Basic Athletic Training Chapter 11 Elbow, Forearm, Wrist, and Hand

Chapter Objectives Identify the anatomy of the elbow, forearm, wrist, and hand Discuss the principles of rehabilitation exercises of the elbow, forearm, wrist, and hand Identify the preventative/supportive techniques and protective devices for the elbow, forearm, wrist, and hand Recognize the components of an evaluation format Discuss the common injuries associated with the elbow, forearm, wrist, and hand Review musculoskeletal conditions/disorders for the elbow, forearm, wrist, and hand

Anatomy The humerus is the largest bone of the upper extermity The ulna remains stationary and the radius rotates on the olecranon process The muscles that control the elbow’s movement originate above the elbow, on the humerus, and the scapula The wrist and hand is the site of some of the most minor, yet irritating, conditions suffered by athletes The hand region is made up of the five metacarpal bones

Elbow, Forearm, Wrist, and Hand Anatomy Bones Forearm extensors and supinators Ligament structures Wrist/hand/fingers extrinsics Wrist/hand/fingers intrinsics Elbow Range of motion Wrist Hand and fingers Joints Fingers Dermatomes Hand Myotomes Muscles and their functions Forearm flexors and pronators

Evaluation Format History—questions should include mechanism of injury, location of pain, sensations experienced, and previous injury Observation—compare the uninvolved to the involved anatomical structure and look for bleeding, deformity, swelling, discoloration, scars, and other signs of trauma Palpation—using bilateral comparison, palpate neurological, circulatory, and anatomical structures, and assess for potential fractures Special tests—assess disability to ligament, muscle, tendon, accessory anatomical structures, inflammatory conditions, range of motion, and pain or weakness in affected area

Assessment Tests Elbow Wrist and Hand Tests for ligament stability Epicondylitis tests—Lateral Epicondylitis tests—Medial Neurological dysfunction tests Wrist and Hand Bone integrity tests Ligamentous tests (fingers/thumb) Musculoskeletal tests Carpal tunnel tests

Conditions that Indicate an Athlete Should be Referred for Physician Evaluation Suspected fracture, separation, or dislocation Gross deformity Significant pain, especially on joint movement Circulation or neurological impairment Joint instability Loss of sensation Abnormal sensations such as clicking, popping, grating, or weakness Any doubt about severity or nature of the injury

Common Injuries Sprain (first, second, and third degree) Olecranon Bursitis Carpal tunnel syndrome Scaphoid fracture Dislocation/subluxation Epicondylitis Contusion Subungual hematoma

Musculoskeletal Conditions/Disorders Elbow and forearm Elbow hyperextension Forearm splints Ganglion Nerve injury Osteochondritis dissecans Supracondylar fracture Volkman’s fracture Volkman’s ischemic contracture Wrist and hand Barton fracture Baseball finger Bennett fracture Boutonniere deformity Boxers fracture Felon Gamekeeper’s thumb Mallet finger Murphy’s sign Profundus tendon rupture Smith’s fracture

Rehabilitation Range of motion exercises Elbow: flexion, extension, supination, pronation Wrist: flexion, extension, radial deviation, ulnar deviation, supination, pronation Fingers: flexion, extension, abduction, adduction, opposition Resistance/strengthening exercises Elbow: arm flexion (bicep curls), arm extension (triceps extension) Wrist, hand and fingers: hand squeeze, finger abduction, pinch grip, lateral/key pinch grip Following rehabilitation guidelines must be met before returning to competition: full range of motion strength, power, and endurance proportional to athlete’s sport and size no pain during upper extremity during running, jumping, or cutting

Preventive/Supportive Techniques Wrapping techniques for compression Elbow compression wrap Wrist/hand compression wrap Taping techniques for the elbow Elbow hyperextension Elbow epicondylitis Taping techniques for the forearm, wrist and hand Forearm splint Thumb spica Thumb C-lock Finger splint Collateral Interphalangeal joint Hyperextension of phalanges Contusion to hand

Protective Devices Archery forearm protectors Lateral/medial elbow strap Counter force forearm band Olecranon pad Elbow pads Specialized gloves Elbow hyperextension brace Wrist braces Forearm pads Wrist hyperextension braces Hand pads Hyperextension braces

Questions ?