Transcript The Elbow Wrist and Hand

The Elbow Wrist and Hand
Elbow
• Bones
– Humerus
– Ulna
– Radius
• Muscles
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Biceps Brachii
Brachioradialis
Triceps Brachii
Brachialis
• Bones
– Humerus
– Ulna
– Radius
Elbow Anatomy
• Biceps Brachii– Long head attached to
coracoid process of
scapula
– Short head attached to
supraglenoid tubercle of
scapula
Anatomy
• Triceps Brachii
– Long head: infraglenoid
tubercle of scapula;
– Lateral head: posterior
surface of humerus,
superior to radial groove;
– Medial head: posterior
surface of humerus,
inferior to radial groove
Elbow Injuries
• Contusions– Due to the nature of
many contact sports
contusions are common
and if treated quickly with
RICE can have a quick
return to play.
– Pay close attention for
myositis ossificans
especially in the upper
arm region.
Olecranon Bursitis
• Bursa are located near the
tendons of the larger joints.
• Usually the result of a direct
blow, but can be chronic.
Small abrasions of elbow can
cause infection to the bursa
and swelling.
• Usually RICE but if there is
infection aspiration may be
needed.
Ulnar Nerve Contusion
• Blow or contusion to the ulnar nerve.
• It runs behind the medial epicondyle so
there is little protection for it.
• Transiant pain and burning occur,
numbness may persist if it is serious.
• If normal sensation does not return
within 15 minutes a doctor visit is
advisable.
Strains
• Common extensor tendon and common flexor
tendon are the most common location.
• It can be chronic or acute.
• A chronic strain can result into an –itis or
rupture or torn muscle.
Epicondylitis
• Overuse of the tendon attached to the
epicondyle of the humerus.
• Faulty technique/mechanics, weak muscles or
improper equipment.
• Can be on lateral side- tennis or golfers elbow
• Can be on the medial side- pitcher’s elbow
Epicondylitis
• Little Leaguer’s elbow-repetitive
action resulting in elbow pain
in young
• The elbow area is the last
epiphyseal center to close so
injuries can occur.
Epicondylitis
• Little Leaguers elbow can
result in in varies fractures or
bone growths.
Epicondylitis
• Signs and Sx
– Pain over epicondyle
– Increase pain with wrist
flexion or extension
– Elbow contracture
• Treatment
– Proper technique
– Proper equipment
– Good warm up with slow
increase in intensity
– Stretching
– RICE
Sprains
• A result of forced hyperextension or
valgus/varus forces.
• The elbow is a relatively stable joint so this is
not a common injury.
Sprains
• Signs and Sx
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Click or pop heard
Sharp pain at time of injury
Localized swelling and pain
Athlete wants to flex elbow
Special Tests?
• Treatment
– Bracing to limit painful
motions
– Strengthen muscles of the
joint
– RICE
Dislocations
• Elbow is the second most commonly
dislocated major joint.
• Most often the ulna/radius dislocate
posterior to the humerus.
• MOI- fall of outstretched arm with elbow
locked in extension.
Dislocations
• Signs and Sx
– Obvious deformity
– Check circulation and
nerve function
• Treatment
– Immobilization
– Wrist strengthening and
then progress to elbow
– RICE
Fractures to Elbow/Forarm
• Often occurs due to a direct blow or a fall on
outstretched arm.
• Most common childhood injury, often involves
the epiphysis.
Fractures to Elbow/Forarm
• Signs and Sx
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Point tenderness
Possible deformity
Swelling
Limited ROM
Splinting?
• Treatment
– Immobilization
– RICE
– Strengthening of the
joints surrounding and
then whole arm when cast
is removed.
Nerves of the Elbow/Wrist
• Ulnar Nerve
• Median Nerve
• Radial Nerve
Ulnar Nerve Injuries
• Cubital Tunnel Syndrome- irritation of the ulnar
nerve as it passes through the cubital tunnel
caused by repetitive throwing and swinging.
• Pain is in medial elbow and paresthesia in ulnar
nerve region of hand.
Radial Nerve Injury
• Radial Tunnel Syndrome- irritation of the radial
nerve as it passes through the muscles of the
anterior lateral elbow. It is caused by repetitive
pronation and supination.
• Pain over the anterior radial head, with
supination with elbow at 90, and extension of
middle finger with elbow extended.
• Can be the cause of lateral elbow pain.
Median Nerve Injury
• Pronator Teres Syndrome- median nerve passes
between the heads of the pronator teres where it
can be entraped due to repetitive pronation of
the forarm.
• Pain will radiate down anterior forearm, increase
with resisted pronation. There will be numbness
in the thumb, index and middle finger.
Median Nerve Injury
• Carpal Tunnel
Syndrome- compression
of the median nerve as it
passes through the carpal
tunnel as a result of
repetitive use of the
hand and wrist.
– The compression is a
result of inflammation.
– Surgery may be needed.
Wrist and Hand Anatomy
• The wrist is made up of
8 wrist bones called
carpals.
Lunate
•Pisiform
Scaphoid
Capitate
Trapezium
Trapezoid
Triquetral
Hamate
Wrist and Hand Anatomy
• The metacarpals form the structure of the hand.
• The phalanges are the fingers.
• There are 27 bones in the hand including the
wrist.
• Each finger has an extender tendon and a flexor
tendon.
Wrist and Hand Anatomy
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The wrist and hand have many muscles.
Flexor muscles are on the anterior side
Extensor muscles are on the posterior side.
Digitorum muscles control the fingers
Pollicis muscles control the thumb.
Wrist and Hand Injuries
• Fractures of the Wrist and Hand
– Finger Fractures
• Boxer’s Fracture- fracture of 5th metacarpal. Hitting something
with fisted hand.
Wrist and Hand Injuries
• Fractures of the Wrist
and Hand
– Finger Fractures
• Scaphoid Fracture- fracture
of scaphoid which you
call palpate in anatomical
snuffbox. Occurs with fall
on hand in extension.
Wrist and Hand Injuries
• Fractures of the Wrist and
Hand
– Wrist Fractures
• Colles’s fracture- fracture of the
radius just above the wrist. A
result of a fall with wrist extended.
Tendon Injuries
• Mallet Finger- hitting something
with the tip of a finger and
causing the extensor tendon to
tear.
• Jersey Finger- grabbing
something and tearing the flexor
tendon.
Tendon Injuries
• Boutonniere deformityextensor tendon injury affecting
two joints of the finger. It is
an injury to the central tendon
on top of the finger.
– It may appear as a “jammed finger” that cannot be
extended from the PIP joint.
– Treatment should be in an extended position so the
tendon can heal.
Dislocations/Subluxations
• Dislocations occur in the fingers
and wrist bones.
• Point tenderness and swelling,
possible deformity.
• Physician intervention may be
necessary.
Contusions
• There are various contusions to the wrist, hand
and fingers.
• Most noted is the nail contusing where blood
pools under the nail. Pressure can be painful
and necessary to drain.
Sprains
• Can happen in fingers
and wrist bones.
• Gamekeeper’s thumbsprain of the ulnar
collateral ligament of the
thumb.
– Special Test
– Taping
Tendonitis
• Various kinds can occur
• deQuervain’s tenosynovitisinflammation at the base of the
thumb on the back of the wrist
and palm side of wrist. It is
usually the result of repetitive
wringing, grasping, turning and
twisting .
Ganglion Cyst of the Wrist
• Ganglion (synovial hernia or cyst)small hard lump above a tendon or
in the capsule that encloses a joint.
It is a fluid filled cyst that is not
cancerous.
– Unknown cause
– May be necessary to drain or surgically
remove if it becomes painful.
Wrist Strengthening
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Flexion
Extension
Ulnar Deviation
Radial Deviation
Pronation
Supination