Elbow, Wrist & Hand SECTA Sports Medicine

The Elbow Bones Ligaments humerus ulna radius ulnar collateral lig. annular lig. radial collateral lig.

The Elbow Muscles triceps brachii biceps brachii brachialis Anconeus (posterior) brachioradialis

The Elbow Common injuries of the elbow: Contusions Sprains/Strains Dislocations Fractures Nerve Injuries Epicondylitis Volkmann’s Contracture

The Elbow Contusions Common Caused by a direct blow Bleeding & bruising Treatment RICE Protective Padding

The Elbow - Contusions Normal Skin Contusion

The Elbow Sprains Commonly result from forced hyperextension or side to side forces “click” or “pop” sound with sharp pain Localized swelling & pain Arm will be held in a flexed position Treatment RICE Use of a specialty brace may be suggested

The Elbow Strain Result from the high amounts of stress place on the elbow Acute Sudden overload Chronic Continued overuse Treatment RICE Use of a specialty brace may be suggested

The Elbow Dislocation The 2nd most frequently dislocated major joint Most common- posterior displacement of the ulna Results from a fall on an outstretched hand with the elbow hyperextended

The Elbow- Dislocation Signs & Symptoms If displaced- obvious deformity Loss of function Considerable pain

The Elbow- Dislocation Treatment Properly immobilized Transport to the athlete’s physician or the nearest medical facility

The Elbow Fractures Caused by direct trauma, indirect stress (falling), excessive forces (throwing) Most common in children or skeletally immature athletes Many involve the growth plate (epiphysis)

Olecranon Process Fracture The Elbow- Fractures Signs & Symptoms Point tenderness Swelling Limited range of motion Disability at the elbow or hand Increased pain at the fracture site when attempting movement Olecranon Process Fracture

The Elbow- Fractures Treatment Immobilization Ice Elevation Immediate referral to medical facility

The Elbow Nerve Injuries Not as common as musculoskeletal injuries Ulnar Nerve Contusion Cubital Tunnel Syndrome Radial Tunnel Syndrome Pronator Teres Syndrome

The Elbow- Nerve Injuries Ulnar Nerve Contusion Blow or contusion to the ulnar nerve (funny bone) Immediate pain & burning sensation shooting down the forearm to the ring and little fingers Depending on the severity of the blow the pain may last from a few minutes to a longer period of time

The Elbow- Nerve Injuries Cubital Tunnel Syndrome Ulnar nerve becomes trapped and compressed in the cubital tunnel (posterior aspect of the medial epicondyle groove) Due to repetitive movement (throwing or swimming) Signs & Symptoms Pain along inner aspect of the elbow Tenderness over medial epicondylar groove Paresthesia in distrubution of ulnar nerve in the hand

The Elbow- Nerve Injuries Radial Tunnel Syndrome Radial nerve becomes trapped during activities requiring repetitive pronation and supination of the forearm Sign & Symptoms Pain over lateral aspect of the elbow Tenderness over anterior radial head

The Elbow- Nerve Injuries Pronator Teres Syndrome Median nerve becomes trapped or compressed due to hypertrophy of pronator teres or repetitive pronation of the forearm Signs & Symptoms Pain radiating down the anterior forearm Numbness, tingling in the thumb, index and middle fingers

The Elbow Epicondylitis Chronic strain of the medial or lateral epicondyle Caused by faulty mechanics or techniques, weak muscle groups, inappropriate equipment Tennis Elbow Commonly given to pain on the lateral side of the elbow Golfer’s Elbow Commonly given to pain on the medial side of the elbow Pitcher’s Elbow, Bowler’s Elbow, Javelin Thrower’s Elbow

The Elbow- Epicondylitis Signs & Symptoms Local tenderness over epicondyle Pain with the use of the involved muscle Possible swelling Treatment Preventive: proper equipment, proper technique, limited stress Proper warm up and stretch RICE Modified activities

The Elbow Volkmann’s Contracture Absence of blood flow (ischemia) to the forearm From swelling, fracture, burns, excessive exercise, injections in the forearm, animal bites Muscles on the palm side of the forearm shorten Causes the fingers to form a fist and flex toward the wrist Mild, Moderate, Severe

The Elbow- Volkmann’s Contracture Signs & Symptoms Severe pain when muscle is passively moved Swollen Shiny Pain when forearm is squeezed Pain gets worse with time Decreased sensation Weakness Paleness of the skin

The Elbow- Volkmann’s Contracture

The Wrist & Hand Bones Ulna Radius Carpals Metacarpals Phalanges

The Wrist & Hand Muscles Hand Fingers Thumb Supinator Pronator teres Pronator quadratus Thumb Flexor pollicis longus Flexor pollicis brevis Extensor pollicis longus Extensor pollicis brevis Adductor pollicis Abductor pollicis longus Abductor pollicis brevis Opponens pollicis Fingers Flexor digitorum profundus Flexor digiti mimimi brevis Interossei dorsalis Flexor digitorum superficialis Extensor indicis Interossei palmaris Abductor digiti minimi Oppenens digiti minimi Extensor digitorum communis

The Wrist & Hand

The Wrist & Hand

The Wrist & Hand Fractures Boxer’s Fracture Baseball (Mallet) Finger Jersey Finger Scaphoid Fracture Colles’s Fracture

The Wrist & Hand- Fractures Boxer’s Fracture A break in the 5th metacarpal leading to the little finger Caused by slamming a clenched fist against a solid object

The Wrist & Hand- Fractures Baseball (mallet) Finger Caused by an object hitting the tip of the finger Finger is bent beyond its normal range of motion The finger tendon is torn and cartilage is damaged

The Wrist & Hand- Fractures Mallet Finger Finger tendon is torn due to over flexion Damage to surrounding tissue due to over flexion and force of impact

The Wrist & Hand- Fractures Mallet Finger Treatment RICE Support Evaluation by physician

The Wrist & Hand- Fractures Jersey Finger Tearing of the flexor tendon to the fingertip Usually caused during a tackle Most often affects the ring finger

The Wrist & Hand- Fractures Jersey Finger Inability to flex finger Treatment consists of surgery to reattach tendon

The Wrist & Hand- Fractures Scaphoid Fracture Most commonly fractured bone in athletics Caused by a fall on an outstretched hand Palpation at the anatomical snuffbox will cause pain

The Wrist & Hand- Fractures Colles’s Fracture Common fracture of the lower radius just above the wrist

The Wrist & Hand- Fractures Colles’s Fracture Treatment often requires surgery with hardware CAUSED BY FALLING ON AN OUTSTRETCHED HAND AND THE WRIST ABSORBS THE FORCE OF IMPACT

The Wrist & Hand Carpal Tunnel Syndrome Anatomy: The carpal tunnel is a passageway that run from the forearm through the wrist Bones form the walls and a ligament bridges over them The median nerve and 9 tendons pass through the tunnel

The Wrist & Hand Carpal Tunnel Syndrome Causes: Inflammation disorder caused by: repetitive stress, physical injury, or other conditions that caused tissues to swell Inflammation of the protective linings of the tendons Thickening & broadening of the ligament that forms the roof of the tunnel High force Repetition Awkward joint posture Direct pressure Vibration Prolonged constrained posture Dislocation Fractures Rheumatoid arthritis Diabetes Hypothyroidism

The Wrist & Hand Carpal Tunnel Syndrome Signs & Symptoms Pain Numbness Tingling Weakness- drop things Loss of heat/cold sensation Feeling of swollen hands though there is no swelling Symptoms may occur at rest as well as during use

The Wrist & Hand Carpal Tunnel Syndrome Treatment Rest for at least 2 weeks Ice Splint or brace b No real evidence they work Some believe they make the problem worse Surgery

The Wrist & Hand Ganglion Cyst Small, hard lump above a tendon or in the capsule that encloses a joint Also known as synovial hernia or synovial cyst

The Wrist & Hand Ganglion Cyst Common condition for: Bowlers Handball players Racquetball players Squash players Tennis players

The Wrist & Hand Ganglion Cyst A ganglion can also appear: Palm side of the wrist Base of the fingers Feet Treatment Small cysts need not be treated

The Wrist & Hand Boutonnière Deformity A tear or slip of the extensor tendon of the proximal interphalangeal joint and the distal interphalangeal joint

The Wrist & Hand Boutonnière Deformity Causes: Finger is bent or hit forcibly Jammed finger Signs & Symptoms Joints will be painful and tender Unable to straighten finger

The Wrist & Hand Boutonnière Deformity Treatment Treatment must be relatively quick to be effective If not treated tissues will lose their elasticity- making it difficult for them to return to normal