Elbow, Wrist & Hand

1. Elbow, Wrist & Hand SECTA Sports Medicine

2. The Elbow • Bones • humerus • ulna • radius • Ligaments • ulnar collateral lig. • annular lig. • radial collateral lig.

3. The Elbow • Muscles • triceps brachii • biceps brachii • brachialis • Anconeus (posterior) • brachioradialis

4. The Elbow • Common injuries of the elbow: • Contusions • Sprains/Strains • Dislocations • Fractures • Nerve Injuries • Epicondylitis • Volkmann’s Contracture

5. The Elbow • Contusions • Common • Caused by a direct blow • Bleeding & bruising • Treatment • RICE • Protective Padding

6. The Elbow - Contusions Normal Skin Contusion

7. The Elbow • Sprains • Commonly result from forced hyperextension or side to side forces • “click” or “pop” sound with sharp pain • Localized swelling & pain • Arm will be held in a flexed position • Treatment • RICE • Use of a specialty brace may be suggested

8. The Elbow • Strain • Result from the high amounts of stress place on the elbow • Acute • Sudden overload • Chronic • Continued overuse • Treatment • RICE • Use of a specialty brace may be suggested

9. The Elbow • Dislocation • The 2nd most frequently dislocated major joint • Most common- posterior displacement of the ulna • Results from a fall on an outstretched hand with the elbow hyperextended

10. The Elbow- Dislocation • Signs & Symptoms • If displaced- obvious deformity • Loss of function • Considerable pain

11. The Elbow- Dislocation • Treatment • Properly immobilized • Transport to the athlete’s physician or the nearest medical facility

12. The Elbow • Fractures • Caused by direct trauma, indirect stress (falling), excessive forces (throwing) • Most common in children or skeletally immature athletes • Many involve the growth plate (epiphysis)

13. The Elbow- Fractures • Signs & Symptoms • Point tenderness • Swelling • Limited range of motion • Disability at the elbow or hand • Increased pain at the fracture site when attempting movement Olecranon Process Fracture

14. The Elbow- Fractures • Treatment • Immobilization • Ice • Elevation • Immediate referral to medical facility

15. The Elbow • Nerve Injuries • Not as common as musculoskeletal injuries • Ulnar Nerve Contusion • Cubital Tunnel Syndrome • Radial Tunnel Syndrome • PronatorTeres Syndrome

16. The Elbow- Nerve Injuries • Ulnar Nerve Contusion • Blow or contusion to the ulnar nerve (funny bone) • Immediate pain & burning sensation shooting down the forearm to the ring and little fingers • Depending on the severity of the blow the pain may last from a few minutes to a longer period of time

17. The Elbow- Nerve Injuries • Cubital Tunnel Syndrome • Ulnar nerve becomes trapped and compressed in the cubital tunnel (posterior aspect of the medial epicondyle groove) • Due to repetitive movement (throwing or swimming) • Signs & Symptoms • Pain along inner aspect of the elbow • Tenderness over medial epicondylar groove • Paresthesia in distrubution of ulnar nerve in the hand

18. The Elbow- Nerve Injuries • Radial Tunnel Syndrome • Radial nerve becomes trapped during activities requiring repetitive pronation and supination of the forearm • Sign & Symptoms • Pain over lateral aspect of the elbow • Tenderness over anterior radial head

19. The Elbow- Nerve Injuries • PronatorTeres Syndrome • Median nerve becomes trapped or compressed due to hypertrophy of pronatorteres or repetitive pronation of the forearm • Signs & Symptoms • Pain radiating down the anterior forearm • Numbness, tingling in the thumb, index and middle fingers

20. The Elbow • Epicondylitis • Chronic strain of the medial or lateral epicondyle • Caused by faulty mechanics or techniques, weak muscle groups, inappropriate equipment • Tennis Elbow • Commonly given to pain on the lateral side of the elbow • Golfer’s Elbow • Commonly given to pain on the medial side of the elbow • Pitcher’s Elbow, Bowler’s Elbow, Javelin Thrower’s Elbow

21. The Elbow- Epicondylitis • Signs & Symptoms • Local tenderness over epicondyle • Pain with the use of the involved muscle • Possible swelling • Treatment • Preventive: proper equipment, proper technique, limited stress • Proper warm up and stretch • RICE • Modified activities

22. The Elbow • Volkmann’s Contracture • Absence of blood flow (ischemia) to the forearm • From swelling, fracture, burns, excessive exercise, injections in the forearm, animal bites • Muscles on the palm side of the forearm shorten • Causes the fingers to form a fist and flex toward the wrist • Mild, Moderate, Severe

23. The Elbow- Volkmann’s Contracture • Signs & Symptoms • Severe pain when muscle is passively moved • Swollen • Shiny • Pain when forearm is squeezed • Pain gets worse with time • Decreased sensation • Weakness • Paleness of the skin

24. The Elbow- Volkmann’s Contracture

25. The Wrist & Hand • Bones • Ulna • Radius • Carpals • Metacarpals • Phalanges

26. The Wrist & Hand • Muscles • Hand • Supinator • Pronatorteres • Pronatorquadratus • Thumb • Flexor pollicislongus • Flexor pollicisbrevis • Extensor pollicislongus • Extensor pollicisbrevis • Adductor pollicis • Abductor pollicislongus • Abductor pollicisbrevis • Opponenspollicis • Fingers • Flexor digitorumprofundus • Flexor digitimimimibrevis • Interosseidorsalis • Flexor digitorumsuperficialis • Extensor indicis • Interosseipalmaris • Abductor digitiminimi • Oppenensdigitiminimi • Extensor digitorumcommunis

27. The Wrist & Hand

28. The Wrist & Hand

29. The Wrist & Hand • Fractures • Boxer’s Fracture • Baseball (Mallet) Finger • Jersey Finger • Scaphoid Fracture • Colles’s Fracture

30. The Wrist & Hand- Fractures • Boxer’s Fracture • A break in the 5th metacarpal leading to the little finger • Caused by slamming a clenched fist against a solid object

31. The Wrist & Hand- Fractures • Baseball (mallet) Finger • Caused by an object hitting the tip of the finger • Finger is bent beyond its normal range of motion • The finger tendon is torn and cartilage is damaged

32. The Wrist & Hand- FracturesMallet Finger Finger tendon is torn due to over flexion Damage to surrounding tissue due to over flexion and force of impact

33. The Wrist & Hand- FracturesMallet Finger • Treatment • RICE • Support • Evaluation by physician

34. The Wrist & Hand- Fractures • Jersey Finger • Tearing of the flexor tendon to the fingertip • Usually caused during a tackle • Most often affects the ring finger

35. The Wrist & Hand- FracturesJersey Finger Inability to flex finger Treatment consists of surgery to reattach tendon

36. The Wrist & Hand- Fractures • Scaphoid Fracture • Most commonly fractured bone in athletics • Caused by a fall on an outstretched hand • Palpation at the anatomical snuffbox will cause pain

37. The Wrist & Hand- Fractures • Colles’s Fracture • Common fracture of the lower radius just above the wrist

38. The Wrist & Hand- FracturesColles’s Fracture CAUSED BY FALLING ON AN OUTSTRETCHED HAND AND THE WRIST ABSORBS THE FORCE OF IMPACT Treatment often requires surgery with hardware

39. The Wrist & Hand • Carpal Tunnel Syndrome • Anatomy: • The carpal tunnel is a passageway that run from the forearm through the wrist • Bones form the walls and a ligament bridges over them • The median nerve and 9 tendons pass through the tunnel

40. The Wrist & HandCarpal Tunnel Syndrome • Causes: • Inflammation disorder caused by: repetitive stress, physical injury, or other conditions that caused tissues to swell • Inflammation of the protective linings of the tendons • Thickening & broadening of the ligament that forms the roof of the tunnel • High force • Repetition • Awkward joint posture • Direct pressure • Vibration • Prolonged constrained posture • Dislocation • Fractures • Rheumatoid arthritis • Diabetes • Hypothyroidism

41. The Wrist & HandCarpal Tunnel Syndrome • Signs & Symptoms • Pain • Numbness • Tingling • Weakness- drop things • Loss of heat/cold sensation • Feeling of swollen hands though there is no swelling • Symptoms may occur at rest as well as during use

42. The Wrist & HandCarpal Tunnel Syndrome • Treatment • Rest for at least 2 weeks • Ice • Splint or brace b • No real evidence they work • Some believe they make the problem worse • Surgery

43. The Wrist & Hand • Ganglion Cyst • Small, hard lump above a tendon or in the capsule that encloses a joint • Also known as synovial hernia or synovial cyst

44. The Wrist & HandGanglion Cyst • Common condition for: • Bowlers • Handball players • Racquetball players • Squash players • Tennis players

45. The Wrist & HandGanglion Cyst • A ganglion can also appear: • Palm side of the wrist • Base of the fingers • Feet • Treatment • Small cysts need not be treated

46. The Wrist & Hand • Boutonnière Deformity • A tear or slip of the extensor tendon of the proximal interphalangeal joint and the distal interphalangeal joint

47. The Wrist & HandBoutonnière Deformity • Causes: • Finger is bent or hit forcibly • Jammed finger • Signs & Symptoms • Joints will be painful and tender • Unable to straighten finger

48. The Wrist & HandBoutonnière Deformity • Treatment • Treatment must be relatively quick to be effective • If not treated tissues will lose their elasticity- making it difficult for them to return to normal