Aside from an overwhelming application of force, biologically, what causes fracture-separation during arm wrestling? A new study looked at medial humeral epicondyle fracture-separation as a result of arm wrestling and found that it most likely occurs because of massive force traction of the attached flexor-pronator muscles.
What Causes Fracture-Separation During Arm Wrestling?
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The study, “Fracture-Separation of the Medial Humeral Epicondyle Caused by Arm Wrestling: A Systematic Review,” was published in the May 2022 issue of the Orthopaedic Journal of Sports Medicine.
“Arm wrestling is a popular sport in which various injuries have occurred, even in children,” the researchers wrote.
A group of researchers from Japan analyzed the mechanism of reported fracture-separation of the medial humeral epicondyle and collected data for both patient characteristics and treatment selection in this systematic review.
Overall, the review included 27 studies with a total of 68 patients who were all boys with a mean age of 14.6 ±1.24 years (based on n = 65, with 3 patients excluded from this calculation as no definitive age was provided).
Boys aged 14 to 15 years accounted for 72% of the cases. Sixty-three boys experienced a fracture suddenly during arm wrestling, while the other 5 boys had antecedent medial elbow pain. Match status at the time of injury varied the researchers reports.
In addition, in 31 boys with known match details, injury occurred when a participant suddenly added more force to change the match status. Eight patients displayed anterior and or proximal displacement of the medial humeral epicondyle fragment.
Twenty-five patients underwent nonoperative treatment while 38 patients had surgery. Outcomes were not significantly different between those who had surgery versus those who had nonoperative treatment.
“Medial humeral epicondyle fracture-separation caused by arm wrestling occurred mostly in boys aged 14 to 15 years regardless of the match status. The likely direct cause is forceful traction of the attached flexor-pronator muscles. A relative mechanical imbalance during adolescence may be an underlying cause. A sudden change from concentric to eccentric contraction of the flexor-pronator muscles increases the likelihood of fracture occurrence,” the researchers wrote.
Study authors include Kiyohisa Ogawa, M.D., Ph.D., of Eiju General Hospital, Tokyo, Japan, Atsushi Yoshida, M.D., Ph.D., of National Hospital Organization Saitama Hospital, Saitama, Japan, Noboru Matsumura, M.D., Ph.D., of Keio University, Tokyo, Japan, and Wataru Inokuchi, M.D., Ph.D., of Eiju General Hospital, Tokyo, Japan.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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