1. Nerve entrapment syndromes in athlets Marko Pećina Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, CROATIA Church of St.Marko, Zagreb, CROATIA

2. Tunnel Syndromes. Peripheral Nerve Compression Syndromes (Entrapment Neuropathies)  As they pass through fibrous, osteofibrous and fibromuscular tunnels, peripheral nerves from their origin in the spinal cord to their effector organ, risk compression, damage and impairment of their end function. Patients present with signs and symptoms usually associated with the motor or sensory function of the involved nerve. Careful linking of these signs and symptoms can indicate a specific compressive or painful pathology commonly known as a tunnel or canalicular syndromes or entrapment neuropathies or peripheral nerve compression syndromes.

3. Entrapment Neuropathies  The term entrapment is now used widely to describe a variety of conditions that compress peripheral nerves. Nerve entrapment may result from a number of mechanisms, including pressure, stretch, angulation, and friction. Because of this variety, the pathophysiology of the peripheral nerve entrapment syndromes differs. Many additional circumstances influence the clinical picture, including the patient's age and the presence of Underlying systematic diseases.

4. 1991.YEAR 33 SYNDROMES

5. 1997. YEAR 41 SYNDROMES

6. 2001 YEAR 2006 YEAR 50 SYNDROMES ? SYNDROMES

7.  Acute trauma and repetitive microtrauma connected with certain athletic activities are often mentioned when describing the etiology of nerve entrapment syndromes. According to the literature it is obvious that nerve entrapment syndromes in athletes are not as rare as they were once considered to be. Certain sports or physical activities have been mentioned that lead to specific nerve entrapment syndromes Nerve Entrapment Syndromes in Athletes Nerve Entrapment Syndromes in Athletes cyclist's palsy cyclist's palsy bowler's thumb bowler's thumb jogger's foot jogger's foot surfer's neuropathy surfer's neuropathy

8.  Unlike nerve entrapment syndromes, vascular and neurovascular syndromes in athletes seem to be more common and have been described in greater detail, while nerve entrapment syndromes in athletes have been reported only recently. Nerve Entrapment Syndromes in Athletes Nerve Entrapment Syndromes in Athletes

9. Supracondylar Process Syndrome in a Handball Player Supracondylar Process Syndrome in a Handball Player  The supracondylar process, an atavistic bony formation, can exist and be connected to the medial epicondyle by a fibrous band - Struthers' ligament. The median nerve can be compressed in this fibro-osseous tunnel. In a young handball player with x-ray visible supracondylar process persisted symptoms of numbness and paresthesia in the first three fingers.

10. Supracondylar Process Syndrome in a Handball Player Supracondylar Process Syndrome in a Handball Player  Coronal T2 weighted and axial GRE 3D MR images of the elbow showed the median nerve passing through fibro-osseous tunnel.

11.  Intraoperative finding in patient and removed patient and removed supracondylar process. supracondylar process.  Three weeks after surgery the patient was allowed to do sports. He is now symptoms free for more than 3 years.

12. Suprascapular Nerve, Axillary Nerve and Musculocutaneous Nerve Entrapment in a Weightlifter During external rotation in the shoulder against force, hypotrophy of the supraspinatus,infraspinatus, teres minor and the posterior part of the deltoideus muscles is visible.

13.  The right shoulder is lower than the left, and the right than the left, and the right biceps muscle shows marked biceps muscle shows marked hypotrophy hypotrophy  Within 1 year, muscular mass and strength had returned

14. Musculocutaneous Nerve Entrapment in a Rower  Wasting and weakness of the biceps and brachialis muscles result when the musculocutaneous nerve is compressed in the shoulder region.  A 23-year old rower described a decrease in his left arm's circumference and a painless weakness in elbow flexion. His strengthening program required strenous workouts, including more than 500 pushups daily. Physical examination verified reduced biceps muscle strength and size.

15. Musculocutaneous Nerve Entrapment in a Rower  Several diagnostic tests confirmed musculocutaneous nerve entrapment, and all upper-extremity exercises was stopped for 6 weeks. Within 3 months, muscular mass and strength had returned. and strength had returned.

16. Pronator teres muscle syndrome  A 20 years-old rower had a characteristic symptom of the right forearm and he complained of impaired thumb, index finger and middle finger flexion. Wide exposure of the proximal forearm including sectioning of the tendinous arch between the origin of FDS, release of the humeral head of the pronator teres and fasciotomy was done.

17. Piriformis syndrome in female athlete (hurdler)  Axial SE T1 weighted image shows dislocation of neurovascular bundle (red arrow) anteriorly by hypertrophic right piriformis muscle (yellow arrow).

18. Piriformis muscle syndrome ( female athlete-hurdler)  Successfull surgical treatment  Posterior approach to the hip joint  Hypertrophic piriformis muscle

19. Piriformis muscle syndrome Surgical Treatment  Operative release of the piriformis tendon and sciaticneurolysis. The patient returns to her usual daily activities 1 month postoperatively and to sports activities 3 months postoperatively.

20.  It is evident that when athletes have pain, one must always consider the possibility of nerve entrapment neuropathy. Diagnosis relies on a detailed history and physical examination with modern diagnostic equipment. In most cases non-operative treatment is sufficient, and surgery is therefore seldom recommended. Nerve entrapment neuropathies must be considered in the differential diagnosis of pain in athletes.