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Arm Wrestling Related Injuries ISSN: 2643-4016 Sahin. Int Arch Orthop Surg 2020, 3:022 DOI: 10.23937/2643-4016.1710022 Volume 3 | Issue 2 International Archives of Open Access Orthopaedic Surgery REVIEW ARTICLE Arm Wrestling Related Injuries: A Literature Review Taner Sahin* Check for Emergency Medicine Clinic, Kayseri City Hospital affiliated with University of Health Science, Turkey updates *Corresponding author: Taner Sahin, Assistant of Professor, Emergency Medicine Clinic, Kayseri City Hospital affiliated with University of Health Science, Turkey During the match, a significant torque occurs as a re- Abstract sult of torsional and axial forces in the humerus shaft Arm wrestling is increasing in popularity and is practised [1]. When the humeral shaft cannot resist these forces, mostly among young people as a recreational or profession- al sport. During this sport, it can cause various injuries in the muscle, joint, connective tissue, nerve injury and frac- muscles, ligaments, veins and radial nerves, especially the ture may occur [2,5]. While the elbow joint is fixed in humerus. The follow-up period can extend up to 16 months, flexion by the biceps and brachialis muscle, the shoul- especially in patients with radial nerve injury. Although the der joint is actively internally rotated against the oppo- treatment methods of patients with humeral fractures vary according to the patient and the doctor, it is chosen as sur- nent by pectoralis major, subscapularis and teres major gical or conservative. muscle. During the match, the arm wrestlers take op- posite positions, and the defending arm-wrestler taking Keywords or being forced to take a posture in which his centre of Arm wrestling, Humerus shaft fracture, Radial nerve injury gravity and therefore his body weight has shifted. When the offensive wrestler continues the attack, the internal Introduction rotator shoulder muscles of the defender suddenly and Arm wrestling is a sport that begins with two people, passively stretch, transforming from their maximum usually by taking mutual positions around a table, plac- concentric contractions into an eccentric compensatory ing their elbows on the table and joining their palms, and contraction, resulting in intense rotational force [1]. ending with the back of the opponent’s hand touching Mechanism of humeral fracture in arm wrestling the table floor [1]. Arm wrestling performed for sports or entertainment purposes in many countries around After arm wrestling, different types of fractures have the world, and it is becoming increasingly common. This reported in the literature, but the most common frac- sport generally perceives as a show of strength among ture is humeral shaft fracture. A fracture of the humerus young people. due to arm wrestling was first reported in 1975 [6]. It has reported that 4-6% of the extremity fractures are Although this sport seems harmless, it can cause humeral shaft fractures [2]. Among the humeral shaft various injuries such as muscle, joint, connective tissue, fractures, the most common region is 1/3 mid-region nerve injury and extremity fracture when performed fractures, and spiral type fractures are the most com- improperly. Most of the injuries from arm wrestling are mon [5]. In fractures caused by torsional forces, firstly a soft tissue injuries as sprain of the shoulder’s muscular fracture line occurs on the bone surface. The spiral frac- strain, wrist and elbow joints. However, different types ture line is formed as a result of high energy stress [3]. of fractures can occur during arm wrestling such as the Spiral fractures have two different fracture lines, one of spiral fracture of the humeral shaft with or without but- which is an angled line rotating around the bone, and terfly fragment [2], fracture of the medial humeral epi- the other is longitudinal, extending to the proximal and condyle [3,4], radial head fracture with anterior disloca- distal of the spiral [4]. These fractures have been de- tion, even a radial shaft fracture [4]. scribed as a strong internal rotation force created by the Citation: Sahin T (2020) Arm Wrestling Related Injuries: A Literature Review. Int Arch Orthop Surg 3:022. doi.org/10.23937/2643-4016/1710022 Accepted: November 19, 2020; Published: November 21, 2020 Copyright: © 2020 Sahin T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Sahin. Int Arch Orthop Surg 2020, 3:022 • Page 1 of 3 • DOI: 10.23937/2643-4016/1710022 ISSN: 2643-4016 subscapularis, pectoralis, and latissimus dorsi muscles Age range of cases in the shoulder, which are resisted by an opponent’s ex- Fracture of the humerus in a fit young man after ternal rotation force or another counter force [7]. Also, arm wrestling match has seen in a rare occurrence [1]. forceful elbow flexion and shoulder internal rotation Fractures of the humeral shaft may occur at any age may lead to fracture of a spiral nature have been report- in anyone engaging in this type of sport [2,9,19]. The ed in the literature [8,9]. According to some authors, patients with humerus fracture ranged in age from 22 pure rotator force without axial load on the humerus to 48-years-old, average of 31.2 years [12]. Also, it was causes spiral fracture only, while axial load and rotator reported that the cases mean (± SD) age was 21.7 ± 3.9 force can cause a butterfly fragment [10]. Some authors years in another study [9]. mentioned that factors such as body and arm position during a competition, fatigue, muscle hypertrophy of Injuries more common in which arm? muscle and body weight may determine the location It has been reported that fractures mostly occur in and type of humeral fracture [11,12]. It has been men- the right arm and left side of the right arm [9]. tioned in the literature that patients with regular sport activity may be injured only muscle strain [13]. Treatment methods Frequency of humeral fracture in arm wrestling Currently, two different treatment methods are most commonly used in the treatment of humeral shaft In a study of 93 patients with a closed humerus frac- fractures. These are surgical method and conservative ture, it was determined that only nine patients (8%) had method [2]. The first approach is surgical method; open a fracture due to arm wrestling [13]. In another study, reduction, internal fixation, and resting the arm with it was reported that humeral fracture caused by arm plaster or splint. The secondary approach is conserva- wrestling was seen in 30 cases in the general population tive method approach, which is followed by resting the [13]. In another study conducted with 123 young sol- arm with plaster or splint [2,15,17,18,20,21]. Fractures diers who had humerus shaft fractures in 2020, it was of the humerus are often successfully treated with con- reported that arm wrestling was the cause of the frac- servative treatment but rarely operative treatment may ture in 65 (52.8%) of the cases [9]. be required [21]. A displaced fracture should be man- Other injuries with or without a fracture of the hu- aged by open reduction and internal fixation if there is a merus in wrist arm wrestling vascular or neural injury [15,17,18,20]. A sharp fragment of the humerus can damage relat- In some literature studies, it was reported that pa- ed structures such as the brachial artery and the median tients were treated conservatively or surgically and -re or radial nerve [9,14-17]. It has also been reported in covered without complications [12,22]. We prefer the the literature that there may be an injury to the radial conservative follow-up method after consultation with nerve as a result of arm wrestling. Although the radi- the orthopedist, if there are no signs of radial nerve al nerve injury rate due to humeral shaft fracture was damage or vascular injury in those who have applied reported to be 9.1% [17] and 11.3% [16] in the normal to our emergency department due to arm injuries as population, the rates of radial nerve damage as a result a result of arm wrestling. Also, we prefer the surgical of humeral shaft fracture due to arm wrestling were re- method for people with signs of radial nerve or vascular ported to be 23% [2] and 26.2% [9]. It has been report- damage (Figure 1). ed that the radial nerve is mostly injured in the spiral Conclusion fracture of the shaft of the humerus, but also in oblique fractures frequently [9,15,17]. Also, It has been stated As a result, arm wrestling is a type of sport that that the recovery of radial nerve palsy in the upper arm seems innocent but can cause serious complications reaches a noticeable level in an average of 5-7 months when performed without professional training. Al- after the injury and this period can be extended up to though the treatment of patients with humeral frac- 16 months [9,18]. As a result of radial nerve damage, tures varies according to the patient and the physician, weakness and atrophy may occur in the wrist muscles, it is determined surgically or conservatively. In addition especially in the wrist extensor muscles. It is also stated to humerus fractures, patients may have soft tissue, that this weakness lasts for 6 months [9]. vascular, muscle and radial nerve injuries. In addition to humerus fractures, patients may have soft tissue, Risk factors vascular, muscle and radial nerve injuries. Therefore, it Various factors have been identified that may facil- is important to note that there may be damage to the itate possible arm injuries during arm wrestling.
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