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Syndesmosis - Chronic Wrist, Elbow, Ankle Or Knee Pain.

Learn more about Syndesmosis. Get the details of what it is, who gets it, and learn some ways of detecting it along with some recommendations to keep it from getting worse.

By: Dr. David Ryan & Ginger Redeker NPC Figure Comp.

It is a very common injury and often mis-diagnosed by physicians. Recurrent or chronic pain in the wrist, elbow, ankle or knee is often associated with damage to the interosseous membrane. A quick review of the anatomy gives us insight as to how this injury can occur.

Note the interosseous membrane located in the forearm and also the lower leg. The diagram shows how the membrane offers stability for the two bones to remain in the correct position. When you have injured the interosseous membrane, it will fail to stablize the position of the bones.

When you jump or run on the legs, the force separates the bones and result in further injury. Similarly, if you bench press, punch something, do a push-up, that force will separate the bones in your forearm. This leads to additional pain and further injury.

Having this kind of injury can feel like carpal tunnel syndrome, tennis elbow, pitchers elbow, glass arm, in the upper extremities. In the lower extremities you can have one or more forms of unstable knee pain on the inside, outside, front and/or back of the knee, constant ankle pain, tarsal tunnel syndrome, shin splints, etc.

Most pain formats show a constant ache that get worse with activity and can feel very sharp when lifting weights.


Anatomy Charts

anterior view
Click Image To Enlarge.
Anterior View.

anterior view
Click Image To Enlarge.
Anterior View.

The following diagram shows how the forces loaded on the hand or elbow, will result in additional damage to the interosseous membrane.

load transfer
Click Image To Enlarge.
Load Transfer Diagram.

The diagram below shows how the force starts in the lower outside ankle and then transfers through the Fibula across the interosseous membrane to the Tibia and on up to the Femur.

anterior view
Click Image To Enlarge.
Force Transfer.


Who Gets A Syndesmosis

Fitness Athletes:

    A syndesmosis is very common to fitness athletes, but also can be quite common for those who have repetitive injury or axial loading to bone structures. Fitness athletes have particular problems with this injury due to their gymnastic routines being practiced and performed on hard non-padded surfaces.

    The back-hand-springs, the repetitive running and strains associated with weight training, are often too much for the body to handle and result in injury. Other athletes who spend a lot of time on a treadmill can have repetitive trauma to the lower limbs, which can result in a syndesmosis.

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Figure Athletes:

    Figure athletes specifically spend a large amount of their time, doing impact cardio and this can result in a syndesmosis. This type of injury also occurs with bodybuilders or other athletes who engage in lifting heavy weights, especially if the activity continues while they have a growth spurt or underlying injury.

Detecting The Problem:

    When the interosseous membrane is damaged, it may be impossible to detect the problem on any diagnostic test. X-rays and MRI's are not established to detect subtle changes in the strength of the ligament. In many cases you would have to remove part of the membrane and look at it under a microscope, which is not feasible.

    As damage continues to the membrane, other ligaments and tendons are affected and become involved in the syndrome of pain. The simple injury becomes more and more complicated and can provide so much pain that any movement or even rest will provide discomfort. Damage can be irreversible and the intervention of surgery to place a screw to hold the bones together may be necessary.

    This type of injury is common for those who perform gymnastic moves or those who have fallen or have had any impact to their lower legs or forearms. Any field, court or ice athlete can obtain this injury from a fall. Any heavy lifting done at too early of an age will result in this type of injury. Tennis Elbow or Pitchers Elbow often is a mis-diagnosed syndesmosis.

    Tennis Elbow:
    A painful inflammation of the tissue surrounding the elbow, caused by strain from playing tennis and other sports. Also called lateral humeral epicondylitis.

Organized Sports For Kids:

    With the current advent of organized sport for kids, there is a significant risk that we put on our children with the ongoing attitude of play through the pain.

    Several conditions are presented to physicians that are merely growth related pain and that child is encouraged to continue to participate, leading to further irreversible injury. How many little league pitchers are throwing on sore arms? How many gymnasts, cheerleaders, soccer players and other athletes are forced by coaches and parents to perform for the good of the team?

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    Early treatment includes lifting lighter, non-impact modifications to the workout. Athletes who choose or are instructed not to modify their activities will likely result in additional injury.

Side Bar Note: Knowing When To Stop Your Kid From Playing

This is kind of a side bar, but it is worth saying to those of you with the sports family.

We all want what is best for our children. We want them to participate in sports and receive a positive outcome from the experience. Pushing your child too hard can be a dangerous thing and result in further or unnecessary injury. Significant danger exists when a child's pain is greater than 50% and they are "recommended" to continue participating in sports.

It is time to remove a child from activity for:

  • Any condition that has your childs attention. It is also worth a physicians review.
  • Any condition that has lasted longer than two days. This should also be reviewed by a phyician.
  • Any activity that aggrevates the child's pain level should be stopped immediately until a physician has reviewed the problem.
  • Fever means "do not participate."
  • Loss of conciousness requires an immediate physician's review.
  • Vomiting means "do not participate."

This list is by no means all inconclusive and the situations involving mental stress can be just as devastating. Make the right choice for your child and allow them to participate in healthy memorable activities that result in growth.

    If you really want to know how bad your kids hurt, try this simple test. Push against the area that your child is telling you that is hurting. If their heart rate increases over 10 bpm, then it really does hurt.

    Early treatment includes lighter lifting, non-impact modifications to the workout. Athletes who choose not to modify their activities will result in additional injury.


Self-Testing

Self-testing can reveal the presence of a syndesmosis. Simply squeeze the wrist or forearm with a steady grip. If your pain lessens with the applied pressure, then you are likely suffering from a syndesmosis.

See Ilustrations:

ankle
Click Image To Enlarge.
The Ankle.

Poof-You're A Doctor: Have the patient stand on their foot or do whatever it is that causes pain. Then apply about five pounds of force with your fingers on each side, then see if the pain is less. If the patient describes less pain, then you are likely dealing with a syndesmosis.

knee
Click Image To Enlarge.
The Knee.

wrist
Click Image To Enlarge.
The Wrist.

elbow
Click Image To Enlarge.
The Elbow.


What Can You Do To Help Treat This Condition

  • Get the right diagnosis. Just reading this article is no replacement for a degree as a physician. Several other conditions are likely to seem just like a syndesmosis, therefore, get professional advice before beginning treatment.
  • Don't just start taking NSAIDs (Advil, Aleve, Aspirin, etc.).
  • Adapt your training or activities to adjust to a reduced pain level.
  • Avoid any activity that produces pain greater than 60% or delivers a sharp pain.
  • Use braces to prevent re-aggravation of any irritation to the syndesmosis. Always place braces on your body in a fashion designed to compress the bones together.
  • Practice all gymnastic moves on a padded surface until 2 weeks prior to the competition.
  • Wear training shoes prior to competition that are fit by a quality shoe store. (i.e. Feet Fleet)
  • Eat more protein.
  • Get more rest.
  • Use supplements that stimulate cartilage, ligamentous, tendon and other soft tissue repair.
  • Specifically, eat more garlic and/or onions.
  • Read The Truth About Tendon Pain on how to train.
  • Use ice massage after you are done treating and use topical heat prior to beginning activities.

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Read More About It:

  1. Syndesmosis injuries: acute, chronic, new techniques for failed management.; Mosier-LaClair S, Pike H, Pomeroy G.; Foot Ankle Clin. 2002 Sep;7(3):551-65, ix.
  2. Syndesmosis injuries in athletes.; Clanton TO, Paul P.; Foot Ankle Clin. 2002 Sep;7(3):529-49.
  3. Clinical association of acute lateral ankle sprain with syndesmotic involvement: a stress radiography and magnetic resonance imaging study.; Uys HD, Rijke AM.; Am J Sports Med. 2002 Nov-Dec;30(6):816-22.
  4. Osteoplastic correction of defects of the forearm bones.; Afaunov AI.; Ortop Travmatol Protez. 1989 Feb;(2):16-20.

Ginger Ginger
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Ginger Redeke, NPC Figure Competitor.

Dr. David Ryan & Ginger Redeker NPC Figure Comp.

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capnmorganTFM

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capnmorganTFM

I think I have this going on in my elbows, they are getting to the point that they get stiff very often and I have to kind of swing my arm straight which makes them pop, it is affecting my bicep workout and some others, I thought maybe I was getting arthritis in them but I am only 34 any thoughts on this?

May 2, 2013 9:46am | report
 
PrithviHiremath

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PrithviHiremath

I have elbow pain from about 7-8 months , i got this when i was doin the chest press with heavy weights. Only tip of the elbow pains and a little part around it , while triceps workout i feel the right triceps get saturated sooner than left. Any work of advice to recover greatly appreciated

Jun 26, 2013 4:46pm | report
 
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