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.
Common Injuries & Conditions
Active Families on the Go
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.
Common Injuries & Conditions
Active Families on the Go
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
PROBLEM AREAS:
Increase muscle tightness.
Pain / tenderness over the medial epicondyle
Muscle weakness / muscle imbalance
Inability to play sports
Little Leaguers Elbow -Conservative Management
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Little Leaguer’s Elbow
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
GOALS – Conservative Treatment
Little Leaguer’s Elbow
Flexibility
Soft Tissue Mobilization
Graston Technique
Instruction in Proper
Stretches
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Little Leaguer’s Elbow
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
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Little Leaguer’s Elbow
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
Common Injuries & Conditions
Active Families on the Go
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.
Active Families on the Go
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
Common Injuries & Conditions
Common Injuries & Conditions
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
Active Families on the Go
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Wrist Fractures
Therapy Interventions – Wrist Fractures
Orthotics / Home exercises / Scar Management / Functional Use /Frequency and
Duration / Strengthening Exercise
Common Injuries & Conditions
Active Families on the Go
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.
Common Injuries & Conditions
Active Families on the Go
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
Common Injuries & Conditions
Active Families on the Go
Treatment / Rehabilitation
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
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Muscle Tightness
Pain / Inflammation
Muscle Weakness / Imbalance
Decrease in Function
Tennis / Golfer’s Elbow
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Tennis / Golfer’s Elbow
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
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
Tennis / Golfer’s Elbow
Epicondylitis – Goals & Treatment
Decrease Pain &
Inflammation
Rest
Use of Orthotics
Muscle Strengthening
Determine Etiology
Common Injuries & Conditions
Active Families on the Go
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.
Common Injuries & Conditions
Active Families on the Go
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
Common Injuries & Conditions
Active Families on the Go
Treatment / Rehabilitation
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
Common Injuries & Conditions
Active Families on the Go
Endoscopic Carpal Tunnel Release
Common Injuries & Conditions
Active Families on the Go - REHABILITATION
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