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 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.
  Click Image To Enlarge. 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.
 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.
 Click Image To Enlarge. Force Transfer.
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.
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.
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.
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?
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.
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 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:
 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.
 Click Image To Enlarge. The Knee.
 Click Image To Enlarge. The Wrist.
 Click Image To Enlarge. The Elbow.
Read More About It:
 Click Image To Enlarge. Ginger Redeke, NPC Figure Competitor. Dr. David Ryan & Ginger Redeker NPC Figure Comp. Recommend this article to a friend by e-mail here! Visitor Reviews Of This Article!
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