1. Elbow, Wrist, Hand & Fingers Anatomy & Injuries

2. Anatomy of the Elbow
Radius
Head of Radius
Ulna
Olecranon
Humerus

3. Anatomy of the Elbow

4. Anatomy of the Elbow -Olecranon Bursa (Letter L)

5. Anatomy of the Elbow Triceps Brachii - Extensor
Bicep Brachii – Flexion & Supination
Brachialis - Flexion
Brachioradialis – Flexion
Pronator Teres – Pronation
Pronator Quadratus – Pronation
Supinator - Supination

6. Anatomy of the Elbow

7. Functional Anatomy of the Elbow
Movements
Flexion
Extension
Pronation
Supination

8. Functional Anatomy of the Elbow -Crossing of bones in forearm for pronation/supination

9. Anatomy of the Wrist/Hand
Ulna
Radius
Carpals
8 bones (Navicular/scaphoid)
Metacarpals
5 bones
Phalanges
14 bones (proximal, middle, distal)

10. Ligaments of the Wrist

11. Functional Anatomy/Movements of Hand

12. Elbow Injuries

13. Olecranon Bursitis Mechanism Signs & Symptoms
Superficial area leaves susceptible to injury
Direct Blow
Signs & Symptoms
Immediate swelling with no heat
Pain and point tenderness

14. Olecranon Bursitis
Management
Compression
Aspiration
Padding

15. Elbow Hyperextension Mechanism – Typical Signs & Symptoms
Forced hyperextension or lateral motion.
Foosh injury.
Signs & Symptoms
Hear click or pop
Pain, tenderness and swelling
Deformity
Loss of function – typically hold in flexion and resists attempt to extend elbow

16. Elbow Hyperextension Management Ice to control bleeding and swelling
Compression if can tolerate it
Immobilization – sling and swathe
Rehabilitation – restore normal motion and strength
Taping/bracing – to prevent hyperextension

17. Lateral Epicondylitis (Tennis Elbow)
Mechanism
Repetitive microtrauma to insertion of extensor muscles on lateral epicondyle
Signs & Symptoms
Pain along lateral elbow
Pain worsens and weakness in wrist and hand develops
Elbow has decreased ROM; pain w/ resistive wrist extension

18. Medial Epicondylitis (Golfers Elbow)
Opposite of Lateral Epicondylitis
Pain on Medial Aspect of Elbow

19. Little League Elbow Mechanism
Caused by repetitive microtraumas that occur from throwing (not type of pitch)
May result in numerous disorders of growth in the pitching elbow
Linked to:
Accelerated apophyseal growth region and delay in medial epicondyle growth plate
Traction apophysitis with possible fragmentation of medial epicondylar apophysis
Avulsion of medial epicondyle or radial head
Osteochondrosis of humeral capitellum
Non-union stress fracture of olecranon epiphysis

20. Little League Elbow Signs and Symptoms
Onset is slow; slight flexion contracture, including tight anterior joint capsule and weakness in triceps
Patient may complain of locking or catching sensation
Decreased ROM of forearm pronation and supination

21. Elbow Dislocation Mechanism
Caused by foosh w/ elbow extended or severe twist while flexed
Bones can be displaced backward, forward, or laterally
Distinguishable from fracture because lateral and medial epicondyles are normally aligned w/ shaft of humerus

22. Elbow Dislocation Signs and Symptoms Severe pain Deformity “Splinting”
Will hear pop or snap

23. Elbow Dislocation Treatment Refer to Orthoped surgeon Relocation,
X-ray for possible fracture
Surgery???
Rehab to Increase Strength and Flexibility

24. Elbow Dislocation Brian Butch injury vs Ohio State
Stewart Bradley Injury

25. Radial Tunnel Syndrome
Numbness in hand/fingers or pain 4 cm beyond the bony prominence on outside of elbow. Pain worsens when bend wrist backward, turn palm upward or hold something with a stiff wrist.
Nerve is compressed or pinched.
Posterior interosseous nerve
EMG may be used to diagnose, but does not always show issues.
Causes: repetitive motions

26. Radial Tunnel Syndrome
Treatment
Non surgical: Rest then movement training. Wrist strap & night elbow pad
Surgical: Last resort. Make incision and then cut around pressure spots on nerve to relieve pressure.

27. Other Elbow Injuries Muscle Strains Ligament Sprains Contusion
Fracture
Cubital Tunnel Syndrome
Irritation of Nerve
Elbow Osteochondritis Dissecans
Deterioration of articular cartilage

28. Hand & Wrist Injuries

29. Navicular (Scaphoid) Fracture
Mechanism
Any abnormal forced motion of wrist
Often missed and diagnosed as wrist sprain until pain does not go away
DOES NOT HEAL!!!!!

30. Navicular (Scaphoid) Fracture
Signs and Symptoms
Swelling
Loss of function – pain increased by upward pressure on the thumb and extension of the wrist
Pain at base of thumb in “anatomical snuffbox”

31. Gamekeepers Thumb Mechanism
Catch thumb in some type of shirt, etc and thumb is abducted and hyperextended back toward the hand
Signs and Symptoms
Pain in metacarpophalangeal joint and with abduction and hyperextension of the thumb
Instability of thumb
Disability of normal pinching and gripping skills

32. Gamekeepers Thumb

33. Sprained Fingers Typically can just “buddy tape” and play
Need to take into consideration which fingers are “buddy” taping
When is this an issue
If can’t fully bend or straighten finger
Jersey Finger – Ruptured Flexor Digitorum Profundus
need surgical repair
Mallet finger – Avulsion of Extensor tendon
Need to be in splint for 5-8 weeks

34. Mallet Finger Deformity at DIP (Distal interphalangeal joint)
Must splint for 6 weeks.

35. Carpal Tunnel Nerves and tendons get caught under the Carpal Ligament.
Signs & Symptoms: Hands go numb. Drop things. Can’t feel things (cold, what is in hand)
Treatment: Immobilize initially. Surgery if needed.

36. Other Hand/Finger Injuries
Contusions
Fractures
Black Finger Nail
Trigger Finger or Thumb
Dislocation
Wrist Ganglion (Bible Bump)
– cyst on joint capsule or synovial sheath