ABSTRACT
@#Introduction: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes. Materials and methods: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain’s tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire. Results: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain’s tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population. Conclusion: The incidence of de Quervain’s tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.
ABSTRACT
Las lesiones del tendón, denominadas Tendinosis son muy frecuentes en la práctica de deportistas de alto rendimiento y recreacionales. Están dentro de las patologías de sobreuso que representan cerca del 60 por ciento de las lesiones deportivas y se relacionan con una sobrecarga cíclica repetidas. Los tendones más afectados del organismo son el rotuliano, aquiliano y manguito rotador. Estudios demuestran que la condición de tendinosis aumenta significativamente su incidencia en relación a la edad; sexo masculino y obesidad. El incremento de la vascularización y terminaciones nerviosas, asociado a un aumento en la producción local de neurotransmisores explicaría la presencia de dolor crónico en las tendinosis. Tendinosis implica una pérdida progresiva de la capacidad de respuesta del tendón para una adecuada regeneración o cicatrización cuando es sometido a una carga cíclica de gran volumen en forma reiterada. La carga cíclica alta repetida induce 1- Estrés oxidativo y apoptosis. 2- Genes cartílago sustituto. Histológicamente esta falla en la respuesta reparativa se refleja en descontrolada proliferación de Tenocitos, disrupción de fibras colágenas, alteraciones en la matriz extracelular, incremento en el fenómeno de apoptosis y cambios en la homeostasis de las Metalo-proteinasas. Se inicia la destrucción de la matriz, aumenta la vascularización y terminaciones nerviosas y el tendón presenta dolor y mecánicamente respuestas a la carga inferiores a un tendón sano. Existe una gran cantidad de opciones de tratamientos pero el objetivo de este artículo es presentar aquellas opciones que nuestro equipo de trabajo aplica, basada en las ciencias básicas y últimos hallazgos con evidencia científica 1- Ejercicios excéntricos asociados a aplicación de ondas de choque radiales han demostrado alto grado de éxito 2- Uso de sustancias esclerosante (polidocanol) y concentrado...
Tendinopathies account for a substantial proportion of overuse injuries associated with sports1 and are a common cause of disability. Most major tendons, such as the Achilles, patellar, rotator cuff, and forearm extensor tendons (among others), are vulnerable to overuse, which induces pathological changes in the tendon. Tendinopathy has an increased incidence with age and the male gender and with obesity. Excessive long-distance running, intensity, and hill work are risk factors for acute. Tendinopathy is a failed healing response of the tendon. The aim of this review is to identify recent advances in the understanding of tendinopathy, particularly from a cell and molecular biology perspective. There has been much new information and there are many gaps in our understanding of the pathogenesis of tendinopathy. The current hypothesisis that tendinopathy is induced when tendon cells experience a large volume of repetitive load. High doses of cyclical strain induce genes for two major pathways ) oxidative stress- apoptosis; and cartilage like genes. The tendon cells become rounded and apoptotic and produce a matrix that contains less Type I collagen and is more cartilaginous and immature in nature. The therapeutic options with clinical evidence are 1- Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. 2- The use of injectable substances such as platelet-richplasma, autologuos blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there isminimal clinical evidence to support their use: 3- The aim of operative treatment is to excise fibrotic adhesions, remove areas of failed healing, and make multiple longitudinal incisions in the tendon to detect intratendinous lesions and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response...