Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists

PURPOSE: To characterize triangular fibrocartilage (TFC) defects in symptomatic and contralateral asymptomatic wrists. MATERIALS AND METHODS: Communicating and noncommunicating defects of the TFC were depicted on bilateral wrist arthrograms in 56 patients with unilateral wrist pain and without associated lesions of the scapholunate or lunotriquetral ligaments. The exact location of each TFC lesion was noted. RESULTS: Communicating defects were noted in 36 (64%) of 56 symptomatic and in 26 (46%) of 56 asymptomatic wrists. Twenty-five (69%) of 36 communicating defects were bilateral. Except for one defect in each group of symptomatic and asymptomatic wrists, all communicating defects were noted radially. Noncommunicating defects were noted in 28 (50%) of 56 symptomatic wrists and in 15 (27%) of 56 asymptomatic wrists. Eleven (39%) of 28 noncommunicating defects were bilateral. On the symptomatic side, 28 of 36 noncommunicating defects (including eight multiple defects) were located proximally at the ulnar side. On the asymptomatic side, 11 of 17 noncommunicating defects (including two multiple defects) were at or near the ulna. CONCLUSION: Noncommunicating TFC defects, which typically are located on the proximal side of the TFC near its ulnar attachment, have a more reliable association with symptomatic wrists than do communicating defects. Radial-sided communicating defects described in the literature (Palmer type 1A and 1D) as posttraumatic commonly are seen bilaterally and in asymptomatic wrists.     

Extensor carpi ulnaris injuries in tennis players: a study of 28 cases

Pain on the ulnar side of the wrist is common among elite tennis players. Ten years of experience has allowed identification of a pathology involving the extensor carpi ulnaris (ECU) tendon. On the basis of 28 clinical cases seen over the last five years, three clinical patterns are described: (a) acute instability of the ECU; (b) tendinopathy; (c) ECU rupture. Each of these clinical entities requires a different therapeutic approach. A review of the relevant anatomy is provided.     

Abnormal geometry of the distal radioulnar joint: MR findings

Previously developed criteria of normal distal radioulnar joint (DRUJ) axial geometry were applied to routine magnetic resonance (MR) images of 50 wrists. All wrists lacked clinically evident DRUJ instability. An attempt to apply the three geometric criteria to seven of the cases was not possible, since the prescribed landmarks were not visible. The remaining 43 cases were retrospectively divided into a symptomatic group (25 wrists), with clinical abnormalities referable to the ulnar side of the wrist, and an asymptomatic group (18 wrists), with no such abnormalities. Abnormal DRUJ geometry was found in 12 symptomatic and 2 asymptomatic wrists. This difference between the groups is significant (p=0.02), suggesting that many symptomatic wrists exhibit different DRUJ geometry than is found in most asymptomatic wrists.     

Ultrasonographic rotator-cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings

The aim of this study was to correlate sonographic abnormalities of the rotator cuff with clinical findings in veteran tennis players. One hundred fifty individuals playing competition-level tennis, aged from 35 to 77 years (mean age 55 years), underwent physical and US examinations of their shoulders. The US abnormalities found in the dominant shoulder were compared with those observed in the non-dominant shoulder and in different subsets of players defined by the absence or presence of former and/or current pain. Tears of the long head of the biceps tendon were seen only in dominant shoulders (n=8), and tears (23 complete and 20 partial) of the supraspinatus tendon were observed in 43 dominant vs 16 (3 complete and 13 partial) contralateral shoulders (p<0.001). Subscapularis tendon calcifications were depicted in 23 dominant vs 12 contralateral shoulders (p<0.05). Seventy players had no pain, 49 had former-but-not-current pain, and 31 had current pain. Abnormal thickening (>2 mm) and effusion of the subacromial–subdeltoid bursa and complete tear of the supraspinatus tendon were more frequent in the latter two groups (p<0.001 and p<0.05), respectively. Although 90% of the players with a complete supraspinatus tear had experienced former pain, no relationship was found between current pain and the presence of a supraspinatus tear or tendon calcification. The rotator cuff may present important asymptomatic lesions, such as complete tears of the supraspinatus tendon or calcifications, that do not prevent the playing competitive tennis. The only US abnormality associated with pain was subacromial–subdeltoid bursa effusion.     

Nerve conduction studies of upper extremities in tennis players

Objectives: The influence of regular and intense practice of an asymmetric sport such as tennis on nerves in the elbow region was examined.

Methods: The study included 21 male elite tennis players with a mean (SD) age of 27.5 (1.7) years and 21 male non-active controls aged 26.4 (1.9) years. Anthropometric measurements (height, weight, limb length, and perimeters of arm and forearm) were determined for each subject, and range of motion assessment and radiographic examination carried out. Standard nerve conduction techniques using constant measured distances were applied to evaluate the median, ulnar, and radial nerves in the dominant and non-dominant limb of each individual.

Results: The sensory and motor conduction velocities of the radial nerve and the sensory conduction velocity of the ulnar nerve were significantly delayed in the dominant arms of tennis players compared with their non-dominant arms and normal subjects. There were no statistical differences in the latencies, conduction velocities, or amplitudes of the median motor and sensory nerves between controls and tennis players in either the dominant or non-dominant arms. However, the range of motion of the upper extremity was significantly increased in tennis players when compared with control subjects. Tennis players were taller and heavier than control subjects and their dominant upper limb lengths were longer, and arm and forearm circumferences greater, than those of the control subjects.

Conclusions: Many of the asymptomatic tennis players with abnormal nerve conduction tests in the present study may have presymptomatic or asymptomatic neuropathy similar to subclinical entrapment nerve neuropathy.

     

Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management

Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral posttraumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18–55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown.     

Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics

PURPOSE: To determine whether the sizes and locations of scapholunate ligamentous communicating defects are different in symptomatic and asymptomatic cases. MATERIALS AND METHODS: Bilateral wrist arthrograms were reviewed for 30 consecutive patients with a history of wrist trauma and unilateral wrist pain who had at least one scapholunate ligamentous communicating defect and unremarkable conventional radiographs. The location and size of each ligamentous defect was recorded. Differences between symptomatic and asymptomatic wrists were analyzed with the chi(2) or Fisher exact test. RESULTS: Most communicating defects in both groups were incomplete and ranged from pinhole size to large. There was a higher frequency of complete disruption in the symptomatic wrists (nine [32%] of 28 wrists) than in the asymptomatic wrists (two [10%] of 20 wrists; P: =.092). Communicating defects involved the dorsal portion in 18 (64%) of the 28 symptomatic cases and in five (25%) of the 20 asymptomatic cases (P: =.007). CONCLUSION: The data suggest that the demonstration of a complete ligamentous disruption or involvement of the dorsal portion of the ligament may indicate a traumatic cause rather than a degenerative change.     

The prevalence of hand and wrist osteoarthritis in elite former cricket and rugby union players

ObjectivesThis study aimed to determine the prevalence of hand and wrist osteoarthritis in former elite cricket and rugby union players, by sport and playing position, and to define the prevalence of severe hand injury, and its association with hand osteoarthritis.DesignCross-sectional.MethodsData from cross-sectional studies of former elite male cricket and rugby players were used to determine the prevalence of hand pain, physician-diagnosed osteoarthritis, and previous severe injury. Multivariable logistic regression was used to determine the association of previous injury with pain and osteoarthritis.ResultsData from 200 cricketers and 229 rugby players were available. Complete case analysis resulted in 127 cricketers and 140 rugby players. Hand pain was more prevalent amongst cricketers (19.7%) than rugby players (10.0%). The prevalence did not differ between cricket and rugby players for hand osteoarthritis (2.4% and 3.6%), wrist osteoarthritis (1.6% and 2.1%), or previous severe hand injury (36.2% and 31.4%). No significant association between previous hand injury and pain or osteoarthritis was identified in either sport.ConclusionsFormer elite cricketers reported more hand pain than rugby players. No significant association was found between self-reported severe injury and hand osteoarthritis in either cohort, potentially indicating that risk factors aside from injury may be more prominent in the development of hand osteoarthritis.     

Stress injury of the lunate in tennis players: a case series and related biomechanical considerations

Objective

To investigate clinical and imaging differential diagnosis and tennis stroke biomechanics potentially involved in lunate stress injury pathogenesis.

Methods

The present report describes five competitive tennis players with overuse‐related dorsal wrist pain assessed by magnetic resonance imaging.

Results

Magnetic resonance imaging revealed the presence of lunate stress injury. All players were treated conservatively, with symptom resolution and complete functional recovery achieved at 14 weeks.

Conclusions

Lunate stress injuries should be considered in the differential diagnosis of overuse‐related dorsal wrist pain in tennis players.Wrist injuries are common among tennis players. They have been reported as the cause of 12.6% of on‐site withdrawals from the professional men''s circuit,¹ and the wrist is also the upper limb joint most often affected during Grand Slam tournaments.² In tennis players in general, most wrist injuries occur due to chronic overuse.³Players often complain of dorsal wrist pain, which can in turn disrupt training and competition. The present report describes five cases of overuse‐related dorsal wrist pain in tennis players, in whom MRI imaging studies revealed the presence of a lunate stress injury. To the best of our knowledge, this entity has not been previously analysed. Differential diagnoses and tennis stroke biomechanics potentially involved in lunate stress injuries pathogenesis are also discussed.     

Acute influences of tennis services on cardiac output and brachial hemodynamics in young male tennis players

ObjectivesThis study aimed to examine the influences of tennis service exercise on cardiac output (CO) and bilateral brachial hemodynamics in young tennis players.DesignExperimental study.MethodsTen young male tennis players (21 ± 2 years of age) participated. Each performed 100 tennis services without a return shot for experimental tennis exercise. Cardiovascular hemodynamic variables, including bilateral brachial blood flow (BF), shear rate (SR), blood pressure, and CO, were collected under three conditions: 1) baseline, 2) immediately after the tennis services (post), and 3) 1 h after the tennis services (1-hour). The positive incremental area under the curve (iAUC) for brachial hemodynamic variables was calculated.ResultsImmediately after the 100 tennis services, CO, brachial BF, SR, and brachial vascular conductance (VC) in the dominant and non-dominant arms increased (p < 0.05). At the 1-hour condition, CO returned to baseline; the brachial BF, SR, and VC in the non-dominant arm returned to baseline levels, whereas the same variables in the dominant arm remained increased. The iAUC for brachial BF and VC in the dominant arm was higher than that in the non-dominant arm. Furthermore, the brachial BF/CO ratio index in the dominant arm increased at the post and 1-hour conditions, whereas that in the non-dominant arm was unchanged.ConclusionsTennis service exercise specifically increases brachial BF, SR, and VC in the dominant arm, independent of increased CO. Our findings contribute to unveiling the underlying mechanisms of brachial artery adaptations in tennis players.     

Repetitive low-energy shock wave treatment for chronic lateral epicondylitis in tennis players

BACKGROUND: There is conflicting evidence regarding extracorporeal shock wave treatment for chronic tennis elbow. HYPOTHESIS: Treatment with repetitive low-energy extracorporeal shock wave treatment is superior to repetitive placebo extra-corporeal shock wave treatment. METHODS: Seventy-eight patients enrolled in a placebo-controlled trial. All patients were tennis players with recalcitrant MRI-confirmed tennis elbow of at least 12 months' duration. Patients were randomly assigned to receive either active low-energy extracorporeal shock wave treatment given weekly for 3 weeks (treatment group 1) or an identical placebo extracorporeal shock wave treatment (sham group 2). Main outcome measure was pain during resisted wrist extension at 3 months; secondary measures were >50% reduction of pain and the Upper Extremity Function Scale. RESULTS: At 3 months, there was a significantly higher improvement in pain during resisted wrist extension in group 1 than in group 2 (mean [SD] improvement, 3.5 [2.0] and 2.0 [1.9]; P =.001 for between-group difference of improvement) and in the Upper Extremity Function Scale (mean [SD] improvement, 23.4 [14.8] and 10.9 [14.9]; P <.001 for between-group difference of improvement). In the treatment group, 65% of patients achieved at least a 50% reduction of pain, compared with 28% of patients in the sham group (P =.001 for between-group difference). CONCLUSION: Low-energy extracorporeal shock wave treatment as applied is superior to sham treatment for tennis elbow.     

Deformation of coracoacromial ligament during overhead movement as an early indicator of subacromial impingement in elite adolescent badminton players

ABSTRACT

Objectives: Deformation of the coracoacromial ligament during overhead movement has been linked to shoulder pathologies such as impingement and rotator cuff tear. We, therefore, explored this relationship in a group of elite adolescent badminton players.

Method: We performed bilateral shoulder physical and ultrasonographic examination in 35 adolescent asymptomatic badminton players, 13 players with unilateral shoulder pain, and 15 non-athletes of similar age. Coracoacromial ligament deformation, defined as the maximal vertical distance between the ligament apex to a line connecting the acromion and coracoid process, was measured during shoulder abduction and internal rotation and compared within and between groups. Other ultrasonographic measurements and the incidence of shoulder pathologies were also evaluated.

Result: Among badminton athletes who reported dominant shoulder pain, coracoacromial ligament deformation was significantly larger in their dominant shoulder than in their non-dominant shoulder (3.5 and 2.0 mm, respectively; p = 0.013); this difference was not present in other groups. Regardless of the presence or absence of pain, athletes displayed more coracoacromial ligament deformation and increased supraspinatus tendon thickness in their dominant shoulder than did the control group. Abnormal ultrasound findings were noted in all groups; however, the incidence was not significantly different.

Conclusion: Increased coracoacromial ligament deformation during overhead movement is associated with shoulder pain in elite adolescent badminton players. Our findings may help clinicians identify athletes at risk of subacromial impingement syndrome.     

City Parks: Untapped Resource for Fitness

In brief: Three tennis players had vague wrist pain when hitting the ball; all three were using the same racket model. Results of physical examination of the three patients were unremarkable, but x-rays of the tennis rackets showed a ‘fracture’ in the handle weights. Replacement of the racket with an identical new model relieved the symptoms in all the patients.     

Isokinetic profile of wrist and forearm strength in elite female junior tennis players

Background

In tennis, injuries to the elbow and wrist occur secondary to the repetitive nature of play and are seen at increasingly young ages. Isokinetic testing can be used to determine muscular strength levels, but dominant/non‐dominant and agonist/antagonist relations are needed for meaningful interpretation of the results.

Objectives

To determine whether there are laterality differences in wrist extension/flexion (E/F) and forearm supination/pronation (S/P) strength in elite female tennis players.

Methods

32 elite female tennis players (age 12 to 16 years) with no history of upper extremity injury underwent bilateral isokinetic testing using a Cybex 6000 dynamometer. Peak torque and single repetition work values for wrist E/F and forearm S/P were measured at speeds of 90°/s and 210°/s, with random determination of the starting extremity. Repeated measures analysis of variance was used to determine differences between extremities for peak torque and single repetition work values.

Results

Significantly greater (p<0.01) dominant arm wrist E/F and forearm pronation strength was measured at both testing speeds. Significantly less (p<0.01) dominant side forearm supination strength was measured at both testing speeds.

Conclusions

Greater dominant arm wrist E/F and forearm pronation strength is common and normal in young elite level female tennis players. These strength relations indicate sport specific muscular adaptations in the dominant tennis playing extremity. The results of this study can guide clinicians who work with young athletes from this population. Restoring greater dominant side wrist and forearm strength is indicated after an injury to the dominant upper extremity in such players.     

Early anterior knee pain in male adolescent basketball players is related to body height and abnormal knee morphology

ObjectivesTo compare knee torque, range of motion, quality of movement, and morphology in dominant and nondominant legs of male adolescent basketball players with and without anterior knee pain and untrained peers.DesignCross-sectional.SettingSports performance laboratory.ParticipantsMale basketball players aged 14–15 years with and without anterior knee pain and healthy untrained subjects (n = 88).Main outcome measuresBasketball players were allocated to a symptomatic or asymptomatic group based on self-reported anterior knee pain. Associations between pain and body mass, height, passive range of motion, muscle peak torque, coactivation, neuromuscular control, proprioception, and ultrasound observations were investigated.ResultsThe prevalence of pain did not differ significantly between sides. Of 176 knees inspected, 44 were painful, and 26 of these exhibited abnormalities in ultrasonography. Symptomatic players were 5.0 and 6.9 cm taller than asymptomatic players and controls, respectively (P < 0.05). In athletes with knee pain, the odds ratios of morphological abnormalities and greater height were increased by 8.6 and 5.0 times (P < 0.001).ConclusionKnee pain prevalence in adolescent basketball players was not related to differences between sides but was higher in tall players. Knee pain was accompanied by morphological abnormalities detected with ultrasound.     

Hand and forearm strength and its relation to tennis

Eight expert tennis players and 12 nontennis playing controls were studied to determine the relationship between dominant and minor extremities in regard to hand and forearm isometric strength. The results revealed that overall strength, including wrist extension, was significantly greater (P 0.01) in the dominant arm in both groups. The tennis players were distinguished from the controls by significantly increased strength of metacarpophalangeal joint extension of the fingers on the dominant side. Examination of a group of 16 "tennis elbow" sufferers demonstrated no significant extensor strength differential in the dominant arm, with no reports of pain during the testing procedure. The increased strength of hand extension in elite tennis players may be significant in explaining the observed rarity of "tennis elbow" in these individuals.     

Lumbar pain and fin swimming

BACKGROUND: It was hypothesised that fin swimming have unique physiopathologic features in particular concerning low back involvement. METHODS: Retrospective study. Setting: elite competitive fin swimmers. Participants: 17 males and 14 females aged from 16 to 23 years. Intervention: piroxicam, sport interruption for a week, proper warming-up and wearing suggestions during out-of-water exercises in the symptomatic group. Absence of intervention in the asymptomatic one. Measures: anthropometric measures (weight, height, legs length discrepancy), isokinetic measures (trunk flexor/extensor ratio) and conventional radiological investigation were taken for all subjects. RESULTS: Low back pain was present in 14 subjects during off season but only 7 referred discomfort in competitive season. 78.5% of symptomatic subjects showed radiological abnormalities while imaging changes were present in 52.9% of the asymptomatic group. Flexor/extensor ratio isokinetically evaluated was less than one in 6 athletes complaining back discomfort. Non steroid medication, physiotherapy, training and wearing cares was suggested. Authors report a pain free return to competition in 57% and a partial resolution in 28% of those symptomatic cases who were not used to training cares (in particular proper "out-of-water" warming up) and wearing precautions (complete wiping and suitable thermic clothing after swimming). CONCLUSIONS: In fin swimming low back pain can be related to the existence of environmental and intrinsic factors. In our series no significant difference in imaging changes was pointed out among asymptomatic or painful athletes. Therefore a cyclic load on the column, in absence of training precautions can make spine abnormalities (in particular schisis, facet derangement and pars lesion) symptomatic.     

A new clinical test for measurement of lower limb specific range of motion in football players: Design,reliability and reference findings in non-injured players and those with long-standing adductor-related groin pain

ObjectiveThe association between groin pain and range of motion is poorly understood. The aim of this study was to develop a test to measure sport specific range of motion (SSROM) of the lower limb, to evaluate its reliability and describe findings in non-injured (NI) and injured football players.DesignCase-controlled.Setting6 Dutch elite clubs, 6 amateur clubs and a sports medicine practice.Participants103 NI elite and 83 NI amateurs and 57 football players with unilateral adductor-related groin pain.Main outcome measuresSport specific hip extension, adduction, abduction, internal and external rotation of both legs were examined with inclinometers. Test-retest reliability (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Non-injured players were compared with the injured group.ResultsIntra and inter tester ICCs were acceptable and ranged from 0.90 to 0.98 and 0.50–0.88. SEM ranged from 1.3 to 9.2° and MDC from 3.7 to 25.6° for single directions and total SSROM. Both non-injured elite and amateur players had very similar total SSROM in non-dominant and dominant legs (188–190, SD ± 25). Injured players had significant (p < 0.05) total SSROM deficits with 187(SD ± 31)° on the healthy and 135(SD ± 29)° on the injured side.ConclusionThe SSROM test shows acceptable reliability. Loss of SSROM is found on the injured side in football players with unilateral adductor-related groin pain. Whether this is the cause or effect of groin pain cannot be stated due to the study design. Whether restoration of SSROM in injured players leads to improved outcomes should be investigated in new studies.     

Running biomechanics in football players with and without hip and groin pain. A cross-sectional analysis of 116 sub-elite players

ObjectiveExamine whether football players with hip and/or groin (hip/groin) pain have impaired running biomechanics when compared to pain-free players, analysing men and women independently.DesignCross-sectional.SettingBiomechanics laboratory.ParticipantsSeventy-eight (62 men, 16 women) football players with >6months of hip/groin pain and a positive flexion-adduction-internal rotation test and 38 (25 men, 13 women) asymptomatic players.Main outcome measuresPelvis angles and hip, knee, and ankle joint angles and moments were analysed during the stance phase of overground running at 3–3.5 m⋅s⁻¹. Continuous joint angle and moment data were compared between symptomatic and asymptomatic football players of the same sex using statistical parametric mapping. Joint moment impulses (area under the curve) were compared between groups using linear regression models.ResultsSymptomatic football players did not display significant differences in pelvis angles or lower-limb joint angles, moments, or moment impulses during the stance phase of running, when compared to asymptomatic players of the same sex.ConclusionOur large sample of football players with hip/groin pain who were still participating in competitive sport displayed similar running biomechanics to asymptomatic players. Impaired running biomechanics might exist in people with worse hip/groin pain, warranting future investigation.