Wrist Injuries with Dr. Jason Tarno

Southern Nevadans that are active in athletic activities often injure their wrists. What are some of the most common activities that cause wrist injuries?

Any activity can cause a wrist injury. However activities that subject the wrist to trauma such as volleyball or basketball expose the wrist to greater chance of fracture. In addition, repetitive activities such as tennis, or sports that place constant pressure on the wrist such as weight lifting can cause sprains or tendonitis.

Can you discuss fractures at the wrist?

The wrist itself is composed of eight carpal bones in addition to the two bones of the forearm, the radius and ulna. Wrist fractures can occur from a variety of mechanisms. In athletics, the most common mechanism for a fracture is a fall with on an outstretched hand.

What is the most common type of wrist fracture?

The most common wrist fracture is a fracture of the scaphoid bone. The scaphoid bone is one of the eight bones of the wrist and it is located at the base of the hand on the thumb side. Scaphoid fractures make up about 60 percent of wrist fractures. This injury occurs during a fall on an outstretched wrist, especially if the wrist is bent at an angle greater than 90 degrees. The next most common wrist fractures are of the radius and ulna. Of course, any bone of the wrist is subject to fracture.

What are the signs and symptoms of a scaphoid fracture?

Signs of scaphoid fracture include pain and tenderness on the thumb side of the wrist. Localized swelling may occur and gripping objects may be painful. In addition athletes will have pain when pressure is applied near the base of the thumb.

Are there any complications for an athlete that does not get proper treatment of a scaphoid fracture?

Scaphoid is latin for “boat shaped”. Unfortunately, because of the shape of this bone, it has a poor blood supply. Because of this poor blood supply, the possibility of avasular necrosis increases without proper treatment.

What is avascular necrosis?

Avascular necrosis (AVN) is a term that describes death of a bone after injury due to lack of blood supply. Bo Jackson, is probably one of the most famous people that has had this problem. Of course his problem was not at the wrist but at the hip.

Can you discuss tendonitis?

Tendons are fibrous cords that connect a muscle with bone. Tendonitis is the inflammation of the tendon which usually occurs as a result of repetitive use.

What are the signs and symptoms of tendonitis?

A pain in the front of the wrist is a common symptom of tendonitis. There may also be pain with gripping. Occasionally, thickening or swelling can be felt in the area where tendonitis occurs. Bending and extending the wrist is usually painful.

Can you give an example of an activity that commonly produces tendonitis?

Cyclists who ride for extended periods put pressure on their wrists while the hand is bent in an awkward position. A common injury seen in ten speed bike riders is tendonitis of the extensor carpi ulnaris (ECU). This tendon, which extends the wrist and fifth finger, is on ulnar (pinky) side of the wrist and can be compressed and irritated after chronic strain from bike riding.

What is DeQuervain's tenosynovitis?

This condition, which was named after a Swiss surgeon, is the irritation of the tunnel which houses two tendons of the thumb. It can be caused by an activity that places the thumb in an awkward position for an extended period of time. Because of the resulting swelling, the narrowing of the tunnel makes it difficult for the tendons to pass smoothly. Signs of this condition include pain on the thumb side of the wrist which can travel up the forearm, a ‘clicking’ or ‘clunking’ sensation as the tendons pass through the swollen tunnel and difficulty gripping.

How does a wrist sprain occur?

Much like the majority of wrist fractures, wrist sprains occur during falls onto outstretched hands. A sprain is an injury to a ligament. A ligament is a band of fibrous tissue which connects two bones.

Is a sprained ligament the same as a torn ligament?

Yes and No. Sprains are categorized by grades. In a Grade I tear, some of the fibers are torn, but the main ligament is still intact. The ligament is stretched, but not torn. On the other hand, a Grade III tear involves the complete tearing (or rupture) of a ligament. Ligaments tend to have a poor blood supply, which is why torn ligaments take a long time to heal.

What are the signs and symptoms of wrist sprains?

Of course the severity of symptoms will vary with the degree of sprain. However, wrist sprains typically present with wrist swelling, pain at time of injury, and with movement, local tenderness and warmth over the area of the sprain. In severe sprains, an athlete might feel a tearing sensation or even hear an audible pop.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com

Running Injuries with Dr. Jason Tarno

Running has been a popular sport since the 1970’s. Because of the climate in Las Vegas, many people enjoy running year round. What are some common injuries that runners sustain?

Most of the injuries that runners sustain are due to the chronic impact of the lower extremities, ie: the feet, shins, and knees. The common injuries to the feet involve fractures, stress fractures, tendonitis, and plantar fasciitis. The common injuries to the shins involve shin splints and tibial stress fractures. The knees can present with pain to the kneecap or to the actual joint itself.

What is the difference between a fracture and a break?

The term fracture is the medical term for a broken bone. The meaning is the same, and the words are used interchangeably.

What is the difference between a fracture and a stress fracture?

A fracture is caused when a bone is overloaded by some outside stress. Usually this outside stress is an acute twist or impact of the bone. A stress fracture occurs when the bone is overloaded over time. Initially, the bone tries to adapt to increases in stress by laying down more bone. However, if the impact, or stress is more than what the bone can keep up with, eventually the bone starts to develop microfractures. This causes pain. Pain is a signal to the body to stop or back off from the activity that is being performed. If the athlete does not listen to their body and continues to impact the bone, eventually the bone can completely fracture.

What is plantar fasciitis?

The plantar fascia is a band of tissue that is on the plantar aspect (or bottom) of the foot. It begins at the heel bone (calcaneus) and attaches to the toes. It acts to support the tendons and the arch of the foot. With overuse, the tissue can become inflamed and tight. This disorder is very common in runners and can be tough to treat in active people.

You mention the arch of the foot. Are people affected differently if they have flat feet vs. a high arch?

If the arch of the foot has flattened out (flat foot), the impact of running is increased in the foot because the shock absorption that the arch provides is not present. The foot becomes floppy, and without the shock absorption that the arch provides, the first and second toes take on a lot more of the impact load. This can lead to stress fractures in the toes. If the arch of the foot is too high, the foot becomes rigid. The impact load then travels up the leg to the shins (tibia), knees, or hips. Occasionally, even the low back takes on some of the load.

What is the difference between shin splints and a stress fracture?

The term shin splints is also known as medial tibial stress syndrome. As the name implies, there is stress to the medial or inside aspect of the tibia (shin bone). The stress does not refer to the bone itself; however, but to the muscles that attach to the tibia. A stress fracture, as detailed above, is an actual defect in the bone itself.

You mentioned above that runners could injure their knees. Can you expound on that?

Runners do not often twist or hyperextend their knees during their activity like football or soccer players do. Running is a straight ahead, impact type of sport. Most of the problems; therefore, have to do with degenerative disorders. The shock absorbers in the knee called the meniscus can become thinned and lead to degenerative tears. This can lead to swelling in the knees. Occasionally, the undersurface of the kneecap, or patella, can become inflamed as well. Exercises for the quadriceps can help pain in this area.

It seems like there are a lot of disorders that can happen with running. Do you recommend against running as an activity?

No. Many people love to run, and simply, cannot function without their daily run. I think that if someone is having constant pain with their activity, they should see their sports physician, because it could be the start of something significant, as described above. There is another population of people that run because they think that they have to run in order to “get in shape” or lose weight. Those people need to know that there are other activities that can provide aerobic benefits without the constant impact to the lower extremities.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com