Wrist, Hand, Elbow & Shoulder Chapters 12, 11 & 10

Anatomy of the Wrist and Hand Looks a lot like the foot Has similar bone structures: Phalanges Metatarsals Carpals There are 26 bones There are many ligaments that hold the structure of the hand together

Carpal Bones Proximal: Distal: A=Scaphoid B=Lunate C=Triquetral D=Pisiform Distal: E=Trapezium F=Trapezoid G=Capitate H=Hamate

The Scaphoid Bone Find your anatomical snuff box Only blood supply at one end of the bone It has difficulty healing if the blood supply is interrupted

Joints of the wrist and hand There are three phalanges in each finger and two in the thumb Distal, middle and proximal Joints: Distal Interphalangeal jnt (DIP) Proximal Iinterphalangeal jnt (PIP) Metacarpal Phalangeal jnt (MCP) Carpometacarpal jnt (CMP)

Muscles of the hand and forearm There are two major groups of muscles at the wrist and forearm Flexors: on the dorsal side of the hand Extensors: on the ventral side of the hand

The Thumb Testing the ulnar collateral ligament of the thumb The collateral ligaments of the thumb provide the majority of its stability

Preventing injuries to the hand Boxing Batting Cycling Field hockey/ girls lacrosse

More Gloves Lineman Gloves Receiver/ Running back gloves

Splints

Wrist Sprains Occur from twisting and overuse Injured structure depends upon the stress placed on the wrist Ulnar Deviation is movement towards the ulnar

Radial deviation is movement towards the radius

The Lunate Dislocation of the lunate bone occurs more often than any other carpal dislocation Presents as deformity, pain, swelling, and decreased range of motion

Ganglion Cyst A pocket of fluid within the sheath Should be referred to a physician Sometimes is removed surgically

Gamekeepers/Skiers Thumb Thumb is forced into abduction forcefully Pain over the joint, swelling may be present An x-ray may be necessary to rule out a fracture

A “Jammed” Finger A sprain of the collateral ligaments in the finger

Finger Dislocations Don’t JUST “pop” it !!!!! There could be underlying hidden issues going on at the joint There could be a tendon rupture or a fracture!!!

Fractures Boxer’s fracture is most common in athletes for many reasons

Fractures Other fractures require the same care and treatment

Muscle and Tendon Injuries Repetitive stress and stretching can cause injuries to these structures Some of these include Carpal tunnel deQuervian’s tendinitis Mallet Finger Jersey finger Boutonniere deformity

Carpal tunnel

Carpal tunnel Most common as an overuse injury Tennis Field hockey Watch for acute carpal tunnel due to poor position in slings and casts

deQuervian’s tendinitis Abductor pollicis longus & Extensor Pollicis brevis tendons Prolonged or repetitive radial deviation (shot putters) Swelling, crepitus and pain with abduction

Mallet Finger An avulsion fracture of the distal phalanx. Cannot extend the distal phalanx

Jersey finger Avulsion fracture of flexor tendon Unable to flex the DIP

Boutonniere deformity Deformity arises when there is a rupture of the central slip of the extensor mechanism. This is an uncommon sporting injury usually due to an end-on injury to the finger with sudden bending at the P.I.P. joint Often in football or basketball

Boutonniere deformity

Elbow This is a very bony joint Common to have contusions all around the elbow. Use PRICES

Elbow

Ligaments There is thick joint capsule surrounding the elbow. Relies on the ligaments for stability Ulnar collateral Radial collateral Annular

Muscles Biceps- elbow flexion Triceps- elbow extension Wrist flexors- medial epicondyle of humerus Wrist extensors- lateral epicondyle of humerus

What it really looks like

Preventing Injuries to the Elbow Not a frequently injured joint Many of the injuries are caused by overuse Most injuries occur in racket sports such as tennis, or overhead throwing sports such as baseball and softball. Many times injuries are brought about by poor training

Preventing Injuries to the Elbow Athletes train the “beach muscles” Overwork the Biceps to get “ pipes” or “guns” What about the Triceps??? What about the wrist flexors and extensors??

What about equipment? Tennis players can cause themselves injuries if the grip is too small on the racket. Throwers should have a strong tricep and lots of flexibility in the elbow to prevent injuries.

Sprains Radial Collateral These are rare Ulnar collateral More common in throwers The stress of overhead activity strains the medial aspect of the elbow. Wrestling? Pain and swelling treat as any other ligament sprain Radial Collateral These are rare Treat the same as a ulnar collateral sprain.

Vascularity and Nerves There are numerous blood vessels and three major nerves that pass though t he elbow

Lateral Epicondylitis aka: Tennis Elbow Poor mechanics and overuse Presents as pain and swelling at the lateral epicondyle Treat with PRICES Medial Epicondylitis aka: Little League Elbow Repetitive Throwing Little league elbow may have an avulsion fracture at the epiphysis

Fractures Elbow fractures are rare in athletics. Often results from a forceful blow to the area or landing on hard surface.

Elbow Dislocation

Elbow Dislocation

Elbow Dislocation One of the most commonly dislocated joints in the body Doesn’t take a lot of force to dislocate the joint MUST BE SEEN by MD immediately

Olecranon Bursitis

Olecranon Bursitis PRICES Use a compression wrap or sleeve to alleviate swelling May have to be drained by MD Not always painful

Shoulder Anatomy A separation occurs here at the acromio-clavicular joint A dislocation occurs here at the gleno-humeral joint

Bony Anatomy Three bones: Many ligaments Not a very stable joint Humerus Bicipital groove Clavicle S shape Scapula Corocoid process Acromion process (a/c joint) Many ligaments Not a very stable joint

JOINTS There are many joints at the shoulder Most commonly injured joints are Acromio-clavicular Gleno-humeral Each held together by many ligaments

JOINTS

Muscles of the shoulder The Rotator Cuff SITS muscles Supraspinatus Infraspiantus Teres minor Subscapularis Deltoid Lays over the head of the humerus Pectoralis Originate at sternum attach to the anterior portion of the humerus

Muscles Triceps Biceps- two heads Originates at the Coracoid process and the Humerus Distal attachment is a the radial head Runs through the bicipital groove ACTION: elbow flexion and forearm supination Triceps Originates at the posterior humeral head and scapula Distal attachment is distal humerus at the elbow ACTION: Elbow extension and shoulder extension

Brachial Plexus

Brachial Plexus

Brachial Plexus

Rotator Cuff Strain Characterized like any other strain 1st, 2nd, and 3rd degree Common in throwing athletes Occurs from excessive motion beyond the normal range

Impingement Syndrome Overdoing it with overhead motions Supraspinatus and Bicep run together beneath the acromion process Space narrows because of swelling, poor posture, muscle imbalance Not enough room for everything in the joint pain occurs with motion sometimes there is numbness along with the pain

Bicipital Tendonitis Pain with overhead motions Palpate crepitus Inflammation of the tendon in the groove

Tendon rupture

Tendon rupture

Fractures There is a tremendous amount of stress at the shoulder Given its role in contact and collision sports fractures are common in athletics Clavicular Humeral Scapular

Fractures

What does this mean? Subluxation Dislocation Separation

Protection

Fitting Correctly