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Musculoskeletal injuries
Overuse syndromes
Whenever a muscle is overused—that is, exercised past its state of conditioning—there is actual destruction of the muscle tissue and generation of lactic acid. Given a reasonable rest period, the products of metabolism are carried away in the circulation and the muscle tissue regenerates to a healthy, sometimes even stronger, condition. However, if the exercise has been vigorous and unrelenting, the participant might suffer from a variety of aches and pains that are generally categorized as overuse syndromes.
Carpal tunnel syndrome
Carpal tunnel syndrome is caused by elevated pressure in the carpal tunnel, which is a space at the base of the wrist through which pass nine tendons that flex (bend toward the palm) the fingers, along with the median nerve. It can be caused for a number of reasons, which include forceful, repetitive use of the wrist. People with short, wide hands and square-shaped wrists might be at greater risk to develop this syndrome. The pressure causes the median nerve to have diminished function, which leads to the signs and symptoms. These include pain, numbness, tingling, and/or burning sensation on the palm side of the thumb, index finger, middle finger, and thumb side of the fourth finger. The “pinkie” side of the fourth finger and entire fifth finger are spared, as they are serviced by the ulnar nerve, which lies outside the carpal tunnel. Treatment is to avoid the offending activity and to splint the wrist in a “neutral” position of function (see page 85), both night and day if possible. A nonsteroidal antiinflammatory drug (NSAID) might be helpful. If the case is severe, a physician can prescribe oral steroids or inject steroids into the carpal tunnel. Medical evidence does not support the use of vitamin B 6 . If carpal tunnel syndrome persists and the victim shows loss of nerve function or muscle wasting at the base of the thumb, surgery might be advised to decrease the pressure.
Cyclist’s palsy
If a cyclist leans on the handlebars for an extended period, they might compress the ulnar nerve as it passes through the wrist. Symptoms include numbness and tingling of the fifth finger and the outside half of the fourth finger. Treat with a wrist splint and administration of an NSAID. On rare occasion, steroid injection or surgical decompression of the nerve is necessary.
Saturday night palsy
This occurs if a person sleeps with his arm draped over the back of a chair or against a hard object, such as a log. The radial nerve is compressed as it wraps around the upper long bone (humerus) of the arm. Symptoms include diminished or no sensation on the top of the hand over the first and second fingers, as well as over the thumb. When the hand is held straight out, palm down, the hand drops down at the wrist into a limp position ( Fig. 214 ). Even though it might have only taken one night to affect the nerve, it might take a few weeks for recovery, so the wrist should be splinted in a position of function (see page 85). Add a sling if necessary to support the forearm and hand.
Rotator cuff tendinitis
The rotator cuff comprises four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. Each of these muscles is connected to the scapula, traverses over the shoulder, and attaches to the upper arm bone. These muscles stabilize the shoulder and lift and rotate the arm. When they are stretched or strained, motion at the shoulder can be quite painful. Rest, avoiding painful motion, intermittent cool compresses or ice packs, and taking an NSAID are recommended for relief and recovery. If the pain persists, then there might be a rotator cuff tear that requires surgical repair.
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