Chapter 12

1. Chapter 12 Injuries to the Arm, Wrist and Hand 1

2. Elbow • Bones • Humerus • Ulna • Radus • Ligaments • Ulnar Collateral • Annular Ligament • Interossius Membrane • Joints • Humeroulnar, • Humeroradial • Radialulnar 2

3. Elbow Movements • flexion/extension, pronation/supination • Wrist Movements • flexion/extension, radial & ulnar deviation 3

4. Soft Tissue Injuries Contusions and fractures • common in contact sports • muscle tissue compressed between skin and bone • Repeated episodes can result in myositis ossificans traumatica. • chronic inflammation of the muscle and underlying periosteum resulting in development of bony mass within the muscle • develops over weeks or months and is often ignored during the early stages 4

5. Signs/symptoms: severe pain in upper arm deformity & loss of function muscle spasm audible snap or pop sensory loss in forearm First Aid: application of ice & compression splint & sling/swathe monitor distal pulse treat for shock summon EMS Fractures of the Humerus

6. Elbow Dislocation Mechanism for this injury includes falling either on a flexed or fully extended arm -- deformity is usually obvious 8

8. Elbow sprains and dislocations • three joints of the elbow • ulnar & radial collateral ligaments -- valgus/varus • injury mechanism includes falling backwards with elbow in extension • valgus/varus forces can result in sprains • dislocations constitute extreme sprains

9. Signs/symptoms: in minor sprains -- mild swelling & localized pain difficulty in gripping or making a fist in dislocations -- gross deformity loss of function & severe pain possible neurological symptoms First Aid: application of ice & compression splint & sling/swathe monitor distal pulse treat for shock summon EMS Elbow Sprains 9

10. Elbow Fractures • generally involve the distal humerus • danger to neurovascular structures • injury mechanism similar to sprains and dislocations • fractures of the olecranon associated with direct blows • if radial artery is compressed -- Volkmann’s contracture may result 10

11. Epicondylitis Epicondylitis of the elbow • lateral epicondyle • attachment of the extensors • Medial epicondyle • Attachment of the flexors • gripping combined with wrist movements 12

12. Elbow Injuries • Golf associated with medial epicondyle • Tennis elbow -- involves the lateral epicondyle • excessive number of strokes • incorrect technique • racket handle too small • change in racket materials • grip too tight • muscle imbalance 13

13. Signs/symptoms: pain in the region of an epicondyle with swelling becomes worse with activity radiating pain into forearm muscles epicondylar pain associated with resisted wrist movements First Aid: ice, compression, rest medical referral if pain persists Elbow Injuries

14. Osteochondritis Dissecans throwing mechanism can result in impingement between radial head and capitulum high velocity elbow extension - joint compression on the lateral side joint cartilage becomes inflamed & may fracture axial loading may also result in damage Signs/symptoms: painful participation swelling 12-24 hrs. after “locking” of joint osteoarthritis in advanced cases First Aid: ice and compression medical referral 14

15. Contusions of the elbow • blows to the elbow are common • majority result in temporary symptoms • exception involves the olecranon bursa • repeated irritation of the bursa can result in inflammation (bursitis) • Signs/symptoms: • swelling in the region of the olecranon process • pain/stiffness with movement • elevated skin temperature • First Aid: • ice and compression • in cases of bursitis -- medical referral 15

16. Wrist and Forearm Injuries 16

19. Anatomy of the wrist • complex due to small size and large number of tendons that serve the wrist, thumb and fingers • Tendons are held in place by retinaculum • Retinaculum is small ligaments • Major nerves and vessels pass through this region as well. They are: • ulnar and radial arteries and veins • ulnar, median, radial nerves 17

20. Colles’ Fracture • rare in sports • Colles’ Fracture is most serious. • Signs/symptoms: • history of significant trauma • snap or popping sound • deformity, swelling into hand/fingers • severe pain and loss of sensation may occur 18

21. Wrist Fractures • Navicular • navicular fracture most common • generally occur at the “waist” 19

22. Navicular Fractures • Signs/symptoms: • history of wrist trauma with popping or snapping • pain with movement/wrist feels locked, positive “snuffbox” test • First Aid: • I.C.E. application • splint with sling & swathe, leave fingertips exposed (to observe circulation • medical referral

23. Wrist and Forearm Injuries A simple test for assessment of the integrity of the carpal navicular bone -- pressing lightly in the “anatomic snuffbox” 20

24. 21

26. Wrist Sprains and Dislocations Mechanism is typically hyperextension, similar mechanism to fractures Signs/symptoms: history combined with snapping/popping sensation painful movement movement may be impossible numbness and/or radiating pain First Aid: application of I.C.E. splint with sling & swathe expose fingertips refer to a physician

27. Nerve injuries in the wrist • median is most commonly injured -- carpal tunnel • carpal tunnel related to inflammation of flexor tendons • carpal tunnel related to sports requiring extensive gripping • ulnar nerve injuries -- produce numbness in the hypothenar eminence 23

28. Signs/symptoms: sensory loss to a portion of the hand/fingers pain/tenderness in the wrist, associated tendonitis and symptoms increase with wrist flexion Care for carpal tunnel syndrome consist of treating the inflammation and rest. Carpal Tunnel

29. Ganglion Cyst • Results from a herniation of the synovium surrounding a tendon herniated area becomes filled with fluid • variable in appearance -- some soft, other hard and painful Ganglions 25

30. Signs/symptoms: visible swelling in advanced cases, painful, hardened nodule First Aid: some spontaneously regress leave alone if possible can be surgically removed Ganglion Cysts

31. Hand Injuries 26 19 bones in the hand and wrist

32. Hand fractures • Bennett fracture • mechanism includes blows with a clenched fist • Metacarpals can be fractured by a crushing mechanism • Phalangeal fractures common in sports • Signs/symptoms: • history of trauma • associated dysfunction • deformity • broken skin (compound) • significant inflammation 27

33. Sprains & dislocations of the hand • any joint in the hand can be involved • most common forms are: • gamekeeper’s thumb • mallet finger • boutonniere deformity 28

34. Gamekeeper’s thumb • involves sprain of the ulnar collateral lig. • mechanism of injury is a valgus force • thumb is unstable • Signs/symptoms: • history of an appropriate mechanism • pain over the area of the ulnar collateral ligament • snapping or popping at the time of injury • swelling of the MP joint • inability to move the thumb • inability to grip tightly using the thumb Anatomy of a gamekeeper’s thumb 29

35. Mallet (baseball) Finger • involves distal phalanx, name comes from the deformity • mechanism -- blow to the fingertip while extending, can’t extend fingertip • Signs/symptoms: • deformity MOST important • recent trauma to fingertip • point tender DIP 30

36. Boutonniere deformity • extensor tendon involved as it crosses the PIP • mechanism is blow while the finger is flexed during active extension • Signs/symptoms: • violent flexion injury associated with feeling of tearing/popping • significant weakness in finger extension • PIP painful and swollen • if uncorrected, deformity will develop • characterized by hyperextension of MP & DIP with flexion of PIP 32

37. Anatomy of the Finger Tendons 31

38. Splinting for fractures of the forearm, wrist and/or hand