The Elbow, Wrist, and Hand
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Transcript The Elbow, Wrist, and Hand
Chapter 20
The Wrist and Hand
◦ Made up of 27 bones
8 carpal bones make up the wrist
5 metacarpals from the structure of the hand
14 phalanges
2 for the thumb
3 for each other 4 fingers
3 bones of the elbow
joint
◦ Humerus
◦ Radius
◦ Ulna
Many structures
surround the elbow
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Ligaments
Nerves
Muscles
Bursa sacs
Forearm Flexors
◦ Brachialis
◦ Biceps Brachii
◦ Brachioradialis
Forearm Extensors
◦ Triceps Brachii
◦ Anconeus
Several causes for a variety of athletic injuries
◦ Direct trauma
◦ Indirect trauma
◦ Acute/Chronic stresses
These MOIs can result in several injuries
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Contusions
Sprains
Strains
Dislocations
Fractures
Nerve involvement
Common injury that may involve the muscles
of the forearm and subcutaneous bony
prominences of the elbow
◦ Usually caused by a direct blow
Symptoms
Treatment
◦ Bruising
◦ Subsequent bleeding
◦ Stiffness during function or
active motion
◦ PRICE
Prevents myositis ossificans
Inflammation of the olecranon bursitis
◦ Caused by direct blows to the olecranon process
◦ Can be accompanied by infection due to the
frequent abrasions that occur over the tip of the
elbow
Treatment
◦ Depends on whether infection is involved
◦ Uninfected bursitis
Ice compresses
Rest
◦ Anti-inflammatory meds
◦ Pain meds
◦ Aspiration of the bursa
Caused by a direct blow the
medial epicondyle of the
humerus
◦ Athlete complaints of
immediate pain and burning
sensation down the ulnar side
of the forearm to the ring and
little fingers
Also known as hitting the “funny
bone”
Treatment
◦ None is usually necessary
Normally occur with a sudden overload to the elbow
joint
◦ can acute or chronic
Acute Strains
Chronic Strains
Common areas of acute strains
◦ Sudden excessive overload
◦ Tenderness over the affected area
◦ Pain on function or resisted motion
◦ Result of continued overuse
◦ Overuse syndrome
◦ Chronic degenerative processes
◦ Common flexor tendon
Medial epicondyle
◦ Common extensor tendon
Lateral epicondyle
Usually due to forced
hyperextension or
valgus/varus forces
Symptoms
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Click or pop
Sharp pain at injury
Tenderness
Localized swelling
Pain when repeating MOI
Usually relieved by bending
the elbow
Usually caused by repetitive
overload of the attached
musculotendinous units
◦ Occurs in the region of the
medial and lateral epicondyle
of the humerus
◦ Called “tennis elbow” if lateral
◦ Called “golfer’s elbow” if
medial
◦ If it occurs in younger patients,
called “little leaguer elbow”
◦ Can also accompany an injury
to the growth plate of the
epiphysis
Symptoms
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Pain when used
Possible swelling
Local tenderness
Pain with resisted wrist motion
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May develop into prolonged degenerative changes
Causes chronic epicondylitis
Contractures of the elbow
Reduced friction
Possible rupture of muscle tendon unit
Without proper treatment condition
may worsen
Treatment
Preventive measures
◦ RICE
◦ Modifying activities that aggravate conditions
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Using proper technique/equipment
Limiting stress
Adequately warming up
stretching
Most commonly involves the posterior
displacement of the ulna and radius in
relationship to the humerus
◦ Often caused by a fall onto an outstretched hand with
elbow in extension
Symptoms
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Obvious deformity
Loss of elbow function
Considerable pain
Initial exam should include evaluation
of nerve function of hand and fingers
Treatment
◦ Immobilzation
◦ Immediate referral to physician of medical facility
◦ Possible vascular and neurological damage
The result of either direct trauma or indirect stresses
transmitted through the upper extremity by falling on an
outstretched arm
◦ Fractures in younger athletes commonly
involve epiphyseal plate fractures
Symptoms
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Directly related to degree of severity
Point tenderness
Hemorrhaging
Swelling
Limited ROM
Disability at elbow or hand
Increased pain with movement
Treatment
◦ Immobilization
◦ Ice
◦ Prompt referral to physician or medical clinic
Occurs in the absence of blood flow (ischemia) to the
forearm
◦ Can lead to contracture, where joint remains bent and cannot
straighten
Causes
3 Levels of severity in Volkmann’s Contracture
◦ Increased pressure from swelling or trauma
◦ Fracture
◦ Mild
Involves contracture of 2 or 3 fingers
No limited loss of sensation
◦ Moderate
Involves all fingers being flexed
Thumb stuck in palm
Wrist may be stuck in flexion
Usually loss of sensation in the hand
◦ Severe
Involves all muscles in forearm (flexors and extensors)
Fingers
Severely disabling condition
Symptoms
◦ Severe pain when a muscle running through a
compartment is passively moved
◦ Forearm may be swollen
◦ Shiny
◦ Painful when squeezed
◦ Pain does not improve with rest, but continues to
worsen with time
◦ If condition is not corrected
Decreased sensation
Weakness
Paleness of the skin
Repetitive throwing and/or
swinging can cause irritation,
compression, or entrapment in
the cubital tunnel
◦ Called cubital tunnel syndrome
Symptoms
◦ Pain along the inner aspect of the
elbow
◦ Tenderness of the medial
epicondylar groove
◦ Paresthesia (numbness or tingling)
of ring and little finger
Usually caused by
entrapment of the nerve
which passes through a
tunnel formed by several
muscles and tendons
◦ Also called radial tunnel
syndrome
Symptoms
◦ Pain over lateral aspect of
the elbow
◦ Pain over radial head
Includes entrapment or
compression due to
hypertrophy of the
pronator teres or
repetitive pronation of the
forearm
◦ Called pronator teres
syndrome
Symptoms
◦ Pain radiating down the
anterior forearm
◦ Numbness and tingling in the
thumb, index, and middle
fingers
◦ Resistive pronation may
increase the pain
Muscles that move the Wrist
◦ 2 Flexor Carpi muscles
◦ 2 Extensor Carpi muscles
◦ 2 Palmaris muscles
Muscles that move the Hand
◦ 1 Supinator muscles
◦ 2 Pronator muscles
Muscles that move the Thumb
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2
2
1
2
1
Flexors
Extensors
adductor
abductors
opponens
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3
2
3
1
flexors
extensors
abductors
adductor
Muscles that move the Fingers
Common injuries
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Fractures
Dislocations
Contusions
Sprains
Tendonitis
Nerve Impingements
Can involve any of the 14
phalange bones.
◦ Most can be treated with a finger
splint
Boxer’s Fracture
◦ A break of the 5th metacarpal
leading to the little finger
Baseball (mallet) finger
◦ Painful injury that occurs when a
ball or other object strikes the tip
of the finger, bending it beyond its
normal ROM which tears the finger
tendon and damages cartilage
Jersey Finger
◦ Caused by tearing the flexor
tendon to the fingertip
Usually occurs from grabbing a
jersey during a tackle.
Ring finger is the most often
affected
Scaphoid fracture
◦ Affects the scaphoid bone
◦ Paplpation of the anatomical
snuffbox will cause pain,
indicates a fracture may be
present
Colles Fracture
◦ A break of the radius just above the wrist
Treatment for all fractures
◦ RICES (rest, ice, compression, elevation, support)
◦ Evaluation by a physician
Fairly common injuries
Causes
◦ Ball striking fingertip
◦ Finger getting hooked into
equipment
Symptoms
◦ Immediate pain
◦ Swelling
◦ Crooked finger
Usually can’t be bent or straightened
Treatment
◦ Ice
◦ Immobilization
◦ Immediate treatment by physician
Usually caused by
direct blows or falling
onto a hard surface
◦ With nails become
contused, pressure
may cause a physician
to drain blood from
beneath the nail
Gamekeeper’s thumb
◦ Sprain of the ulnar
collateral ligament of the
metacarpalphalangeal
joint (MPJ)
Common in alpine skiiing
◦ Caused by force applied
to the medial side of the
thumb, forcing the MPJ to
stretch, tear, or even
rupture
The inflammation of the tendons
caused by overuse or repetitive
stress
Symptoms
◦ Ache or pain at the wrist
Worsens forceful gripping, rapid wrist
movements or moving the wrist or
fingers to an extreme position
Treatment
◦ The same as other forms of
tendonitis
◦ Most common sites in the wrist
Base of the thumb near anatomical
snuffbox
deQuervian’s tenosynovitis
Also called Carpal Tunnel syndrome
An inflammatory disorder caused by the
following
◦ Repetitive stress
◦ Physical injury
◦ Other conditions that cause swelling around the
median nerve near the carpal tunnel
Symptoms
Treatment
◦ Pain
◦ Numbness
◦ Tingling in the wrist, hand, fingers (except
little finger)
◦ Tendency to drop things
◦ Loss of sense of heat or cold
◦ Feeling of swelling, even though it is visibly
swollen
◦ Symptoms may occur only when the hand is
being used or only when at rest
◦ RICE
◦ In severe cases, surgery to decompress the
median nerve
A small, usually hard
lump above a tendon
or in a capsule that
encloses a joint
◦ Also called a synovial
hernia or synovial cyst
It is common in
handball, racquetball,
squash and tennis
◦ Cause of the cyst is
unknown
An injury to the extensor tendon
affecting the proximal
interphalangeal joint (PIP) at the
middle of the finger or the distal
interphalangeal joint at the end of the
finger
◦ Caused by a direct blow to a bent finger
Symptoms
Treatment
◦ Problems flexing and extending the
finger
◦ Physician should be contacted
immediately
◦ Joints will be painful and tender
◦ Finger misshapen or deformed
◦ The athlete will not be able to straighten
it
◦ Must be done promptly
◦ Athlete may not regain normal use of the
finger