Domino Playing and Regional Pain Syndrome of Elbow Joint; a New Association Among Old Iraqi People

Uqba N. Yousif^*

Division of Rheumatology, Department of medicine, College of medicine, Tikrit University, Salah Aldin, Iraq

Abstract

An association has been demonstrated between Domino playing and regional pain syndrome of the elbow joint among old Iraqi people. Reason for this are discussed. Haji Kasim and many of non-athletes aged people have been suffered from tennis, golfer elbow or olecranon bursitis, so more clarification is required whether the association is due to aging process or because of domino and the mechanical continuous trivial stress on the elbow or both. Also highlighting on the further contributing factors especially among general population would enhance our understanding of the degree to which they are preventable or treatable.

Keywords

Domino, Regional Pain Syndrome, Golfer Elbow, Tennis Elbow, Epicondylitis Olecranon Bursitis

Received: March 21, 2015
Accepted: April 9, 2015
Published online: April 19, 2015

@ 2015 The Authors. Published by American Institute of Science. This Open Access article is under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/

1. Introduction

Domino is one of the common public games in Iraq. Most of old aged males who are sometimes a heavy smokers and sick with numerous chronic diseases spent there long times after retirement in a simple local coffee shops called "Al Gahwa" playing domino. The players always sit on a woody couch called "Karaweeta" which has a woody handles and they took a specific position that the left elbow lean on a woody hard handle or on a wooden table, while the Rt.arm is the most active moving one which throw repetitively the pieces of domino(picture no.1,2).

Medial humeral epicondylitis or what is called golfer’s elbow caused by repetitive flexion and pronation of the wrist. Tenderness over the medial humeral epicondyle can be elicited with palpation over the medial humeral epicondyle. Pain is reproduced with resisted wrist flexion and pronation. (picture no.3)

On the other hand, lateral humeral epicondylitis or what is called tennis elbow, is seen with repetitive extension and supination of the wrist. It causes pain over the lateral epicondyle with palpation and is reproduced with resisted wrist extension and supination.(1)(picture no.3)

The initial treatment for humeral epicondylitis is splinting of the elbow at 90 degrees of flexion for 3 to 5 days. If symptoms persist, other conservative measures such as nonsteroidal anti-inflammatory drugs (NSAIDs), ice, or local glucocorticosteroid injections may be tried. For chronic cases of humeral epicondylitis, a compression band may be used for symptomatic relief. Pain that is refractory to these measures might require surgical intervention.

Olecranon Bursitis;

The bursa is a synovial tissue–lined sac that provides a gliding surface to reduce friction between tendons and muscles over bony structures. Inflammation of this structure resulting from overuse, infection, trauma, or systemic inflammatory disease called bursitis.

Patients with olecranon bursitis complain of swelling over the posterior elbow and tenderness with pressure, but they have normal elbow range of motion.(picture no.4) Drainage and protective measures against trauma are usually sufficient. A compression bandage might provide enough pressure to prevent reaccumulation of fluid in the bursa. In some instances, the bursa can be excised if there is persistent infection or recurrent bursitis. (2)

Picture no.1. Al- Gahwa

Picture no.2. Domino pieces

Picture no.3. Common wrist flexors & extensors origins

Picture no.4. Olecranon bursitis

2. Patient & Method

Haji Kasim accepted to be included in this paper.

Chief complaint:

In 13 June2014 a 67 year old man presented with constant chronic elbows pain of 2 months duration.

From history the patient had got no trauma & he is not a Tennis or Golf player but he is a good super Domino player since long time. He is hypertensive & heavy smoker.

Clinical examination:

By inspection only a small tender swelling at olecranon process of left elbow.

By palpation: Painful regional tenderness over the lateral humeral epicondyle of right elbow.

Painful regional tenderness over the medial humeral epicondyle of right elbow. (picture no.5)

Picture no.5. Classical sites of pain

Tender cystic swelling over olecranon process of left elbow.

Movement: Normal range of motion of both elbows.

Specific test for wrist extensors was positive. (Resisted dorsiflexion of the wrist with elbow extended was painful at lateral epicondyle of right elbow)(picture no.6)

Specific test for wrist flexors was positive. (Resisted palmar flexion of the wrist with elbow extended was painful at medial epicondyle of right elbow)(picture no.6)

Picture no.6. Spesific test Tennis & golfer s elbow

X-ray of both elbows were normal

Musculoskeletal Sonographic study of right lateral epicondyle shows very tiny hyper echoics. with focal signal intensity of power Doppler scale.

Musculoskeletal Sonographic findings of Right medial epicondyle show just focal signal intensity at power Doppler scale and a small non echoic sac which is compressible & displaceable over the olecranon process of left elbow.

Diagnosis:

Lateral humeral epicondylitis of the right elbow (Tennis Elbow)

Medial humeral epicondylitis of the eight elbow (Golfer Elbow)

Olecranon bursitis of the left elbow

Treatment:

The patient refuses local corticosteroids injection.

He had got benefit from Rest, Ice, and Compression & Exercise.

Course of nonsteroidal anti-inflammatory drugs.

3. Discussion & Conclusion

Most of previous studies of epicondylitis have been conducted among small selected occupational population. Few studies have reported the prevalence & determinants of lateral and medial epicondylitis in general population (3). That is call for highlighting on the real contributing factors among general population.

The non-neutral posture of the arm and repetitive spontaneous subconscious interaction of domino player with the game as they kick the piece of domino vigorously on wooden table explain the combination of risk factors of epicondylitis, such as force and repetition ,or either force or repetition and extreme non-natural postures of the arm (4,5)

Many life or social activities are mimic to certain sports activities in its bio mechanism of action, these conditions develop as the result of a number of factors such as repetitive movement, constant muscle contraction or straining, forceful movements and constricted postures.

Since the patient is an old age & he is not a tennis player, He had weak degenerated muscle tendon fibers that might be torn with a simple trivial non-athletic activity. Although muscle atrophy, declining strength and physical build are generally accepted as inevitable concomitants of aging, the causes are unknown. Much of the age-associated muscle atrophy and declining strength may be explained by selective denervation of muscle fibers with reinnervation by axonal sprouting from an adjacent innervated unit. The process of age-related denervation may be aggravated by an increased susceptibility of muscles in old animals to contraction-induced injury coupled with impaired capacity for regeneration. (6)

In addition to combination of contributing factors, Haji Kasim was a heavy smoker and a long time domino player that is compatible to a studies reported earlier (5, 7, 8).Smoking may interfere with circulation to tendons, which not only places these tissues at risk for injury but also slows or prevent their healing during recovery period and also compatible with a fact that playing time is a factor in tennis elbow occurrences (9)

Olecranon bursitis, a relatively common condition, it is inflammation of the subcutaneous synovial-lined sac of the bursa overlying the olecranon process at the proximal aspect of the ulna. (10) The bursa cushions the olecranon and it reduces the friction especially during movement.

The superficial location of the bursa, between the ulna and the skin at the posterior tip of the elbow, makes it susceptible to inflammation from acute or repetitive (cumulative) trauma. The left elbow was under continuous & frequent frictional state causing damage to these sensitive tissues.

Clarification of the mechanisms responsible for these changes and highlighting on the further contributing factors especially among general population would enhance our understanding of the degree to which they are preventable or treatable.

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