2. What am I?

3. Articulations of the humerus, radius, and ulna
Articulations of the humerus, radius, and ulna. [ olecranon process ] Medial collateral ligament: 3 portions, anterior, posterior, oblique
The anterior fibers are tight in extension, while the posterior fibers are tight in flexion [ beyond 90 degrees ] The posterior fibers are fan shaped and thin when compared to the anterior fibers.

4. Causes: Back Hand Swing (tennis); Painting ; Carrying heavy buckets

5. Lateral Epicondylitis
Symptoms: Point lateral epicondyle; radiating pain to mid forearm and into the middle and ring finger; stiffness in elbow.

6. Medial Epicondylitis – Golfer’s Elbow

7. Movements of elbow Elbow: flexion - extension
Wrist: supination - pronation - ulnar and radial deviation flexion and extension
Flexion and extension originate at the humeroradial and humeroulnar joints while pronation and supination occur from the radio scaphoid (Navicular)
articulations at the wrist and the radioulnar joint at the elbow.

8. Elbow Dislocations
6. Dislocations (fractures of the coronoid process occur in approx % of elbow dislocations)
Dislocations of the elbow are infrequent occurrences in intercollegiate athletics.
However, when they do occur, the are often serious injuries due to the potential for fractures and impaired distal circulation.

9. Muscles of elbow, wrist, & hand
Biceps = primary supinator of the forearm also primary for elbow flexion.
Brachial, originates on the humerus, extends anteriorly across the joint and inserts into the ulna.
Triceps, 3 heads, Primary responsible for extension of elbow.
Flexor - pronator group, originates on medial side
Extensor - supinator group,
Olecranon bursae, separates the skin over the tip of the elbow from the pointed end of the ulna. [ Olecranon process ]
Radial - humeral bursae, lies anteriorly between the radial head and the lateral epicondyle between the muscle attachments

10. Hand & Wrist Injuries Gamekeeper’s Thumb Mallet Finger Jersey Finger
Central Slip Injury / Boutenniere Deformity
Swan Neck Deformity
Colles Fracture / Smith Fracture
Scaphoid Fracture
Bennet’s Fracture
Boxer’s Fracture
Dislocated Fingers
Smash/Avulsion Injuries

11. Gamekeeper’s Thumb Normal thumb Normal Carrying Angle
Gamekeeper’s Sprain
(Notice the opening of joint

12. Mallet Finger How ? S/S? Tx? Hit on tip of finger with ball
Tip of Finger Drops
Blood under nail
Swelling
Tx?
PRICE, Splint into ext., Need to refer within a week

13. Mallet Finger

14. Jersey Finger How? – Flexor tendon rupture S/S? TX?
Finger caught in jersey
S/S?
Unable to actively flex finger at DIP or PIP joint
DIP represents Profundus rupture
PIP represents Superficialis rupture
TX?
Surgery
Splint

15. Jersey Finger

16. Swan Neck Deformity

17. Swan Neck Deformity DIP goes into extension PIP goes into flexion
Look now, there is only one tendon that is responsible for extending the both the joints of the finger. This is in contrast to the flexor tendons that are two in number. This extensor tendon divides into three slips (branches). The central one extends the proximal joint and the remaining two (one on each side of the finger) join further up and extend the distal joint.
Now if the lateral slips that extend the distal joint stop functioning for whatever reason, then the distal joint will remain flexed. The central slip continues to function (in fact it over functions because you still continue trying to extend the distal joint with your non functioning lateral slips) and this results in excessive extension of the proximal joint. This eventually produces swan neck deformity.
Causes of this deformity include
rheumatoid arthritis (most common)
mallet finger (due to rupture of lateral slips at their junction with bone)
cerebral palsy (due to muscle imbalance)
congenital joint laxity

18. Central Slip Injury / Boutenniere Deformity
How?
PIP forceabley flexed and same time
Common in Basketball Players
S/S?
Unable to actively extend the joint
Tenderness over the dorsal aspect of the middle phalanx
Tx?
Splint in full extension x 6 weeks

19. Central Slip Injury / Boutenniere Deformity

20. Colles Fracture TX? What? How? S/S? PRICE Distal Radial Fracture
Refer to MD
Cast if no surgery
Surgery possible
What?
Distal Radial Fracture
Most common arm fracture
How?
Fall on outstretched hand
Wrist goes into extension
S/S?
immediate (acute) pain,
tenderness, bruising, and swelling
Frequently, the wrist hangs in an odd or bent way (deformity).

21. Colles Fracture

22. Smith Fracture What? How? S/S? TX? Distal Radial Fracture
Fall on flexed hand
S/S?
Same as Colles Fracture
TX?

23. Scaphoid Fracture What? How? S/S? TX? Fracture small carpal bone
2nd most common wrist fracture
How?
Fall on outstretched hand
S/S?
Swelling
Point tenderness (anatomical
snuff box)
TX?
Refer for xray – CYA!!!

24. Bennett’s Fracture Fracture of 1st MCP jt Fall on outstretched hand
Dropped object TX
Refer for xray
Splint

25. Boxer’s Fracture Break in the small end of the 5th metacarpal
What caused it? Punching something harder than the hand, such as a wall or another person's head.
TX?
PRICE
REFER
The end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm

26. Dislocated Fingers
During sports activities, a basketball or baseball may strike the tip of an outstretched finger.
Your finger might get caught in equipment such as a game jersey or pads.
You might fall onto your outstretched hand.

27. Dislocated Finger S/S Do Not Try to Reduce! Splint Refer
Obvious Deformity
Pain
Swelling
Do Not Try to Reduce!
Splint
Refer

28. Smash / Avulsion Injury

29. Smash / Avulsion Injury
3 months post op