Transcript Elbow, Wrist, and Hand

Injuries to the Arm, Wrist and Hand
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Elbow
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Bones
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Ligaments
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Humerus
Ulna
Radus
Ulnar Collateral
Annular Ligament
Interossius Membrane
Joints
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Humeroulnar,
Humeroradial
Radialulnar
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Elbow Movements
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flexion/extension,
pronation/supination
Wrist Movements
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flexion/extension,
radial & ulnar deviation
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Soft Tissue Injuries
Contusions and fractures
common in contact sports
 muscle tissue compressed between skin and bone
 Repeated episodes can result in myositis
ossificans traumatica.
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chronic inflammation of the muscle and underlying
periosteum resulting in development of bony mass
within the muscle
 develops over weeks or months and is often ignored
during the early stages
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Fractures of the Humerus
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Signs/symptoms:
severe pain in upper
arm
 deformity & loss of
function
 muscle spasm
 audible snap or pop
 sensory loss in
forearm
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First Aid:
application of ice &
compression
 splint &
sling/swathe
 monitor distal pulse
 treat for shock
 summon EMS
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Elbow Dislocation
Mechanism for this
injury includes
falling either on a
flexed or fully
extended arm -deformity is usually
obvious
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Elbow sprains and dislocations
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three joints of the elbow
ulnar & radial collateral ligaments -- valgus/varus
injury mechanism includes falling backwards with elbow in
extension
valgus/varus forces can result in sprains
dislocations constitute extreme sprains
Elbow Sprains
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Signs/symptoms:
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in minor sprains -- mild swelling & localized pain
difficulty in gripping or making a fist
in dislocations -- gross deformity
loss of function & severe pain
possible neurological symptoms
First Aid:
application of ice & compression
splint & sling/swathe
monitor distal pulse
treat for shock
summon EMS
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Elbow Fractures
generally involve the distal humerus
 danger to neurovascular structures
 injury mechanism similar to sprains and dislocations
 fractures of the olecranon associated with direct
blows
 if radial artery is compressed -- Volkmann’s
contracture may result
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Epicondylitis
Epicondylitis of the
elbow
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lateral epicondyle
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Medial epicondyle
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attachment of the
extensors
Attachment of the
flexors
gripping combined
with wrist
movements
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Elbow Injuries
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Golf associated with medial epicondyle
Tennis elbow -- involves the lateral
epicondyle
excessive number of strokes
 incorrect technique
 racket handle too small
 change in racket materials
 grip too tight
 muscle imbalance
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Elbow Injuries
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Signs/symptoms:
pain in the region of an epicondyle with swelling
 becomes worse with activity
 radiating pain into forearm muscles
 epicondylar pain associated with resisted wrist
movements
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First Aid:
ice, compression, rest
 medical referral if pain persists
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Osteochondritis Dissecans
throwing mechanism can result in impingement between
radial head and capitulum
 high velocity elbow extension - joint compression on the
lateral side
 joint cartilage becomes inflamed & may fracture
 axial loading may also result in damage
Signs/symptoms:
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painful participation
swelling 12-24 hrs. after
“locking” of joint
osteoarthritis in advanced cases
First Aid:
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ice and compression
medical referral
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Contusions of the elbow
blows to the elbow are common
 majority result in temporary symptoms
 exception involves the olecranon bursa
 repeated irritation of the bursa can result in
inflammation (bursitis)
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Signs/symptoms:
swelling in the region of the olecranon process
 pain/stiffness with movement
 elevated skin temperature
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First Aid:
ice and compression
 in cases of bursitis -- medical referral
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Wrist and Forearm Injuries
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Anatomy of the wrist
complex due to small size and large number of
tendons that serve the wrist, thumb and fingers
 Tendons are held in place by retinaculum
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Retinaculum is small ligaments
Major nerves and vessels pass through this region
as well. They are:
ulnar and radial arteries and veins
 ulnar, median, radial nerves
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Colles’ Fracture
•rare in sports
•Colles’ Fracture is most serious.
•Signs/symptoms:
•history of significant trauma
•snap or popping sound
•deformity, swelling into hand/fingers
•severe pain and loss of sensation may occur
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Wrist Fractures
Navicular
•navicular
fracture most
common
•generally
occur at the
“waist”
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Navicular Fractures
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Signs/symptoms:
history of wrist trauma with popping or snapping
 pain with movement/wrist feels locked, positive
“snuffbox” test
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First Aid:
I.C.E. application
 splint with sling & swathe, leave fingertips
exposed (to observe circulation
 medical referral
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Wrist and Forearm Injuries
A simple test for assessment of the integrity of the
carpal navicular bone -- pressing lightly in the
“anatomic snuffbox”
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Wrist Sprains and Dislocations
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Signs/symptoms:
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Mechanism is typically hyperextension, similar mechanism to
fractures
history combined with snapping/popping sensation
painful movement
movement may be impossible
numbness and/or radiating pain
First Aid:
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application of I.C.E.
splint with sling & swathe
expose fingertips
refer to a physician
Nerve injuries in the
wrist
median is most commonly
injured -- carpal tunnel
 carpal tunnel related to
inflammation of flexor
tendons
 carpal tunnel related to
sports requiring extensive
gripping
 ulnar nerve injuries -produce numbness in the
hypothenar eminence
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Carpal Tunnel
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Signs/symptoms:
sensory loss to a portion of the hand/fingers
 pain/tenderness in the wrist, associated
tendonitis and symptoms increase with wrist
flexion
 Care for carpal tunnel syndrome consist of
treating the inflammation and rest.
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• Ganglion Cyst
• Results from a
herniation of the
synovium
surrounding a
tendon herniated
area becomes filled
with fluid
• variable in
appearance -- some
soft, other hard and
painful
Ganglion
s
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Ganglion Cysts
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Signs/symptoms:
visible swelling
 in advanced cases, painful, hardened nodule
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First Aid:
some spontaneously regress
 leave alone if possible
 can be surgically removed
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Hand Injuries
19 bones in the hand and wrist
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Hand fractures
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 Bennett fracture
 mechanism includes blows
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with a clenched fist
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Metacarpals can be
fractured by a crushing
mechanism
Phalangeal fractures
common in sports
Signs/symptoms:
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history of trauma
associated dysfunction
deformity
broken skin
(compound)
significant inflammation
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Sprains & dislocations of the hand
– any joint in the hand can be involved
– most common forms are:
– gamekeeper’s thumb
– mallet finger
– boutonniere deformity
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Gamekeeper’s thumb
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Signs/symptoms:
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Anatomy of a gamekeeper’s thumb
involves sprain of the ulnar
collateral lig.
mechanism of injury is a
valgus force
thumb is unstable
history of an appropriate
mechanism
pain over the area of the ulnar
collateral ligament
snapping or popping at the
time of injury
swelling of the MP joint
inability to move the thumb
inability to grip tightly using the
thumb
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Mallet (baseball)
Finger
involves distal
phalanx, name comes
from the deformity
 mechanism -- blow to
the fingertip while
extending, can’t
extend fingertip
Signs/symptoms:
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deformity MOST
important
recent trauma to fingertip
point tender DIP
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Boutonniere deformity
extensor tendon involved
as it crosses the PIP
 mechanism is blow while
the finger is flexed during
active extension
Signs/symptoms:
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violent flexion injury associated
with feeling of tearing/popping
significant weakness in finger
extension
PIP painful and swollen
if uncorrected, deformity will
develop
characterized by hyperextension
of MP & DIP with flexion of
PIP
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Anatomy of the Finger Tendons
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Splinting for fractures of the
forearm, wrist and/or hand