What am I?

Articulations of the humerus, radius, and ulna Articulations of the humerus, radius, and ulna. [ olecranon process ] Medial collateral ligament: 3 portions, anterior, posterior, oblique The anterior fibers are tight in extension, while the posterior fibers are tight in flexion [ beyond 90 degrees ] The posterior fibers are fan shaped and thin when compared to the anterior fibers.

Causes: Back Hand Swing (tennis); Painting ; Carrying heavy buckets

Lateral Epicondylitis Symptoms: Point tenderness @ lateral epicondyle; radiating pain to mid forearm and into the middle and ring finger; stiffness in elbow.

Medial Epicondylitis – Golfer’s Elbow

Movements of elbow Elbow: flexion - extension Wrist: supination - pronation - ulnar and radial deviation flexion and extension Flexion and extension originate at the humeroradial and humeroulnar joints while pronation and supination occur from the radio scaphoid (Navicular) articulations at the wrist and the radioulnar joint at the elbow.

Elbow Dislocations 6. Dislocations (fractures of the coronoid process occur in approx. 35-40% of elbow dislocations) Dislocations of the elbow are infrequent occurrences in intercollegiate athletics. However, when they do occur, the are often serious injuries due to the potential for fractures and impaired distal circulation.

Muscles of elbow, wrist, & hand Biceps = primary supinator of the forearm also primary for elbow flexion. Brachial, originates on the humerus, extends anteriorly across the joint and inserts into the ulna. Triceps, 3 heads, Primary responsible for extension of elbow. Flexor - pronator group, originates on medial side Extensor - supinator group, Olecranon bursae, separates the skin over the tip of the elbow from the pointed end of the ulna. [ Olecranon process ] Radial - humeral bursae, lies anteriorly between the radial head and the lateral epicondyle between the muscle attachments

Hand & Wrist Injuries Gamekeeper’s Thumb Mallet Finger Jersey Finger Central Slip Injury / Boutenniere Deformity Swan Neck Deformity Colles Fracture / Smith Fracture Scaphoid Fracture Bennet’s Fracture Boxer’s Fracture Dislocated Fingers Smash/Avulsion Injuries

Gamekeeper’s Thumb Normal thumb Normal Carrying Angle Gamekeeper’s Sprain (Notice the opening of joint

Mallet Finger How ? S/S? Tx? Hit on tip of finger with ball Tip of Finger Drops Blood under nail Swelling Tx? PRICE, Splint into ext., Need to refer within a week

Mallet Finger

Jersey Finger How? – Flexor tendon rupture S/S? TX? Finger caught in jersey S/S? Unable to actively flex finger at DIP or PIP joint DIP represents Profundus rupture PIP represents Superficialis rupture TX? Surgery Splint

Jersey Finger

Swan Neck Deformity

Swan Neck Deformity DIP goes into extension PIP goes into flexion Look now, there is only one tendon that is responsible for extending the both the joints of the finger. This is in contrast to the flexor tendons that are two in number. This extensor tendon divides into three slips (branches). The central one extends the proximal joint and the remaining two (one on each side of the finger) join further up and extend the distal joint. Now if the lateral slips that extend the distal joint stop functioning for whatever reason, then the distal joint will remain flexed. The central slip continues to function (in fact it over functions because you still continue trying to extend the distal joint with your non functioning lateral slips) and this results in excessive extension of the proximal joint. This eventually produces swan neck deformity. Causes of this deformity include rheumatoid arthritis (most common) mallet finger (due to rupture of lateral slips at their junction with bone) cerebral palsy (due to muscle imbalance) congenital joint laxity

Central Slip Injury / Boutenniere Deformity How? PIP forceabley flexed and extended @ same time Common in Basketball Players S/S? Unable to actively extend the joint Tenderness over the dorsal aspect of the middle phalanx Tx? Splint in full extension x 6 weeks

Central Slip Injury / Boutenniere Deformity

Colles Fracture TX? What? How? S/S? PRICE Distal Radial Fracture Refer to MD Cast if no surgery Surgery possible What? Distal Radial Fracture Most common arm fracture How? Fall on outstretched hand Wrist goes into extension S/S? immediate (acute) pain, tenderness, bruising, and swelling Frequently, the wrist hangs in an odd or bent way (deformity).

Colles Fracture

Smith Fracture What? How? S/S? TX? Distal Radial Fracture Fall on flexed hand S/S? Same as Colles Fracture TX?

Scaphoid Fracture What? How? S/S? TX? Fracture small carpal bone 2nd most common wrist fracture How? Fall on outstretched hand S/S? Swelling Point tenderness (anatomical snuff box) TX? Refer for xray – CYA!!!

Bennett’s Fracture Fracture of 1st MCP jt Fall on outstretched hand Dropped object TX Refer for xray Splint

Boxer’s Fracture Break in the small end of the 5th metacarpal What caused it? Punching something harder than the hand, such as a wall or another person's head. TX? PRICE REFER The end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm

Dislocated Fingers During sports activities, a basketball or baseball may strike the tip of an outstretched finger. Your finger might get caught in equipment such as a game jersey or pads. You might fall onto your outstretched hand.

Dislocated Finger S/S Do Not Try to Reduce! Splint Refer Obvious Deformity Pain Swelling Do Not Try to Reduce! Splint Refer

Smash / Avulsion Injury

Smash / Avulsion Injury 3 months post op