Elbow and Forearm Injuries Taelar Shelton, MS, ATC, AT/L

Contusions  Soft tissue or bone contustions  Usually on the medial aspect  MOI- collision, repeated blows  Acute contusions- pain, swelling, hematoma  Chornic- scars and bony callus  Treatment- RICE, protection, may need x-ray if serious

Olecranon Bursitis  Most common bursitis in the elbow  Superficial location  Acute or chronic- direct blow MOI  S&S- pain, warm, point tender, swelling  Try conservative Rx first- cold compression  Aspiration if serious

Strains  Muscles around elbow  Excessive restrictive ROM  Usually from a fall or repeated microtraumas  X-ray to r/o avulsion or epiphyseal Fx  RICE, rehabilitation exercises, theraputic ultrasound, cryotherapy (ice)

Sprains  Ligaments around the elbow  Usually from hyperextension of elbow joint  S&S- pain, shifting of elbow joint, click/pop/snap, crepitis, tender to palpation, swelling, decrease in function of elbow  Cold compress, main concern is ROM, do not massage, taping may assist in protecting injury

Lateral Epicondylitis  “Tennis Elbow” is inflammation of extension muscles at the lateral epicondyle  Repetitive extension of the wrist, throwing, microtrauma  S&S- pain during flexion/extension exercises, pain may radiate down the arm, mild swelling, point tenderness  RICE for actue tendonitis, chronic- bracing or taping and rehab

Medial Epicondylitis  “Golfer’s Elbow” is inflammation of the flexor tendons at the medial epicondyle  Repetitive flexion of the wrist, pitching, golf swing  Same Rx as tennis elbow

Osteochondritis Dissecans  OCD also occurs in the knee  Occurs in the bone and articular cartilage  Impariment of blood supply, causes loose bodies in the joint  “Locking” joint  Can require surgery  Can lead to arthritis

Ulnar Nerve Injuries  Ulnar nerve is involved  MOI- friction due to valgus force at elbow  Can be caused by impingment at the elbow  S&SS- parasthesia down ulnar side of forearm, numbness and tingling  Rx- Avoid pressure, can require surgery

Dislocation of the Elbow  FOOSH is a common MOI  Can dislocate anteriorly, posteriorlly or laterally  Olecranon deformity  Many ligmaents and tendons can be involved and may also cause a Fx  Referral imediately, reduction by MD, sling, immobilize in flexion, rehab

Fractures- Elbow  Humerus, radius or ulna  Usually a FOOSH or direct blow MOI  Higher rate of injury in children  S&S: discoloration, swelling, muscle spasm, bone displacement is possible, swelling and muscle spasm  Referral for X-ray

Volkman’s Contracture  Complication of a serious injury  Causes blood flow problems  S&S: pain, swelling, muscle spasm, pressure  Leads to permanaent muscle contracture and permanent paralysis in servere cases  Immediate referral

Wrist/Hand Injuries

Colles’ Fx  Fracture to the distal radius  FOOSH, hyperextension  Visible deformity  Ligaments are usually involved  Splint and get an xray

Carpal Tunnel Syndrome  Anterior aspect of the wrist  Transverse ligament can be too tight  Usually overuse but can be from a direct blow  Limited space for structures  S&S: complain of numbnress and tingling

de Quervain’s Tendosynovitis  Synovial lining becomes inflammed  Constant wrist movement makes this worse  S&S: aching, radiating pain in the forearm, pain with extension of the thumb, may hear a snap with movement  Rx: imobilize, ice, rest, antiinflammatory medications

Scaphoid Fx  Most common carpal bone fracture  FOOSH  Can be misdiagnosed as a sprain  Poor blood supply to this bone- can lead to necrosis  Need to get an xray and imoblize

Hamate Fx  MOI: from the handle of a golf club, tennis racquet or baseball bat  S&S: wrist pain, weakness  Usually needs to be casted

Wrist Ganglion  Herniation of the joint capsule or synovial sheath of a tendon  Can aslo be a cyst  Occurs after a wrist sprain that did not get proper Rx  Rx: Apply a pressure pad, surgical removal or draw the fluid out

Lunate Dx  Most common bone to dislocate of the carpal bones  Usually dislocates anteriorly  Deformity on the palmar aspect  Murphy’s sign  Reduction by a physician