1. Chapter 20: The Elbow, Wrist, and Hand

2. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2 Common Injuries  Contusions  Olecranon bursitis  Ulnar nerve contusion  Strains and sprains  Epicondylitis  Fractures  Volkmann’s contracture  Nerve injury  Dislocations and subluxations  Tendonitis

3. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3 Common Injuries (cont.)  Nerve impingement and carpal tunnel syndrome  Ganglion cyst  Boutonniere deformity

4. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4 Special Tests  Certain tests can be performed that aid in the evaluation of injury.

5. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5 Varus/Valgus Stress Tests  The varus test (see text Figure 20- 8) applies forces laterally at the elbow, medially at the wrist. The valgus test (see text Figure 20-9) is exactly the opposite.

6. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6 Scaphoid Fracture Test  The anatomical snuff box is where pressure is exerted over the scaphoid bone. A pain response indicates the presence of a fracture.

7. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7 Gamekeeper’s Thumb Test  The first metacarpal is stabilized while the thumb is passively abducted. Taping can keep the thumb from moving laterally.

8. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8 Collateral Ligament Test  The PIP joint is gently stressed in a varus direction, then the valgus direction. Pain and/or excessive laxity indicates injury.

9. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9 Finkelstein’s Test  This tests for deQuervain’s tenosynovitis. With the thumb within a fist, move the wrist into ulnar deviation. Pain on the radial side is a positive sign.

10. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10 Tinel’s Sign  Tap a reflex hammer on the carpal tunnel. Tingling or shooting pain in the palm, thumb, index finger, and often the long finger indicates carpal tunnel syndrome.

11. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11 Phalan’s Test  Hold the position (see text Figure 20-27) figure for 60 seconds or less. Tingling or shooting pain in the palm, thumb, index, and long fingers indicates carpal tunnel syndrome.

12. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12 Modified Phalan’s Test  Holding the position for 60 seconds produces tingling or shooting pain in the median nerve branches of the hand with carpal tunnel syndrome. (See text Figure 20-28.)

13. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13 Elbow/Forearm Nerve Injuries  Injury to the three nerves of the elbow and forearm produces different effects.

14. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14 Ulnar Nerve  Weakness of wrist flexion and ulnar deviation  Flexion loss of DIP joints of the little and ring fingers  Loss of flexion and extension of fingers  Inability to abduct or adduct fingers  Inability to adduct thumb

15. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15 Median Nerve  Weakness with flexion and radial deviation  Loss of pronation  Loss of thumb opposition  Loss of flexion at MCP joints

16. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16 Radial Nerve  Loss of wrist extension and supination  Loss of extension at MCP joints  Inability to extend and abduct the thumb  Loss of triceps reflex  Weakness of elbow flexion  Ulnar and radial deviation

17. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17 Wrist Strengthening  These exercises are used to strengthen the wrist after a wrist or hand injury has healed.

18. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18 Wrist Flexion  Use weights and a padded bench to strengthen the forearm flexor muscles.

19. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19 Wrist Extension  Use weights and a padded bench to strengthen the forearm extensor muscles.