The Elbow, Forearm, Wrist, and Hand

1. The Elbow, Forearm, Wrist, and Hand Chapter 19

2. Elbow Anatomy • Bones • Articulations • Ligaments and Capsule • Synovium and Bursa • Musculature • Nerve Supply • Blood Supply • Functional Anatomy

3. Preventing/Assessing ElbowInjuries • History • Observation • Palpation (bony and soft tissue) • Special Tests • Tinel sign • Test for capsular injury • Valgus and Varus tests • Medial and Lateral Epicondylitis Test • Pinch Grip test • Pinch Grip Test • Pronator Test syndrome test • Functional Evaluation

4. Contusion Etiology Signs and Symptoms Management Olecranon Bursitis Etiology Signs and Symptoms Management Strains Etiology Signs and Symptoms Management Elbow Sprains Etiology Signs and Symptoms Management Lateral Epicondylitis Etiology Signs and Symptoms Management Medial Epicondylitis Etiology Signs and Symptoms Management Recognition and Management of Injuries

5. Elbow Osteochondritis Dissecans Etiology Signs and Symptoms Management Little League Elbow Etiology Signs and Symptoms Management Cubital Tunnel Syndrome Etiology Signs and Symptoms Management Elbow Dislocation Etiology Signs and Symptoms Management Fracture of the Elbow Etiology Signs and Symptoms Management Volkmann’s Contracture Etiology Signs and Symptoms Management Recognition and Management of Injuries (contd.)

6. Rehabilitation Principles for the Elbow • Phase I - immobilization (maintain wrist and hand strength) - 6 weeks • Phase II - Increase ROM (after cast removal) • Therapy: Ice (5 to 15 minutes) • Exercise: PREs in all directions • General Body Conditioning • Joint mobilization • Flexibility • Strengthening • Functional Progression • Return to Activity • Protective Taping and Bracing

7. Forearm Anatomy • Radius and Ulna: Elbow • Joints: radioulnar joint (superior, middle, and distal) • Bone: proximal radial head, olecranon process, radial shaft, ulnar shaft, distal radius, radial styloid process, ulnar head, ulnar styloid • Musculature: Forearm, flexors, pronators, extensors, and supinators • Nerve/Blood Supply: median and radial nerve and brachial, radial, and ulnar artery

8. Forearm Assessment • History • Observation • Palpation • Special Tests

9. Contusion Etiology Signs and Symptoms Management Forearm Splints Etiology Signs and Symptoms Management Colles’ fracture Etiology Signs and Symptoms Management Forearm Splints Etiology Signs and Symptoms Management Recognition and Management of Forearm Injuries

10. Wrist, Hand, and Finger Anatomy • Bones: carpals and metacarpals • Joints: radiocarpal, carpal, metacarpal, and phalangeal joints • Ligaments: “many at each joint in the hand” • Musculature: “many intrinsic and extrinsic muscles” • Blood and Nerve Supply: ulnar, median, radial nerve and radial and ulnar superficial and deep palmar arch arteries

11. Assessment of Wrist, Hand, and Finger Injuries • History • Observation • Palpation • Special Tests: Finklestein’s test, Tinel’s Sign, Phalen’s test, valgus and varus stress test, Glide test, Lunotriquetral Ballotment test • Circulatory and Neurological Evaluation • Allen test • Functional Evaluation

12. Wrist Sprain Etiology Signs and Symptoms Management Triangular Fibrocartilage Complex Injury Etiology Signs and Symptoms Management Carpal tunnel syndrome Etiology Signs and Symptoms Management Tenosynovitis Etiology Signs and Symptoms Management Tendinitis Etiology Signs and Symptoms Management Nerve Compression, Entrapment, Palsy Etiology Signs and Symptoms Management Recognition and Management of Wrist, Hand, and Finger Injuries

13. De Quervain’s Disease Etiology Signs and Symptoms Management Dislocation of the Lunate Bone Etiology Signs and Symptoms Management Scaphoid Fracture Etiology Signs and Symptoms Management Hamate Fracture Etiology Signs and Symptoms Management Wrist Ganglion Etiology Signs and Symptoms Management Recognition and Management of Wrist, Hand, and Finger Injuries

14. Contusion to hand and fingers Etiology Signs and Symptoms Management Bowler’s Thumb Etiology Signs and Symptoms Management Jersey finger Etiology Signs and Symptoms Management Trigger finger or thumb Etiology Signs and Symptoms Management Mallet finger Etiology Signs and Symptoms Management Boutonniere deformity Etiology Signs and Symptoms Management Recognition and Management of Wrist, Hand, and Finger Injuries

15. Dupuytren’s Contracture Etiology Signs and Symptoms Management Sprains, Dislocations, and Fractures Etiology Signs and Symptoms Management Gamekeeper’s Thumb Etiology Signs and Symptoms Management Sprains PIP and DIP joint Etiology Signs and Symptoms Management Swan neck deformity Etiology Signs and Symptoms Management PIP Dorsal dislocation Etiology Signs and Symptoms Management Recognition and Management of Wrist, Hand, and Finger Injuries

16. MCP dislocation Etiology Signs and Symptoms Management Metacarpal fracture Etiology Signs and Symptoms Management Bennett’s Fracture Etiology Signs and Symptoms Management Distal/Middle/Proximal phalangeal fracture Etiology Signs and Symptoms Management Fingernail deformity Etiology Signs and Symptoms Management Recognition and Management of Wrist, Hand, and Finger Injuries

17. Rehabilitation Principles for the Forearm, Wrist, Hand, and Fingers • General Body Conditioning • Joint Mobilization • Flexibility • Strength • Neuromuscular Control • Return to Activity