Carpal tunnel syndrome(CTS) can be caused by direct
trauma, repetitive use, or anatomic anomalies. It is
commonly seen in the dominant upper extremity of ath-
letes who participate in repetitive flexion and extension
of the wrist such as lacrosse and gymnastics, and in
grip-intensive activities such as cycling, racquet sports,
and archery (Plancher, Peterson, and Steichen, 1996).
Hypertrophy of the lumbrical muscles as seen in
weightlifters can also cause CTS. Athletes have similar
classic complaints as other patients with CTS such as
pain and paresthesias in the radial three and one-half
digits, especially at night. They may also complain of
clumsiness and weakness with grip related activities.
Phalen’s and Tinel’s tests are variably positive.
Electrodiagnostic study results fluctuate, but com-
monly exhibit delays across the wrist.
•Treatment consists of rest, anti-inflammatory medica-
tion, nighttime splinting, and activity modification.
Corticosteroid injection into the carpal tunnel may be
diagnostic and therapeutic, but often relief is only tem-
porary. Surgical decompression with release of the
transverse carpal ligament is the treatment of choice
when symptoms persist. Patients returning to sports
using a racquet, club, or bat should use a specially
padded glove to protect the hand from shock and vibra-
tory trauma until pillar pain resolves (Rettig, 2001).
ULNAR NERVE
- Ulnar tunnel syndrome is compression of the ulnar
nerve at the level of the wrist as it enters Guyon’s canal
or as the deep branch curves around the hook of the
hamate and traverses the palm. Compression may occur
due to ganglias, lipomas, anatomic anomalies, carpal
fractures (e.g., hook of hamate), local inflammation, or
ulnar artery thrombosis (Plancher, Peterson, and
Steichen, 1996; Sicuranza and McCue, III, 1992). The
most common mechanism of injury in sports occurs in
cyclists, owing to the term cyclist’s or handlebar palsy.
It can also be seen in baseball players, golfers, hockey
players, and racquet sports as well as a result of per-
forming numerous push-ups (push-up palsy (Walker
and Troost, 1988)). Compression of the nerve may
cause motor, sensory, or mixed symptoms. A fixed
motor deficit results in a claw hand appearance and is
rare. Sensory complaints involve usually the ulnar one
and one-half digits. EMG is performed on both ulnar
and median nerves, as coincident involvement is fre-
quent (Plancher, Peterson, and Steichen, 1996).
Treatment consists of rest, anti-inflammatory medica-
tion, and activity modification including changing hand
position on the handlebars or padding of affecting
object. If symptoms persist, surgical decompression of
the ulnar nerve in Guyon’s canal should be performed
and provides excellent relief from symptoms with
return to activity in 4 to 8 weeks.RADIAL NERVEDISTALPOSTERIORINTEROSSEOUS
NERVESYNDROME- Compression and/or irritation of the terminal sensory
branch of the radial nerve is called distal posterior
interosseous nerve syndrome. The terminal branch
crosses over the dorsal aspect of the distal radius and
enters the wrist capsule and is susceptible to injury
from repetitive and forceful wrist dorsiflexion such
as in gymnastics (Linscheid and Dobyns, 1985).
Symptoms include a deep, dull ache in the wrist, pain
with forceful wrist extension, and tenderness with
deep palpation during wrist hyperflexion. This is a
diagnosis of exclusion and should only be made after
other conditions such as occult fracture, carpal insta-
bility, ganglions, and dorsal impaction syndrome
have been ruled out. Radiographs should be taken to
rule out other causes. A local injection of anesthetic
may be diagnostic and provide short-term relief. If
conservative therapy fails, surgical excision of the
nerve as it exits under the extensor digitorum com-
munis on the floor of the fourth extensor compart-
ment is indicated (Dellon, 1985).
SUPERFICIALRADIALNERVECOMPRESSION- Compression of the superficial radial nerve is also
called Cheiralgia paresthetica, or Wartenberg syn-
drome. The nerve is subcutaneous and is susceptible
to injury as it pierces the deep fascia between the ten-
dons of the extensor carpi radialis longus(ECRL)
and brachioradialis. Constriction of the nerve may
occur during sports that include pronation and supina-
tion, such as batting, throwing, and rowing (Dellon
and Mackinnon, 1986). It also may occur from exter-
nal compression from tight wristbands, tape, watches,
archery guards, gloves, or straps from a racquetball
racquet (Plancher, Peterson, and Steichen, 1996;
Sicuranza and McCue, III, 1992). Direct trauma may
also cause nerve irritation from contact sports, e.g.,
hockey, football, and lacrosse. - The athlete complains of numbness or paresthesias
over the dorsoradial aspect of the wrist, hand, dorsal
thumb, and index finger. There may also be associated
dorsoradial pain with thumb flexion and wrist ulnar
deviation, similar to that in de Quervain’s tenosynovi-
tis; however, wrist pain is present when performing the
Finklestein test regardless of thumb position in
Cheiralgia paresthetica compared with thumb flexion
302 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE