UPPER EXTREMITY INJURIES ASSOCIATED WITH STRENGTH TRAINING

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Strength training in now an integral part of the training program for competitive athletes. With the general population's interest in health and fitness and the growing number of personal trainers, however, strength training is becoming a part of the general fitness programs for all age groups of both sexes. As a result, strength training injuries are likely to become more common. Understanding the injury patterns associated with strength training will benefit team physicians and those caring for competitive athletes, and assist general practitioners and sports medicine specialists caring for the general population.

This article reviews the reported injuries associated with strength training, and discusses their treatment and preventive strategies that emphasize proper strength training techniques. The injury patterns are presented on an anatomic basis.

Section snippets

SHOULDER

Strength training can place considerable stress across the shoulder. Essentially, strength training causes the shoulder to become a weightbearing joint. Overuse complaints are common and include strains of all the major muscle groups about the shoulder, including the deltoid and the rotator cuff. Strains of the trapezius and paracervical musculature during heavy bench pressing activities are common, as is bicipital tendinitis. We have encountered several instances of significant adhesive

ELBOW

Soft tissue complaints are common about the elbow during strength training activities. Lateral epicondylitis is quite common as a result of repetitive use of a power grip to hoist dumbbells and barbells. Less commonly, medial epicondylitis and bicipital tendinitis at the elbow can occur. Intensive training of the triceps muscle commonly results in triceps tendinitis in strength-training athletes.

Treatment for all these conditions includes rest, ice massage techniques, nonsteroidal

FOREARM, WRIST, AND HAND

A powerful hand grip is required in most strength-training exercises. We have encountered several patients with a compression neuropathy at the ulnar nerve in Guyon's canal, usually as a result of improper grip. This improper grip places the thumb under a straight bar during a pressing motion, allowing the weight to rest on Guyon's canal, which can result in discomfort in Guyon's canal and paresthesia in the ulnar nerve distribution at the ring and long fingers. A normal grip, in which the

NEUROLOGIC INJURY

Several cases of neurologic injury as a result of strength training have been described. Two reports of suprascapular neuropathy after intensive strength training have been reported.1, 5 In one case, the strength-training program consisted of the use of Nautilus equipment, emphasizing exercises to strengthen shoulder abduction. The initial treatment for this patient did not include rest but instead a low-resistance, high-repetition shoulder-strengthening program. Rest may have allowed this

ANABOLIC STEROIDS

The abuse of anabolic steroids most often occurs in strength-training athletes. Under the proper conditions, anabolic steroids can induce significant strength gains and muscle hypertrophy.21 In addition to their multiple systemic adverse side effects, anabolic steroids seem to play a role in soft tissue injuries about the upper extremity. As noted earlier, several cases of triceps tendon rupture have been associated with anabolic steroids.3, 23, 40 Also, a spontaneous rupture of the extensor

SUMMARY

Most injuries sustained during strength training are mild strains that resolve with appropriate rest. More severe injuries include traumatic shoulder dislocations, tendon ruptures of the pectoralis major, biceps, and triceps; stress fractures of the distal clavicle, humerus, radius, and ulna; traumatic fractures of the distal radius and ulna in adolescent weightlifters; and compressive and stretch neuropathies. These more severe injuries are usually the result of improperly performing a

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    Address reprint requests to Herbert A. Haupt, MD, 3009 N Ballas Rd, Suite 105, St. Louis, MO 63131

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    Orthopedic Associates, LLC, St. Louis, Missouri

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