Cubital Tunnel Syndrome

Also referred to as ulnar nerve entrapment, cubital tunnel syndrome is the second most common nerve compression disorder. (The first is carpal tunnel.) The pathway of the ulnar nerve predisposes it to compressive, traction, and friction forces. The cubital tunnel is found deep to the arcuate, which connects the ulnar and humeral heads of the flexor carpi ulnaris (FCU) muscle. Repeat elbow flexion can cause irritation of the ulnar nerve through this tunnel and lead to nerve irritation and...

Distal Radius Fracture

Distal radius fractures are the most common forearm fracture. Etiology usually involves a fall on an outstretched hand, although different subsets of this fracture group may have slightly different etiologies. Classification of distal radius fractures is based on angulation, displacement, intra- or extra-articular injury, and ulnar or carpal bone involvement. Terms included within the term of distal radius fracture include Colles' fracture, Smith's fracture, Barton's fracture, and Chaffeur's...

Ulnar Nerve Palsy Handlebar Palsy

Handlebar palsy is a common problem for competitive and recreational cyclists. Compression is the result of direct pressure on the ulnar nerve from grip on the handlebars. Often, the nerve may be stretched or hyperextended when a drop-down handlebar is held in the lower position. Due to the change of riding position and shape of handlebars (horn handle) in recent years, a single bicycle ride may be sufficient to cause disruption of the ulnar branch. This is especially relevant in downhill...

Disabled Athletes

There are approximately two to three million athletes in the United States with physical and mental disabilities who participate in organized sports. It is important to be sensitive to the ethical and legal issues involved with this population, as well as their particular risk factors. For example, patients with severe lupus and rheumatoid arthritis, who may or may not be on steroid treatment, are prone to injuries from weakened tendons and capsular structures. Athletes with rheumatoid...

Sacroiliac Joint Pain

The sacroiliac joint is believed to be the source of up to 10 of chronic lower back pain. In sports, with the repetitive movement and torsional forces placed on the spine, the sacroiliac joint suffers repetitive stress and this may predispose to injury. It is thought that in addition to repetitive stress, sacroiliac joint pain may be due to muscle imbalances. The typical patient is a young athlete who presents with a dull, achy pain over the sacrum. The patient may be a young woman who was...

Acute Cervical Disc Herniation 331 Mechanism of Injury

An acute cervical disc herniation most often occurs as a result of excessive neck flexion. The annulus of the intervertebral disc can tear with extrusion of the nucleus pulposus to tissues outside the disc. The nucleus pulposus contains proinflamma-tory cytokines, most notably TNF-a that can chemically irritate surrounding tissue, in addition to physically compressing neighboring structures. The ligamentous architecture of the cervical spine dictates that the most common orientation of...

Lateral Epicondylitis

Commonly referred to as tennis elbow (frequency includes 75 of club tennis players), lateral epicondylitis is the most common overuse injury of the elbow. It is an injury to the extensor tendons (i.e., extensor carpi radialis) that arises from repetitive microtrauma and overload. Patients commonly complain of worsening aching pain over the lateral elbow, which is worse with movement and alleviated by rest. In more chronic cases, however, the pain may be persistent and associated with forearm...

Avulsion Injuries

Avulsion injuries are common in athletes, especially adolescents due to an inherent weakness of apophysis. Acute avulsion injuries occur as a result of extreme active contraction or sudden passive lengthening of a muscle. Avulsion fractures most commonly occur at the ischial tuberosity. Other common sites are the anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), the lesser and greater trochanter as well as the pubic bone. The ischial tuberosity is the origin of the...

Distal Biceps Tendon Rupture

Rupture of the proximal biceps tendon comprises 90-97 of all biceps ruptures and almost exclusively involves the long head. Distal biceps tendon ruptures account for the remainder. Predisposition to this rare rupture occurs with degeneration of the tendon. When forceful extension is applied to a flexed elbow this already weakened structure can rupture. Distal biceps tendon rupture is characterized by sudden pain over the anterior aspect of the elbow after a forceful effort against resistance....

Hook of the Hamate Fracture 241 Clinical Presentation

Fracture of the hamate can occur while swinging a golf club, tennis racquet, or baseball bat. The fracture is especially likely to happen when the golf club strikes the ground instead of the ball, forcing the top of the handle of the club against the hook of the hamate. This mechanism may also compress the terminal branches of the ulnar nerve, producing sensory and motor changes. As a result, patient symptoms include reduced grip strength, numbness and tingling in the distribution of the ulnar...

Plantar Fasciitis

This condition is characterized by inflammation of the plantar fascia. The origin of the plantar fascia, the calcaneus, is the site most often affected. Activities such as running, prolonged standing or walking, dancing, and high-impact aerobics can cause repetitive microtrauma of the fascia leading to this condition. Other predisposing factors include a tight Achilles tendon, improper or new footwear, alterations in training intensity, pes planus, and pes cavus. Patients often present with...

Fractures

Jones Fracture (Transverse fracture of diaphysis of 5th metatarsal) Avulsion Fracture of the 5th metatarsal Dancer's Fracture (Spiral fracture of neck of 5th metatarsal) Lisfranc Fracture (Injury to the tarsometatarsal joints) March Fracture (Stress Fracture 2nd metatarsal and calcaneus most common Overuse injury or inversion of plantarflexed foot common in dancers due to missteps and fall from the Demi pointe position Axial loading on a plantarflexed foot Lateral foot pain with weight-bearing...

Stress Fractures of the Femoral Neck

Stress fractures are caused by repetitive overload and overuse. Stress fractures are classified into two types based on etiology insufficiency fractures and fatigue fractures. Insufficiency fractures are most commonly seen in the elderly population with osteoporosis and other underlying bone diseases and are defined as fractures of abnormal bone subjected to normal forces. Fatigue fractures are most often seen in young athletes, especially those involved in running and jumping, and are seen in...

Medial Epicondylitis

Commonly referred to as golfer's elbow, medial epicondylitis is an injury to the common flexor tendons (i.e., flexor carpi radialis). Compared with lateral epicondylitis, it is seen < 10 of the time, and results from repetitive microtrauma from valgus stress on the medial epicondyle. Athletes typically present with pain and tenderness over the medial elbow. In more chronic cases, weakness can be reported the forearm and wrist. Diagnosis is based primarily on physical exam and history. Pain on...

Heel Fat Pad Contusion

The fat pad over the heel of the foot serves as a shock absorber. It may be injured either by excessive forces being placed repetitively on the heel or due to a traumatic event such as a direct blow to the bottom of the heel. This type of injury occurs in sports players such as runners, long jumpers, and hurdlers, who have repetitive stresses placed on the heel. Footwear with poor heel cushioning also predisposes patients to this type of injury. Heel pain that occurs with weight-bearing and...

Internal Disc Disruption

As has been discussed, the nerve fibers in the disc are present in the outer third of the annulus. There have been limited reports of these fibers extending into the middle third of the annulus. For a disc to cause pain there must be irritation of these fibers by a tear in the annulus. Once there is an annular tear, mechanical pressures as well as chemical irritation from inflammatory substances within the nucleus pulposus leads to back pain. X-rays may reveal decreased disc space, but they may...

Key Cardiovascular Risk Factors

Persistent high blood pressure (upper limits of normal 130 75 in children less than 10 years old, 140 85 in children over 10). 4. High cholesterol (elevated serum total and LDL cholesterol and low serum HDL cholesterol). 6. History of cardiac symptoms palpitations, dizziness collapse, shortness of breath, or chest pain. Table 1.1 Preparticipation physical evaluation Explain Yes answers. Circle questions you don't know answers to. 1. Have you had a medical...

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve. Although compression of the median nerve can occur at multiple levels, CTS refers to compression at the wrist by the transverse carpal ligament. The degree of symptoms depends on the chronicity and degree of compression. Symptoms can progress from purely sensory to include motor loss with associated atrophy. Sensation loss occurs at the tips of the first three fingers and may travel to the forearm and wrist. Weakness...

Facet Joint Syndrome

The facet joints in the back are paired synovial joints. They allow the spine to flex and extend and help prevent anterior and posterior displacement. Trunk extension and oblique extension in particular loads the facet joints. Just like any other synovial joint (e.g., knee), the facet joints can become arthritic and painful. In fact, as much as 40 of chronic lower back pain in older individuals, and 20 of younger individuals is thought to be due to facet joint disease. Sports that involved...

Transient Brachial Plexopathy and Radiculopathy 341 Mechanism of Injury

Transient brachial plexopathies and radiculopathies, commonly referred to as stingers or burners result from trauma to the brachial plexus or nerve roots. The mechanism of injury is traction to these neurological structures that occur when the head is forcibly laterally tilted and extended as the contralateral shoulder is depressed. They often occur at the time of a block or tackle in football. As many as 65 of collegiate football players are diagnosed with at least one career stinger most of...

Ankle Sprains

Lateral ankle sprains are the most common form of ankle sprains and are caused by excessively inverting the ankle. This injury occurs in sports involving jumping (e.g., basketball, volleyball) when an athlete lands incorrectly and in sports involving abrupt direction changes (e.g., football, soccer). These ankle sprains involve partial or complete tears of the (ATFL, CFL, and or PTFL, which are listed from most to least often injured. Damage to the medial ligamentous structures (i.e., deltoid...

Spondylolysis and Spondylolisthesis

One of the most common causes of lower back pain in the young athlete involves a stress fracture of the pars interarticularis. The pars interarticularis is stressed with lumbar extension. Athletes who participate in activities involving repetitive extension (e.g., gymnasts, ballet dancers, divers, baseball pitchers) are at increased risk to suffer a pars stress fracture. Once a pars fracture has occurred, particularly if it occurs bilaterally, the athlete may go on to develop a...

Lower Face

The mandible is a U-shaped bone, composed of the body, two rami, and their articulating temporomandibular joints. It is the only mobile bone of the facial skeleton, and proper motion is essential for adequate mastication. Fractures of the mandible are common. These fractures can involve any region of the body, ramus, condyle, or joint. The direction and magnitude of the force influence the sites of the fracture and the amount and direction of bone displacement. Complicated mandible fractures...