–VI, anterior or posterior dislocation that cannot be reduced and possibly a
fracture.
• CLINICAL FINDINGS
There is localised tender and fluctuating swelling over the acromio-clavicular
joint and, depending on the grade, a ‘loose’ clavicle end and typical
deformation. Cross-body test is positive.
ACROMIO-CLAVICULAR DISLOCATION
cont.
• INVESTIGATIONS
This is a clinical diagnosis. X-rays should be
taken in different planes to rule out fracture
and demonstrate the severity of dislocation
by adding slight traction to the arm. MRI or
ultrasound will confirm the diagnosis.
• TREATMENT
For Grades I-III this injury usually responds to
conservative treatment including cold and
compression and an 8-bandage to hold the
acromio-clavicular joint in position for three
to five weeks. There is seldom any indication
for surgery for these grades. Some Grade III
injuries and most Grade IV–VI injuries will
require surgery. Surgery for this injury may
not always be straightforward and should be
handled by a shoulder specialist
 BICEPS TENDON RUPTURE
• SYMPTOMS
There is acute onset of pain over the anterior part of the shoulder with a lump typically forming at the
mid-biceps from the retracted muscle bulk (the ‘Popeye sign’). Usually the biceps longus tendon,
originating from the anterior superior labrum, ruptures and the short biceps tendon originating at the
coracoid s intact. This leaves some biceps function infact.
• AETIOLOGY
This injury often occurs in middle aged or elderly athletes or after cortisone injections. The rupture
can be partial, causing pain but no lump. If complete, the sudden lump on the mid-biceps is typical.
• CLINICAL FINDINGS
The typical deformation can be seen clearly on resisted elbow flexion. A proximal partial tear or
subluxation gives a positive palm-up test.
• INVESTIGATIONS
This is a clinical diagnosis. MRI or ultrasound is usually not required for the diagnosis but may be done
to investigate associated injuries.
• TREATMENT
Usually this injury is treated without surgery with gradual and progressive rehabilitation. Even though
the long head of the biceps, subject to sufficient length and quality, can be re-inserted into the
humeral head, the functional improvement may be questionable. However, an associated, SLAP tear is
not unusual and may require surgery
FROZEN SHOULDER
• SYMPTOMS
There is sudden or gradual onset of localised pain and stiffness in the
shoulder, often in a middle-aged athlete, with no preceding trauma.
• AETIOLOGY
Frozen shoulder is a capsulitis of unknown origin that makes the shoulder
freeze because of a gradually shrinking capsule. The onset can be
dramatic; the patient wakes up with a stiff shoulder having had no
previous problems. It is sometimes associated with general collagen
disorders and diabetes.
• CLINICAL FINDINGS
The shoulder is passively restricted in movements in all directions. The
condition is very painful.
• INVESTIGATIONS
This is a clinical diagnosis. X-rays should be taken in different planes to
rule out bony pathology. MRI is usually not helpful since it is a static
examination and the syndrome is a dynamic problem. Individual
discussion with the radiologist is important.
• TREATMENT
A frozen shoulder is often said to be incurable but can heal within two
years. That is not true: physiotherapy and occasionally arthroscopic
release can improve the condition dramatically. NSAID can help in the
initial stages. Each case needs to be discussed individually. Secondary
problems in the neck and upper back are almost inevitable and must be
addressed.