Elbow, Wrist, Hand & Fingers Anatomy & Injuries

Anatomy of the Elbow Radius Head of Radius Ulna Olecranon Humerus

Anatomy of the Elbow

Anatomy of the Elbow -Olecranon Bursa (Letter L)

Anatomy of the Elbow Triceps Brachii - Extensor Bicep Brachii – Flexion & Supination Brachialis - Flexion Brachioradialis – Flexion Pronator Teres – Pronation Pronator Quadratus – Pronation Supinator - Supination

Anatomy of the Elbow

Functional Anatomy of the Elbow Movements Flexion Extension Pronation Supination

Functional Anatomy of the Elbow -Crossing of bones in forearm for pronation/supination

Anatomy of the Wrist/Hand Ulna Radius Carpals 8 bones (Navicular/scaphoid) Metacarpals 5 bones Phalanges 14 bones (proximal, middle, distal)

Ligaments of the Wrist

Functional Anatomy/Movements of Hand

Elbow Injuries

Olecranon Bursitis Mechanism Signs & Symptoms Superficial area leaves susceptible to injury Direct Blow Signs & Symptoms Immediate swelling with no heat Pain and point tenderness

Olecranon Bursitis Management Compression Aspiration Padding

Elbow Hyperextension Mechanism – Typical Signs & Symptoms Forced hyperextension or lateral motion. Foosh injury. Signs & Symptoms Hear click or pop Pain, tenderness and swelling Deformity Loss of function – typically hold in flexion and resists attempt to extend elbow

Elbow Hyperextension Management Ice to control bleeding and swelling Compression if can tolerate it Immobilization – sling and swathe Rehabilitation – restore normal motion and strength Taping/bracing – to prevent hyperextension

Lateral Epicondylitis (Tennis Elbow) Mechanism Repetitive microtrauma to insertion of extensor muscles on lateral epicondyle Signs & Symptoms Pain along lateral elbow Pain worsens and weakness in wrist and hand develops Elbow has decreased ROM; pain w/ resistive wrist extension

Medial Epicondylitis (Golfers Elbow) Opposite of Lateral Epicondylitis Pain on Medial Aspect of Elbow

Little League Elbow Mechanism Caused by repetitive microtraumas that occur from throwing (not type of pitch) May result in numerous disorders of growth in the pitching elbow Linked to: Accelerated apophyseal growth region and delay in medial epicondyle growth plate Traction apophysitis with possible fragmentation of medial epicondylar apophysis Avulsion of medial epicondyle or radial head Osteochondrosis of humeral capitellum Non-union stress fracture of olecranon epiphysis

Little League Elbow Signs and Symptoms Onset is slow; slight flexion contracture, including tight anterior joint capsule and weakness in triceps Patient may complain of locking or catching sensation Decreased ROM of forearm pronation and supination

Elbow Dislocation Mechanism Caused by foosh w/ elbow extended or severe twist while flexed Bones can be displaced backward, forward, or laterally Distinguishable from fracture because lateral and medial epicondyles are normally aligned w/ shaft of humerus

Elbow Dislocation Signs and Symptoms Severe pain Deformity “Splinting” Will hear pop or snap

Elbow Dislocation Treatment Refer to Orthoped surgeon Relocation, X-ray for possible fracture Surgery??? Rehab to Increase Strength and Flexibility

Elbow Dislocation Brian Butch injury vs Ohio State http://www.youtube.com/watch?v=XZiLPZXjZd4&feature=related Stewart Bradley Injury http://www.youtube.com/watch?v=YFTwWsj7v2s

Radial Tunnel Syndrome Numbness in hand/fingers or pain 4 cm beyond the bony prominence on outside of elbow. Pain worsens when bend wrist backward, turn palm upward or hold something with a stiff wrist. Nerve is compressed or pinched. Posterior interosseous nerve EMG may be used to diagnose, but does not always show issues. Causes: repetitive motions

Radial Tunnel Syndrome Treatment Non surgical: Rest then movement training. Wrist strap & night elbow pad Surgical: Last resort. Make incision and then cut around pressure spots on nerve to relieve pressure.

Other Elbow Injuries Muscle Strains Ligament Sprains Contusion Fracture Cubital Tunnel Syndrome Irritation of Nerve Elbow Osteochondritis Dissecans Deterioration of articular cartilage

Hand & Wrist Injuries

Navicular (Scaphoid) Fracture Mechanism Any abnormal forced motion of wrist Often missed and diagnosed as wrist sprain until pain does not go away DOES NOT HEAL!!!!!

Navicular (Scaphoid) Fracture Signs and Symptoms Swelling Loss of function – pain increased by upward pressure on the thumb and extension of the wrist Pain at base of thumb in “anatomical snuffbox”

Gamekeepers Thumb Mechanism Catch thumb in some type of shirt, etc and thumb is abducted and hyperextended back toward the hand Signs and Symptoms Pain in metacarpophalangeal joint and with abduction and hyperextension of the thumb Instability of thumb Disability of normal pinching and gripping skills

Gamekeepers Thumb

Sprained Fingers Typically can just “buddy tape” and play Need to take into consideration which fingers are “buddy” taping When is this an issue If can’t fully bend or straighten finger Jersey Finger – Ruptured Flexor Digitorum Profundus need surgical repair Mallet finger – Avulsion of Extensor tendon Need to be in splint for 5-8 weeks

Mallet Finger Deformity at DIP (Distal interphalangeal joint) Must splint for 6 weeks.

Carpal Tunnel Nerves and tendons get caught under the Carpal Ligament. Signs & Symptoms: Hands go numb. Drop things. Can’t feel things (cold, what is in hand) Treatment: Immobilize initially. Surgery if needed.

Other Hand/Finger Injuries Contusions Fractures Black Finger Nail Trigger Finger or Thumb Dislocation Wrist Ganglion (Bible Bump) – cyst on joint capsule or synovial sheath