“This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein”
Wrestler’s upper limb common Injuries- Prevention exercises
Upon completion of this module the reader will be able to:
- Understand basic anatomy and functional anatomy for the upper limbs complex.
- Understand the shoulder, elbow and wrist injury epidemiology
- Understand the mechanisms for the shoulder, elbow and wristinjuries.
- Determine common risk factors that can lead to the shoulder, elbow and wrist injuries.
- Incorporate exercises in order apply a prevention strategy for the shoulder, elbow and wrist injuries.
- Review the «Anatomy and Functional of the shoulder and elbow joints» topic and the «Injury prevention strategies». Read the corresponding presentation and then follow the proposed videos for some ideas of “Upper limb prevention exercises”. End the session with the “Bibliography and the additional learning materials” and assess your understanding with the “Upper limb injuries”
The shoulder consists of a ball-and-socket joint formed by the humerus and scapula and their surrounding structures – ligaments, muscles, tendons – which support the bones and maintain the relationship of one to another. These supporting structures attach to the clavicle, humerus, and scapula, the latter providing the glenoid cavity, acromion and coracoid processes. The main joint of the shoulder is the shoulder joint (or glenohumeral joint), between the humerus and the glenoid process of the scapular. The acromioclavicular joint and sternoclavicular joint also play a role in shoulder movements. White hyaline cartilage on the ends of the bones (called articular cartilage) allows the bones to glide and move on each other, and the joint space is surrounded by a synovial membrane. Around the joint space are muscles – the rotator cuff, which directly surrounds and attaches to the shoulder joint – and other muscles that help provide stability and facilitate movement.
The glenoid labrum is the second kind of cartilage in the shoulder which is distinctly different from the articular cartilage. This cartilage is more fibrous or rigid than the cartilage on the ends of the ball and socket. Also, this cartilage is also found only around the socket where it is attached.
The shoulder joint (also known as the glenohumeral joint) is the main joint of the shoulder. It is a ball and socket joint that allows the arm to rotate in a circular fashion or to hinge out and up away from the body. It is formed by the articulation between the head of the humerus and the lateral scapula (specifically-the glenoid cavity of the scapula). The “ball” of the joint is the rounded, medial anterior surface of the humerus and the “socket” is formed by the glenoid cavity, the dish-shaped portion of the lateral scapula. The shallowness of the cavity and relatively loose connections between the shoulder and the rest of the body allows the arm to have tremendous mobility, at the expense of being much easier to dislocate than most other joints in the body. There is an approximately 4-to-1 disproportion in size between the large head of the humerus and the shallow glenoid cavity.The glenoid cavity is made deeper by the addition of the fibrocartilaginous ring of the glenoid labrum.
The capsule is a soft tissue envelope that encircles the glenohumeral joint and attaches to the scapula, humerus, and head of the biceps. It is lined by a thin, smooth synovial membrane. This capsule is strengthened by the coracohumeral ligament which attaches the coracoid process of the scapula to the greater tubercle of the humerus. There are also three other ligaments attaching the lesser tubercle of the humerus to lateral scapula and are collectively called the glenohumeral ligaments.
- “shoulder”. The Free Dictionary.
- ^ Jump up to:ab “shoulder – definition of shoulder in English | Oxford Dictionaries”. Oxford Dictionaries | English. Retrieved 2016-11-04.
- ^ Jump up to:ab c d e f g h i j k l m n o p q r s t u v w x y z aa Bogart, Bruce (2007). Elsevier’s Integrated Anatomy and Embryology. Elsevier. pp. 246–260. ISBN 978-1-4160-3165-9.
- ^Wexler, Barbara (2006). Encyclopedia of Nursing and Allied Health Vol. 1 (2nd ed.). Farmington Hills, MI: Gale. pp. 414–416. ISBN 978-1-4144-0374-8.
- ^“labrum tear”. Johns Hopkins Orthopaedic Surgery. Archived from the original on 2011-11-20. Retrieved 2010-05-16.
Injuries to the upper limbs are frequently reported in wrestling. Generally these injuries are caused by a combination of leverage and twisting (applied by the dominated wrestler). Most often these opposing forces act on a joint, which sustains the injury. Also in a study carried out by Lorish et al. (1992) in adolescent and preadolescent boys, the primary areas of injury were to the upper extremities (33%), and the neck and back (24%). Similarly Halloran, (2008) supported that the most commonly injured area in the upper extremity is the shoulder
In high school wrestlers reports ranging from 18% to 24% of injuries (Borowski et al., 2008). The most common wrestling situation resulting in injury was the takedown position (Halloran, 2008). Often shoulder injuries occur when the wrestler is trying to escape a hold and inadvertently forces the joint past what would be the individual’s normal range of motion. Injuries may also occur when shoulder joints are held in either extreme abducted or adducted positions and the wrestler in control forces his opponent to the mat (Brindle & Cohen, 1998; Mudgal & Waters, 1998). Shoulder injuries may cost wrestlers an entire season or may mean the end of their career as high school athletes. Wrestlers with ligamentous laxity suffered fewer shoulder injuries than the other wrestlers, indicating that flexibility training should be an important area for conditioning emphasis (Pasque & Hewitt, 2000).
Among high school wrestlers who missed more than 3 weeks of wrestling, shoulder dislocation/subluxation was the most common injury, followed by fractures of the hand, shoulder, and elbow.
Amateur wrestling is a highly physically demanding sport, and the upper limb is put under enormous stresses (Thomas, Zamanpour, 2018; Goodman, Twomey-Kozak, DeFroda, Owens, 2018). Classically, the upper limb can become weight bearing and can be subjected to high impact loads, for example when a wrestler lands on the hand after a throw from a standing position with the elbow fully extended, the forearm pronated and the shoulder elevated
Elbow injuries are sustained less frequently than shoulder injuries but appear to be more severe. Elbow injuries accounted for 1.0–7.9% of all wrestling injuries. According to Haugegaard et al., (1993) the most common elbow injury is the hyperextension abduction sprain affecting the ulnar collateral ligament and the anterior capsule. However, Yard (2008) supported that the most common are elbow dislocations (Yard, 2008). The mechanism of injury is often related to a fall on an outstretched arm. In relation to wrestling, this often occurs during takedown maneuvers and can be either anterior or posterior (Halloran, 2008). This can occur when the wrestlers may be trying to brace themselves from either a backward or forward fall (Halloran, 2008). In any elbow dislocation, brachial artery entrapment is a possible complication.
Elbow injuries, while relatively uncommon, are a significant source of disability (Hassebrock et al., 2019). The anatomic structure of this complex joint is important in understanding the injuries and disability that occur. The elbow joint is a modified hinge joint composed of 3 articulations (radiocapitellar, radioulnar, and ulnohumeral) covered by a joint capsule (Rahman, et al., 2008). Elbow stability is imparted by both static and dynamic mechanics. Primary static stabilizers to varus and valgus stress are the lateral collateral ligament and the medial ulnar collateral ligament (UCL), respectively (Rahman, et al., 2008). Dynamic stabilizers largely consist of 4 muscle groups that cross the elbow: wrist flexors, wrist extensors, elbow flexors, and elbow extensors (Rahman, et al., 2008; Karbach & Elfar, 2017).
Injury to any of the aforementioned structures can lead to significant pain and disability, limiting the ability of the athlete to participate. Tendinopathies, usually the result of overuse, are relatively common in the general population. The flexor-pronator muscles are frequently involved; however, lateral tendinopathies are still the most common overall (Rineer, Ruch. 2009). Ligamentous injuries also frequently occur. Rupture of the anterior oblique band of the UCL destabilizes the elbow to a valgus force and this is often injured secondary to the repetitive valgus loads experienced by overhead throwing athletes (Rahman, et al., 2009). Traumatic or overuse injuries resulting in posterolateral rotatory instability are secondary to lateral UCL injury and are the most common form of recurrent instability in the elbow (Reichel, et al., 2013; Pereira, 2013). Severe instability can lead to subluxation or frank dislocation when multiple stabilizers are compromised (Armstrong, 2015). These injuries often result in osseous injury or fractures as well (Armstrong, 2015).
Elbow injury rates were significantly higher during competition versus practice. Most injuries occurred in-season. Among injury mechanisms, injury through contact was the most common (67%), followed by overuse or gradual injuries (17%) (Hassebrock, et al., 2019).
Also, younger wrestlers appear to be susceptible to various types of avulsion fractures about the elbow, including the olecranon and the medial humeral epicondyle
Upper limb injuries prevention exercises for wrestlers
Phase I : Muscular conditioning to restore dysfunctional movement patterns that can impede performance
Phase II: Functional exercise – Building efficient movement pattern
Bibliography and the additional learning materials
- First try to increase your joint flexibility using stretches
- Strengthen you muscles, especially the rotator cuff
- Perform plank exercises
- Always exercise in a pain-free range of motion. Exercises or parts of exercise that lead to pain should be avoided.
Agel, J., Ranson, J., Dick, R., Opplinger, R., & Marshal S. (2007). Descriptive epidemiology of collegiate men’s wrestling injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–89 through 2003–2004. Journal of Athletic Training, 42(2), 303–310.
Akbarnejad A, Sayyah M. (2012) Frequency of sports trauma in elite national level greco-roman wrestling competitions. Arch Trauma Res. 2012;1(2):51–3.
American Medical Association, Committee on the Medical Aspects of Sports. Standard Nomenclature of Athletic Injuries. Chicago: American Medical Association; 1966.
Armstrong A. (2015). Simple elbow dislocation. Hand Clin. 2015;31(4): 521-531.
Barroso BG, Silva JMA, Garcia AC, Ramos NCO, Martinelli MO, Resende VR, et al. (2011) Musculoskeletal injuries in wrestling athletes. Acta Ortop Bras. 2011;19(2):98–101.
Boden BP, Lin W, Young M, Mueller FO. (2002) Catastrophic injuries in wrestlers. Am J Sports Med. 2002;30(6):791-795.
Borowski LA, Yard EE, Fields SK, Comstock RD. (2008) The epidemiology of US high school basketball injuries, 2005Y2007. Am. J. Sports Med. 2008; 36(12): 2328-35.
Brindle, T. J., & Cohen, M. (1998). Scapular avulsion fracture of a high school wrestler. Journal of Orthopaedic & Sports Physical Therapy, 27(6), 444–447.
Centers for Disease Control and Prevention. (2006). Sports related injuries among high school athletes—United States, 2005–2006 school year. Morbidity and Mortality Weekly Report, 296(22).
Yard EE, Collins CL, Dick RW, Comstock RD. (2008). An epidemiologic comparison of high school and college wrestling injuries. Am. J. Sports Med. 2008; 36(1):57-64.
Yard EE, Comstock RD. (2008). A comparison of pediatric freestyle and Greco- Roman wrestling injuries sustained during a 2006 US national tournament. Scand J Med Sci Sports. 2008;18(4):491–7.
Yard, E. E. (2008). An epidemiologic comparison of high school and college wrestling injuries. The American Journal of Sports Medicine, 36(1), 57–64.
“This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.”