1. The Elbow Wrist and Hand

2. Bones of the Elbow Three bones of the elbow:Three bones of the elbow: –Humerus –Radius- lateral bone –Ulna- medial bone

3. Elbow BonesBones –Humerus –Ulna –Radius Muscles –Biceps Brachii –Brachioradialis –Triceps Brachii –Brachialis Ligaments –Ulnar Collateral –Radial Collateral

4. Elbow Anatomy Biceps Brachii-Biceps Brachii- –Long head attached to coracoid process of scapula –Short head attached to supraglenoid tubercle of scapula

5. Anatomy Triceps BrachiiTriceps Brachii –Long head: infraglenoid tubercle of scapula; –Lateral head: posterior surface of humerus, superior to radial groove; – Medial head: posterior surface of humerus, inferior to radial groove

6. Elbow Injuries Contusions-Contusions- –Due to the nature of many contact sports contusions are common and if treated quickly with RICE can have a quick return to play. –Pay close attention for myositis ossificans especially in the upper arm region.

7. Olecranon Bursitis Bursa are located near the tendons of the larger joints.Bursa are located near the tendons of the larger joints. Usually the result of a direct blow, but can be chronic. Small abrasions of elbow can cause infection to the bursa and swelling.Usually the result of a direct blow, but can be chronic. Small abrasions of elbow can cause infection to the bursa and swelling. Usually RICE but if there is infection aspiration may be needed.Usually RICE but if there is infection aspiration may be needed.

8. Ulnar Nerve Contusion Blow or contusion to the ulnar nerve.Blow or contusion to the ulnar nerve. It runs behind the medial epicondyle so there is little protection for it.It runs behind the medial epicondyle so there is little protection for it. Transiant pain and burning occur, numbness may persist if it is serious.Transiant pain and burning occur, numbness may persist if it is serious. If normal sensation does not return within 15 minutes a doctor visit is advisable.If normal sensation does not return within 15 minutes a doctor visit is advisable.

9. Strains Common extensor tendon and common flexor tendon are the most common location.Common extensor tendon and common flexor tendon are the most common location. It can be chronic or acute.It can be chronic or acute. A chronic strain can result into an –itis or rupture or torn muscle.A chronic strain can result into an –itis or rupture or torn muscle.

10. Epicondylitis Overuse of the tendon attached to the epicondyle of the humerus.Overuse of the tendon attached to the epicondyle of the humerus. Faulty technique/mechanics, weak muscles or improper equipment.Faulty technique/mechanics, weak muscles or improper equipment. Can be on lateral side- tennis or golfers elbowCan be on lateral side- tennis or golfers elbow Can be on the medial side- pitcher’s elbowCan be on the medial side- pitcher’s elbow

11. Young Athletes Elbow Injury Little Leaguer’s elbow- repetitive action resulting in elbow pain in youngLittle Leaguer’s elbow- repetitive action resulting in elbow pain in young The elbow area is the last epiphyseal center to close so injuries can occur.The elbow area is the last epiphyseal center to close so injuries can occur.

12. Young Athletes Elbow Injury Little Leaguers elbow can result in in varies fractures or bone growths.Little Leaguers elbow can result in in varies fractures or bone growths.

13. Epicondylitis Signs and SxSigns and Sx –Pain over epicondyle –Increase pain with wrist flexion or extension –Elbow contracture Treatment –Proper technique –Proper equipment –Good warm up with slow increase in intensity –Stretching –RICE

14. Ulnar Collateral Ligament Tommy Johns surgery-Tommy Johns surgery- Replace the ulnar collateral Ligament on the medial Side of the elbow. Usually The ligament tears when Pitcher feels a pop. MRI is Confirming diagnosis.

15. Ulnar Ligament Injures

16. Sprains A result of forced hyperextension or valgus/varus forces.A result of forced hyperextension or valgus/varus forces. The elbow is a relatively stable joint so this is not a common injury.The elbow is a relatively stable joint so this is not a common injury.

17. Sprains Signs and SxSigns and Sx –Click or pop heard –Sharp pain at time of injury –Localized swelling and pain –Athlete wants to flex elbow Treatment –Bracing to limit painful motions –Strengthen muscles of the joint –RICE Special Tests? Lets Tape Lets Tape

18. Dislocations Elbow is the second most commonly dislocated major joint.Elbow is the second most commonly dislocated major joint. Most often the ulna/radius dislocate posterior to the humerus.Most often the ulna/radius dislocate posterior to the humerus. MOI- fall of outstretched arm with elbow locked in extension.MOI- fall of outstretched arm with elbow locked in extension.

19. Dislocations Signs and SxSigns and Sx –Obvious deformity –Check circulation and nerve function Treatment –Immobilization –Wrist strengthening and then progress to elbow –RICE

20. Fractures to Elbow/Forarm Often occurs due to a direct blow or a fall on outstretched arm.Often occurs due to a direct blow or a fall on outstretched arm. Most common childhood injury, often involves the epiphysis.Most common childhood injury, often involves the epiphysis.

21. Fractures to Elbow/Forarm Signs and SxSigns and Sx –Point tenderness –Possible deformity –Swelling –Limited ROM Treatment –Immobilization –RICE –Strengthening of the joints surrounding and then whole arm when cast is removed. Splinting?

22. Wrist and Hand Injuries Fractures of the Wrist and HandFractures of the Wrist and Hand –Finger Fractures Boxer’s Fracture- fracture of 5 th metacarpal. Hitting something with fisted hand.Boxer’s Fracture- fracture of 5 th metacarpal. Hitting something with fisted hand.

23. Wrist and Hand Injuries Fractures of the Wrist and HandFractures of the Wrist and Hand –Wrist Fractures Colles’s fracture- fracture of the radius just above the wrist. A result of a fall with wrist extended.Colles’s fracture- fracture of the radius just above the wrist. A result of a fall with wrist extended.

24. Nerves of the Elbow/Wrist Ulnar NerveUlnar Nerve Median NerveMedian Nerve Radial NerveRadial Nerve

25. Median Nerve Injury Carpal Tunnel Syndrome- compression of the median nerve as it passes through the carpal tunnel as a result of repetitive use of the hand and wrist.Carpal Tunnel Syndrome- compression of the median nerve as it passes through the carpal tunnel as a result of repetitive use of the hand and wrist. –The compression is a result of inflammation. –Surgery may be needed.

26. Wrist and Hand Anatomy The wrist is made up of 8 wrist bones called carpals.The wrist is made up of 8 wrist bones called carpals. PisiformPisiform Triquetral Hamate Lunate Trapezium Trapezoid Capitate Scaphoid In a group make up pneumonicIn a group make up pneumonic

27. Wrist and Hand Anatomy The metacarpals form the structure of the hand.The metacarpals form the structure of the hand. The phalanges are the fingers.The phalanges are the fingers. There are 27 bones in the hand including the wrist.There are 27 bones in the hand including the wrist. Each finger has an extender tendon and a flexor tendon.Each finger has an extender tendon and a flexor tendon.

28. Wrist and Hand Anatomy The wrist and hand have many muscles.The wrist and hand have many muscles. Flexor muscles are on the anterior sideFlexor muscles are on the anterior side Extensor muscles are on the posterior side.Extensor muscles are on the posterior side. Digitorum muscles control the fingersDigitorum muscles control the fingers Pollicis muscles control the thumb.Pollicis muscles control the thumb.

29. Wrist and Hand Anatomy The wrist and hand have many muscles.The wrist and hand have many muscles. Flexor muscles are on the anterior sideFlexor muscles are on the anterior side Extensor muscles are on the posterior side.Extensor muscles are on the posterior side. Digitorum muscles control the fingersDigitorum muscles control the fingers Pollicis muscles control the thumb.Pollicis muscles control the thumb.

30. Wrist and Hand Injuries Fractures of the Wrist and HandFractures of the Wrist and Hand –Finger Fractures Scaphoid Fracture- fracture of scaphoid which you call palpate in anatomical snuffbox. Occurs with fall on hand in extension.Scaphoid Fracture- fracture of scaphoid which you call palpate in anatomical snuffbox. Occurs with fall on hand in extension.

31. Tendon Injuries Mallet Finger- hitting something with the tip of a finger and causing the extensor tendon to tear.Mallet Finger- hitting something with the tip of a finger and causing the extensor tendon to tear. Jersey Finger- grabbing something and tearing the flexor tendon.Jersey Finger- grabbing something and tearing the flexor tendon.

32. Tendon Injuries Boutonniere deformity-Boutonniere deformity- extensor tendon injury affecting two joints of the finger. It is an injury to the central tendon on top of the finger. –It may appear as a “jammed finger” that cannot be extended from the PIP joint. –Treatment should be in an extended position so the tendon can heal.

33. Dislocations/Subluxations Dislocations occur in the fingers and wrist bones.Dislocations occur in the fingers and wrist bones. Point tenderness and swelling, possible deformity.Point tenderness and swelling, possible deformity. PhysicianPhysicianintervention may be necessary.

34. Contusions There are various contusions to the wrist, hand and fingers.There are various contusions to the wrist, hand and fingers. Most noted is the nail contusing where blood pools under the nail. Pressure can be painful and necessary to drain.Most noted is the nail contusing where blood pools under the nail. Pressure can be painful and necessary to drain.

35. Sprains Can happen in fingers and wrist bones.Can happen in fingers and wrist bones. Gamekeeper’s thumb- sprain of the ulnar collateral ligament of the thumb.Gamekeeper’s thumb- sprain of the ulnar collateral ligament of the thumb. –Special Test –Taping

36. Tendonitis Various kinds can occurVarious kinds can occur deQuervain’s tenosynovitis- inflammation at the base of the thumb on the back of the wrist and palm side of wrist. It is usually the result of repetitive wringing, grasping, turning and twisting.deQuervain’s tenosynovitis- inflammation at the base of the thumb on the back of the wrist and palm side of wrist. It is usually the result of repetitive wringing, grasping, turning and twisting.

37. Ganglion Cyst of the Wrist Ganglion (synovial hernia or cyst)- small hard lump above a tendon or in the capsule that encloses a joint. It is a fluid filled cyst that is not cancerous.Ganglion (synovial hernia or cyst)- small hard lump above a tendon or in the capsule that encloses a joint. It is a fluid filled cyst that is not cancerous. –Unknown cause –May be necessary to drain or surgically remove if it becomes painful.

38. Wrist Strengthening FlexionFlexion ExtensionExtension Ulnar DeviationUlnar Deviation Radial DeviationRadial Deviation PronationPronation SupinationSupination