WRIST AND HAND OVERUSE SYNDROMES
Section snippets
TENOSYNOVITIS OF WRIST AND HAND
Tendinitis can occur due to tension overload or shear stress. Pitner32 noted that overuse is defined as a level of repetitive microtrauma that exceeds the ability of the tissue to adapt. At the molecular level, tendon failure occurs due to stretching of collagen, the chief component of the structure. Up to 4% of elongation is well tolerated, and no tissue damage occurs. Between 4% and 8% of elongation, the collagen cross-links rupture, and collagen fibers slide past one another.4 Macroscopic
De Quervain Syndrome
Tenosynovitis of the first dorsal compartment, or de Quervain syndrome, is the most common tendinitis of the wrist in athletes. The abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons course beneath the fibrous sheath overlying a groove along the radial styloid process (Fig. 2). Shear stress resulting from repetitive wrist motion, including radial and ulnar deviation as well as flexion and extension, results in inflammation of the tenosynovium.2, 9, 26 Sports most commonly
NEUROVASCULAR SYNDROMES
Nerve entrapment syndromes are thought to be due to mechanical compression and ensuing vascular compromise. The pathophysiology involves obstruction of venous return from the nerve by compression, which results in venous congestion involving epineural, perineural, and intrafascicular vessels. Anoxia of the nerve segment can result, with subsequent edema, which can enhance the effect of the regional compression. If the process continues for a long time, fibroblast proliferation will lead to
OVERUSE VASCULAR SYMPTOMS
Vascular injuries occur due to repetitive trauma to the palmar aspect of the hand and wrist and are seen in athletes whose sports involve significant repetitive energy absorption in the hands. Vascular syndromes specifically include hypothenar hammer syndrome due to trauma to the ulnar artery at the wrist, trauma to the digital vessels, and vasospastic disorders of the digits in baseball players.
The primary blood supply to the hand is from the terminal branches of the ulnar and radial arteries.
SUMMARY
Overuse syndromes in the wrist or hand can occur from repetitive use of the wrist and hand or from recurrent direct trauma to the hand area. Tendinitis syndromes due to overstretching or shear stress are seen commonly on both the extensor and flexor sides of the wrist. Overuse syndromes also can take the form of neurovascular syndromes, resulting in compression syndromes of the median, ulnar, and superficial branch of the radial nerve in the wrist area and trauma to the ulnar and digital
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Cited by (30)
Tendinopathies of the Wrist and Hand
2011, Neck and Arm Pain Syndromes: Evidence-informed Screening, Diagnosis and ManagementTendinopathies of the wrist and hand
2011, Neck and Arm Pain SyndromesWrist injuries in young adults: The diagnostic impact of CT and MRI
2011, European Journal of RadiologyDrop hand in a 12-year-old girl: Radial nerve at peril due to knitting
2009, European Journal of Paediatric NeurologyCitation Excerpt :In closing, presenting this interesting patient of ours, we have drawn attention to a yet unreported cause of radial nerve palsy in children. In this regard, it would be noteworthy to add knitting to the roster of overuse injuries hitherto mentioned in the literature.4,5 Last but not the least, both parents and physicians should be vigilant alike in order to prevent or manage relevant cases.
Soft-Tissue Injuries of the Hand and Wrist
2008, The Sports Medicine Resource ManualErgonomics of Play and Leisure
2008, Ergonomics for Therapists
Address reprint requests to Arthur C. Rettig, MD, 201 Pennsylvania Parkway, Suite 200, Indianapolis, IN 46280
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Methodist Sports Medicine Center, Thomas A. Brady Clinic, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana