WRIST AND HAND OVERUSE SYNDROMES

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Overuse injuries of the wrist and hand are common in athletic endeavors. It has been estimated that 25% to 50% of all sports injuries are attributed to overuse.32, 34 Wrist syndromes are the most common upper extremity overuse injuries.30

The incidence of wrist problems in athletic activities is extremely high. For example, in gymnastics, the wrist and hand support body weight. Repetitive activities in which the wrist and hand have contact with a ball (such as handball and volleyball) or grip a racquet or an oar also result in a high number of overuse injuries.10

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)

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      Citation 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 Manual
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      2008, Ergonomics for Therapists
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    Address reprint requests to Arthur C. Rettig, MD, 201 Pennsylvania Parkway, Suite 200, Indianapolis, IN 46280

    *

    Methodist Sports Medicine Center, Thomas A. Brady Clinic, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana

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