Hand, Wrist & Elbow Injuries and Conditions€¦ · Hand, Wrist & Elbow Injuries and Conditions ......

Hand, Wrist & Elbow Injuries and

ConditionsAffecting Active Families

Korsh Jafarnia MD / September 17, 2014

Two common Hand & Upper Extremity Injuries in Youth Sports:

Little Leaguer’s Elbow and Wrist Fractures

Advancement of Surgical and Therapeutic Treatments:

When nonsurgical treatment fails to relieve pain

Therapies for rapid recovery and resumption of activity

Today We’ll Discuss

Common Hand, Wrist & Elbow Pain in Adults:

The difference between Tennis Elbow and Golfer’s Elbow

Some of the risk factors for Carpal Tunnel Syndrome

Common Injuries & Conditions

Two Common Hand & Upper Extremity Injuries in Youth Sports: Little Leaguer’s Elbow and Wrist Fractures

Active Families on the Go

Little Leaguer’s Elbow, or Medial

Apophysitis, is one of the most common

throwing injuries we see in young athletes,

particularly pitchers.

Wrist Fractures are common in youth

sports and can represent a number of

different types of fractures, some of the

most diagnosed include Distal Radius

Fractures and Buckle Fractures.



Causes / Risk Factors•Repetitive stress from frequent throwing

•Fatigue, insufficient rest between practice

and play

•Improper Mechanics

•Immature muscles, bones, joints and soft

tissue

Symptoms•Pain on the inside of the elbow, which may

be severe and occur abruptly, or mild –

increasing in intensity, gradually over time

•Swelling, redness and warmth over the inner

elbow

•Restricted range of motion

•Inability to straighten the elbow

Concerns•In the immature elbow this condition can

cause damage to the growth plate (comprised

of growth cartilage).

•Repetitive stress weakening growth

cartilage, causing small fissures - in more

severe cases separating from the bone

(Osteochondritis Dissecans)

•Repeated pulling tearing ligaments and

tendons from bone – potentially pulling tiny

bone fragments with it

•Disruption of normal bone growth and

deformity

Little Leaguer’s ElbowLittle Leaguer’s Elbow is an overuse condition seen in adolescent baseball player’s, which causes the

inside of the elbow (medial epicondyle) to become inflamed. During the overhand throw the elbow

experiences both traction and compression - pulling at and irritating the growth plates located on the

inside of the elbow.



Treatment / RehabilitationNonsurgical

Rest, refrain from throwing activity

Icing to reduce swelling

Rehabilitation to refine throwing technique to reduce stress on the elbow joint

Surgical

In more severe cases, surgery may be required to reattach a ligament and/or the bone or growth plate –

stabilizing the elbow joint.

Rehabilitation

A structured throwing program monitored by a physical therapist can focus on mechanics, body control,

core strengthening and endurance.

Prevention Proper rest between play and adherence to Pitch Count regulations and other recommendations outlined

by the American Sports Medicine Institute - www.asmi.org.

No overhead throwing for at least two to three months per year.

No competitive baseball pitching for at least four months per year.

Avoid pitching on multiple teams with overlapping seasons.

Learn good throwing mechanics - 1) basic throwing, 2) fastball pitching, 3) change-up pitching.

A pitcher should not also be a catcher - this combination results in many throws, increasing injury risk.

Little Leaguer’s Elbow

http://www.asmi.org/

PROBLEM AREAS:

Increase muscle tightness.

Pain / tenderness over the medial epicondyle

Muscle weakness / muscle imbalance

Inability to play sports

Little Leaguers Elbow -Conservative Management


Active Families on the Go - REHABILITATION




GOALS – Conservative Treatment


Flexibility

Soft Tissue Mobilization

Graston Technique

Instruction in Proper

Stretches




GOALS – Conservative TreatmentDecrease Pain

Allow ligaments to heal/decrease stress

Rest from activity

Orthotics

Limit from extreme ranges of the elbow

Improve Muscle Strength Strengthening/Conditioning Exercises

“Throwers 10”

Return to Sports and Play Communication between Therapists and

Physicians

Specific Outline for progression of

throwing

Specialized, trained therapists to analyze

throwing technique




PREVENTION of Little Leaguer’s Elbow

Warm up before pitching, stretching

Follow the pitching rules of the league

Pitch Count

Types of pitches

Do not play in (2) leagues at the same time

Proper pitching techniques



Wrist Fractures

Distal Radius Fractures are among the most common wrist fractures, affecting the lower part of one of the

forearm bones. Sometimes it results in instability to the distal radio ulnar joint (DRUJ) or damage to a

carpal bone, such as the scaphoid.


Causes / Risk Factors

Fall onto an outstretched arm

Harsh impact with a structure/other

player

Impact sports

Symptoms

Immediate pain, tenderness, bruising

and swelling

Possibly visible deformity - wrist hangs

in an unnatural or bent way

Concerns

Damage to the scaphoid bone

Other nerve or soft tissue damage

Loose bone fragments

Infection if “open or compound fracture”

(bone pierces through the skin)

Concerns for wrist fractures in young

adults verses mature adults are

different.

Wrist Fractures



Treatment / Rehabilitation

Nonsurgical

Rest, refrain from activityIcing to reduce swelling

Splinting or casting, depending on type of fracture and severity

Surgical

In more severe cases, surgery may be required to ensure there are no loose bony fragments

and bones are aligned properly - possibly with internal fixation.

Rehabilitation

Therapy focuses on range of motion, scar management (if open reduction) and limb

strengthening.

PreventionWhile it is difficult to avoid accidents or hits in a contact sport, some preventive measures that

may reduce the severity of the injury include: maintaining strong biceps and triceps, ensuring

proper nutrition for bone health and taping or bracing for additional limb and joint support.

Wrist Fractures




Wrist Fractures

Therapy Interventions – Wrist Fractures

Orthotics / Home exercises / Scar Management / Functional Use /Frequency and

Duration / Strengthening Exercise



Commonly Seen in the Weekend Warrior / Active IndividualBoth TENNIS ELBOW and GOLFER’S ELBOW are overuse, repetitive stress conditions

affecting muscles and tendons of the elbow and forearm, though on opposite sides of the elbow.



Tennis Elbow (Lateral Epicondylitis) Golfer’s Elbow (Medial Epicondylitis)

Causes / Risk Factors of Tennis Elbow Repetitive stress - in extracurricular or work

related activity such as pruning shrubs,

hammering, lifting heavy items

Improper stroke technique or equipment in a

racquet sport

Commonly affects seen in those between 30 -

50 years of age

Symptoms Tenderness and pain near the bony part on the

outside of the elbow

Weakness in the wrist and possibly difficulty

performing simple daily tasks

Causes / Risk Factors of Golfer’s

Elbow Repetitive stress, overuse of tendons

involved in swinging the golf club

Poor technique

Symptoms Tenderness and pain on the inside of the

elbow joint and forearm

Weakness in the arm hindering golf

swing and other arm movements

Possibly forearm pain that radiates down

to the wrist




Nonsurgical - Effective for 80% - 90% of Patients (when seen early)

Rest, refrain from activity

Non-steroidal anti-inflammatory medication

Equipment and technique assessment

Bracing

Steroid Injections

Platelet Rich Plasma (PRP) Injections

Physical Therapy*

Surgical

When pain persists despite conservative treatment, a lateral epicondyle release may be recommended. It is an outpatient

procedure.

*Rehabilitation

Rehabilitation therapy may include different approaches to these elbow conditions - including ultrasound therapy,

Iontophoresis, the Graston Technique, bracing, stretching and strengthening exercises.

PreventionModeration and a good balance of activities will reduce stress to one particular limb, muscle group or joint. Repetitive

stress conditions, though, are usually the result of a repetitive function in work or a favorite pastime and therefore difficult to

avoid. Resting and incorporating some of the conservative treatments discussed above may reduce the frequency of flare

ups.

Tennis / Golfer’s Elbow

Epicondylitis – Problem Areas



Muscle Tightness

Pain / Inflammation

Muscle Weakness / Imbalance

Decrease in Function





Epicondylitis – Goals & Treatment

Decrease Muscle Tightness/

Improve Flexibility

Soft tissue massage

Stretches

Graston technique

Limit from extreme ranges of the elbow

Decrease Pain/Inflammation

Ultrasound therapy

Iontophoresis

Thermal Modalities




Epicondylitis – Goals & Treatment

Decrease Pain &

Inflammation

Rest

Use of Orthotics

Muscle Strengthening

Determine Etiology



Carpal Tunnel Syndrome (CTS)CTS is the result of irritation and swelling, which causes compression within the narrow carpal tunnel

located at the wrist. This compression makes passage for the median nerve, one of the major nerves in

the arm, difficult. It then becomes irritated and causes numbness, pain, tingling and weakness in the

thumb, index and middle fingers.



Causes / Risk Factors of Tennis Elbow

Poor ergonomic work station / Occupational

insult - repetitive task, repeated vibrations

Diabetes

Obesity

Hypothyroidism

Pregnancy

Following a wrist fracture

Rheumatoid Arthritis

Symptoms Reduced sensation

Pain, tingling and weakness in the thumb,

index and middle fingers

Wasting of Thenar muscles

Weakened wrist strength

Concerns

Ulnar nerve compression

Chronic CTS may lead to permanent

nerve damage - causing constant

numbness, atrophy of some of the

muscles of the thenar eminence, and

weakness of palmar abduction

Carpal Tunnel Syndrome




Nonsurgical

Wrist sprint to reduce flexion

Steroid injection

Physical therapy*

Surgical

An Endoscopic Carpal Tunnel Release is recommended for those suffering from CTS that is

non responsive to conservative treatment. This minimally invasive procedure is a simple,

outpatient procedure which utilizes small instruments to cut the transverse carpal ligament to

release pressure on the median nerve. Incisions are small and recovery is rapid.

Rehabilitation

Therapy may include education on posture and wrist/arm position, stretching exercises to

improve wrist flexibility.

PreventionBreaks in your routine and ongoing stretching exercises for flexibility may help in the

prevention of CTS. A healthy diet and exercise program may reduce the risk from some at a

higher risk for CTS - and work site precautions such as ergonomic work stations, anti-vibration

gloves or wraps for tool handles, etc.

Carpal Tunnel Syndrome



Endoscopic Carpal Tunnel Release



Carpal Tunnel Syndrome – TreatmentCarpal Tunnel Syndrome

CONSERVATIVE TREATMENT

Orthotics

Stretches

Warm up before activity

Strengthening & Conditioning Exercises

Avoid repetitive activity

POSTOPERATIVE MANAGEMENT

Nerve and Tendon Glides

Scar management

Progression of activity

Pain management

Strengthening exercises

Resumption of daily activity

Hand, Wrist & Elbow Injuries and Conditions€¦ · Hand, Wrist & Elbow Injuries and Conditions ......

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