Transcript Hand, Wrist & Fingers

Elbow Injuries
• Critical link in kinetic chain of upper extremity
• Extremely susceptible to injury
– Big range of motion
– Weak lateral bone structure
– Boney anatomy prominent causing soft tissue damage
– Excessive stress on joint from sports
– Locking motion of some activities
– Use of implements
– Throwing motion
Olecranon
Olecranon
Radial notch
Head of radius
Neck of radius
Head of radius
Neck of radius
Tuberosity of radius
Ulna
Radius
Interosseous
Membrane
Styloid Process
Styloid Process
Anterior View
Styloid Process
Styloid Process
Posterior View
Posterior Alignment
• Extended Elbow
• Straight line formed
• Flexed Elbow
• IsoscolesTriangle
Carrying Angle of Elbow
Normal Angle
– Females 10-15 º
– Males 5 º
Extension 0º
Flexion 150º
Pronation
Supination
Elbow ROM
Supination 90º
Pronation 90º
Hyperextended Elbow
Supination
Pronation
Ulnar Collateral Ligament
Medial View
Annular Ligament
Biceps Tendon
(cut)
Radius
Humerus
Joint Capsule
Triceps Tendon
Ulnar Collateral Ligament
Olecrenon Bursa
Ulna
Coronoid Process
Valgus Stress Test
Valgus Stress
Stabilize
Ulnar Collateral Ligament
Varus Stress Test
Apply Stress
Radial Collateral Ligament
Ulnar Collateral Ligament Sprains
• Etiology
– Valgus force
– Repetitive trauma
– Related injuries
• Ulnar nerve inflammation
• Wrist flexor tendinitis
• Overuse flexor/pronator strain
• Elbow flexion contractures
• Instability
Ulnar Collateral Ligament Sprains
• Signs and Symptoms
– Pain
• Medial aspect of elbow
• UCL
• Valgus stress test at 20 degrees
– End-point laxity
– Paresthesia
• Positive Tinel’s sign
• Signs and Symptoms (con’t)
– Positive X-ray
• Bone spurs
• Calcification w/in UCL
• Loose bodies
• Posterior impingement
• Management
– Conservative treatment
• RICE
• NSAID’s
– W/ resolution
• Strengthening
• Analysis of the throwing motion
– Surgical intervention
• Reconstruction
• (Tommy John procedure)
• Return to activity 22-26 weeks post op
Lateral Epicondylitis
Tennis Elbow
– Etiology
• Repetitive microtrauma
• Insertion of extensor/supinator muscle/s
• Lateral epicondyle
– Signs and Symptoms
• Aching pain after activity
• Pain w/ resistive wrist extension
• Weakness in wrist and hand
• Elbow decreased ROM
Assessment
Management
• RICE
• NSAID’s
• Analgesics
• Rehabilitation
– ROM exercises
– PRE
Resisted
Eccentric
Contraction
– Deep friction massage
– Stretching in pain free ROM
• Mechanics training
• Bracing
– Counter force brace
– Neoprene sleeve
• Superficial location
• Extremely susceptible to injury
Olecrenon Bursitis
• Etiology
– Direct blow
– Irritation to bursa
• Chronic irritation
– Production of fluid
– Increased capillary permeability
– Fluids and exudates flow into the bursa
– Bursal wall thickens over time
– May have irregular areas of scar tissue
• Feels like loose joint cartilage (joint mice)
• Calcium deposits
– Acutely injured joint
• Blood may fill the bursa
• Risk of infection