Overuse Injuries
Overuse injuries are a general name for musculoskeletal problems that arise from repetitive use. These can occur in the upper extremity at the elbow, wrist, and hand. Many patients will have a combination of different overuse injuries that can be related to repetitive motion from activities at home or work, hobbies, or sports.
Figure 1
Causes
As the name implies, overuse injuries occur from repetitive stress from use. The hand, wrist, and elbow consist of an intricate collection of muscle, tendons, bones, nerves, and ligaments. These structures work in uniform to help the extremity move and function in a variety of ways. Any excessive stress or use can lead to an imbalance. This imbalance causes the symptoms of overuse.
Signs and Symptoms
If you’re experiencing an overuse injury, you may feel:
Hand
Hand overuse injuries mostly come in the form of tendon inflammation. The most common is a condition commonly referred as trigger finger (stenosing tenosynovitis). This is the most common inflammatory condition of the upper extremity. Tendons are rope-like structures that connect a muscle to a bone. When the muscle contracts, the tendon pulls the bone to move. Tendons run through tunnels in the hand called pulleys. In trigger finger, the tendons that bend fingers into a fist can become inflamed and get trapped in the pulley. This can lead to significant pain, stiffness, and weakness. The finger can lock or click due to the swelling. In severe cases, the finger barely bends or is unable to fully straighten.
Wrist
Wrist overuse injuries can include both tendon and nerve conditions. The most common tendon condition is an irritation of the wrist and thumb tendons called de Quervain’s tenosynovitis (first dorsal compartment tendinitis). The tendons that move the thumb cross the wrist and travel in small tunnel. Like trigger finger in the hand, the tunnel can become swollen, causing pain, swelling, and limited range of motion. This is a common form of tendinitis new parents and grandparents can get from excessively picking up the baby under the armpits. One suggestion would be to scoop the baby and support behind the head and under the bottom. Using a larger surface area, such as the palm, decreases the stress to the smaller joints.
The most common nerve condition of the wrist is called carpal tunnel syndrome. Nerves provide feeling to the thumb, index, middle, and ring fingers and strength to parts of the hand. The median nerve is the largest nerve in the hand that travels through a large tunnel along with the finger flexor tendons. Compression of this nerve occurs from positioning the wrist in a bent position repeatedly or for prolonged periods of time. The tunnel is called the carpal tunnel. When there is inflammation in the carpal tunnel, the nerve can be compressed. This can lead to numbness in the hand, weakness, and stiffness.
Elbow
Like the wrist, overuse injuries in the elbow can include both tendon and nerve conditions. The most common tendon condition is called epicondylitis. This is irritation of the location where tendons in the forearm attach to the bones in the elbow. This can occur on the inside of the elbow (medial epicondylitis or golfer’s elbow) or on the outside of the elbow (lateral epicondylitis or tennis elbow). Both conditions arise from repetitive wrist and forearm use, particularly with lifting. This can cause weakness and pain with lifting and pain with even light activity in some situations.
The most common nerve condition is called cubital tunnel syndrome. This is compression of the ulnar nerve at the elbow. The ulnar nerve gives feeling to the small and ring fingers and strength to parts of the hand. This nerve runs through a tunnel called the cubital tunnel in the elbow. Compression of this nerve occurs from prolonged bending of the elbow (such as when holding a cell phone to the ear or sleeping with the elbows bent). This can lead to numbness in the hand, weakness, and stiffness.
Diagnosis starts with a careful physical examination by a hand surgeon. X-rays are rarely needed unless there is recent trauma or a suspicion of arthritis. In some cases, an ultrasound or MRI may be requested. For nerve conditions, a nerve conduction study may be helpful in making the diagnosis and understanding the severity.
- Pain
- Swelling
- Loss of motion/stiffness
- Numbness
Types of Overuse Injuries
The best way to characterize overuse injuries is based on body parts. The most common locations and injuries are:Hand
Hand overuse injuries mostly come in the form of tendon inflammation. The most common is a condition commonly referred as trigger finger (stenosing tenosynovitis). This is the most common inflammatory condition of the upper extremity. Tendons are rope-like structures that connect a muscle to a bone. When the muscle contracts, the tendon pulls the bone to move. Tendons run through tunnels in the hand called pulleys. In trigger finger, the tendons that bend fingers into a fist can become inflamed and get trapped in the pulley. This can lead to significant pain, stiffness, and weakness. The finger can lock or click due to the swelling. In severe cases, the finger barely bends or is unable to fully straighten.
Wrist
Wrist overuse injuries can include both tendon and nerve conditions. The most common tendon condition is an irritation of the wrist and thumb tendons called de Quervain’s tenosynovitis (first dorsal compartment tendinitis). The tendons that move the thumb cross the wrist and travel in small tunnel. Like trigger finger in the hand, the tunnel can become swollen, causing pain, swelling, and limited range of motion. This is a common form of tendinitis new parents and grandparents can get from excessively picking up the baby under the armpits. One suggestion would be to scoop the baby and support behind the head and under the bottom. Using a larger surface area, such as the palm, decreases the stress to the smaller joints.
The most common nerve condition of the wrist is called carpal tunnel syndrome. Nerves provide feeling to the thumb, index, middle, and ring fingers and strength to parts of the hand. The median nerve is the largest nerve in the hand that travels through a large tunnel along with the finger flexor tendons. Compression of this nerve occurs from positioning the wrist in a bent position repeatedly or for prolonged periods of time. The tunnel is called the carpal tunnel. When there is inflammation in the carpal tunnel, the nerve can be compressed. This can lead to numbness in the hand, weakness, and stiffness.
Elbow
Like the wrist, overuse injuries in the elbow can include both tendon and nerve conditions. The most common tendon condition is called epicondylitis. This is irritation of the location where tendons in the forearm attach to the bones in the elbow. This can occur on the inside of the elbow (medial epicondylitis or golfer’s elbow) or on the outside of the elbow (lateral epicondylitis or tennis elbow). Both conditions arise from repetitive wrist and forearm use, particularly with lifting. This can cause weakness and pain with lifting and pain with even light activity in some situations.
The most common nerve condition is called cubital tunnel syndrome. This is compression of the ulnar nerve at the elbow. The ulnar nerve gives feeling to the small and ring fingers and strength to parts of the hand. This nerve runs through a tunnel called the cubital tunnel in the elbow. Compression of this nerve occurs from prolonged bending of the elbow (such as when holding a cell phone to the ear or sleeping with the elbows bent). This can lead to numbness in the hand, weakness, and stiffness.
Diagnoses
Diagnosis starts with a careful physical examination by a hand surgeon. X-rays are rarely needed unless there is recent trauma or a suspicion of arthritis. In some cases, an ultrasound or MRI may be requested. For nerve conditions, a nerve conduction study may be helpful in making the diagnosis and understanding the severity.Treatment
Treatment for all these conditions is similar and dependent on the patient and severity.
First and foremost, activity-based changes must be made. Typically, changing activity and behaviors effectively can treat the problem. It is important to note that all symptoms cannot be neatly classified in one or two diagnoses as often there is collection of several ailments that leads to the symptoms. Therefore, the most important first treatment is modifying the activity or how it is performed.
This includes:
© 2023 American Society for Surgery of the Hand. This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a Hand Surgeon near you.
First and foremost, activity-based changes must be made. Typically, changing activity and behaviors effectively can treat the problem. It is important to note that all symptoms cannot be neatly classified in one or two diagnoses as often there is collection of several ailments that leads to the symptoms. Therefore, the most important first treatment is modifying the activity or how it is performed.
This includes:
- Limiting or modifying the repetitive activity
- Reducing the amount of time the activity is performed
- Avoiding the activity for a period
- Ergonomic changes / assessment
- Focus on mechanics and posture
- Braces/ splints
- Anti-inflammatory medication or treatments
- Cortisone shots/steroid injections
- Alternative injections (such as stem cells) in certain locations
- Therapy for isolated stretching and strengthening
© 2023 American Society for Surgery of the Hand. This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a Hand Surgeon near you.
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