1. Elbow, Wrist & Hand
SECTA
Sports Medicine

2. The Elbow Bones Ligaments humerus ulna radius ulnar collateral lig.
annular lig.
radial collateral lig.

3. The Elbow Muscles triceps brachii biceps brachii brachialis
Anconeus (posterior)
brachioradialis

4. The Elbow Common injuries of the elbow: Contusions Sprains/Strains
Dislocations
Fractures
Nerve Injuries
Epicondylitis
Volkmann’s Contracture

5. The Elbow Contusions Common Caused by a direct blow
Bleeding & bruising
Treatment
RICE
Protective Padding

6. The Elbow - Contusions
Normal Skin
Contusion

7. The Elbow
Sprains
Commonly result from forced hyperextension or side to side forces
“click” or “pop” sound with sharp pain
Localized swelling & pain
Arm will be held in a flexed position
Treatment
RICE
Use of a specialty brace may be suggested

8. The Elbow
Strain
Result from the high amounts of stress place on the elbow
Acute
Sudden overload
Chronic
Continued overuse
Treatment
RICE
Use of a specialty brace may be suggested

9. The Elbow Dislocation The 2nd most frequently dislocated major joint
Most common- posterior displacement of the ulna
Results from a fall on an outstretched hand with the elbow hyperextended

10. The Elbow- Dislocation
Signs & Symptoms
If displaced- obvious deformity
Loss of function
Considerable pain

11. The Elbow- Dislocation
Treatment
Properly immobilized
Transport to the athlete’s physician or the nearest medical facility

12. The Elbow
Fractures
Caused by direct trauma, indirect stress (falling), excessive forces (throwing)
Most common in children or skeletally immature athletes
Many involve the growth plate (epiphysis)

13. Olecranon Process Fracture
The Elbow- Fractures
Signs & Symptoms
Point tenderness
Swelling
Limited range of motion
Disability at the elbow or hand
Increased pain at the fracture site when attempting movement
Olecranon Process Fracture

14. The Elbow- Fractures Treatment Immobilization Ice Elevation
Immediate referral to medical facility

15. The Elbow Nerve Injuries Not as common as musculoskeletal injuries
Ulnar Nerve Contusion
Cubital Tunnel Syndrome
Radial Tunnel Syndrome
Pronator Teres Syndrome

16. The Elbow- Nerve Injuries
Ulnar Nerve Contusion
Blow or contusion to the ulnar nerve (funny bone)
Immediate pain & burning sensation shooting down the forearm to the ring and little fingers
Depending on the severity of the blow the pain may last from a few minutes to a longer period of time

17. The Elbow- Nerve Injuries
Cubital Tunnel Syndrome
Ulnar nerve becomes trapped and compressed in the cubital tunnel (posterior aspect of the medial epicondyle groove)
Due to repetitive movement (throwing or swimming)
Signs & Symptoms
Pain along inner aspect of the elbow
Tenderness over medial epicondylar groove
Paresthesia in distrubution of ulnar nerve in the hand

18. The Elbow- Nerve Injuries
Radial Tunnel Syndrome
Radial nerve becomes trapped during activities requiring repetitive pronation and supination of the forearm
Sign & Symptoms
Pain over lateral aspect of the elbow
Tenderness over anterior radial head

19. The Elbow- Nerve Injuries
Pronator Teres Syndrome
Median nerve becomes trapped or compressed due to hypertrophy of pronator teres or repetitive pronation of the forearm
Signs & Symptoms
Pain radiating down the anterior forearm
Numbness, tingling in the thumb, index and middle fingers

20. The Elbow Epicondylitis
Chronic strain of the medial or lateral epicondyle
Caused by faulty mechanics or techniques, weak muscle groups, inappropriate equipment
Tennis Elbow
Commonly given to pain on the lateral side of the elbow
Golfer’s Elbow
Commonly given to pain on the medial side of the elbow
Pitcher’s Elbow, Bowler’s Elbow, Javelin Thrower’s Elbow

21. The Elbow- Epicondylitis
Signs & Symptoms
Local tenderness over epicondyle
Pain with the use of the involved muscle
Possible swelling
Treatment
Preventive: proper equipment, proper technique, limited stress
Proper warm up and stretch
RICE
Modified activities

22. The Elbow Volkmann’s Contracture
Absence of blood flow (ischemia) to the forearm
From swelling, fracture, burns, excessive exercise, injections in the forearm, animal bites
Muscles on the palm side of the forearm shorten
Causes the fingers to form a fist and flex toward the wrist
Mild, Moderate, Severe

23. The Elbow- Volkmann’s Contracture
Signs & Symptoms
Severe pain when muscle is passively moved
Swollen
Shiny
Pain when forearm is squeezed
Pain gets worse with time
Decreased sensation
Weakness
Paleness of the skin

24. The Elbow- Volkmann’s Contracture

25. The Wrist & Hand
Bones
Ulna
Radius
Carpals
Metacarpals
Phalanges

26. The Wrist & Hand Muscles Hand Fingers Thumb Supinator
Pronator teres
Pronator quadratus
Thumb
Flexor pollicis longus
Flexor pollicis brevis
Extensor pollicis longus
Extensor pollicis brevis
Adductor pollicis
Abductor pollicis longus
Abductor pollicis brevis
Opponens pollicis
Fingers
Flexor digitorum profundus
Flexor digiti mimimi brevis
Interossei dorsalis
Flexor digitorum superficialis
Extensor indicis
Interossei palmaris
Abductor digiti minimi
Oppenens digiti minimi
Extensor digitorum communis

27. The Wrist & Hand

28. The Wrist & Hand

29. The Wrist & Hand Fractures Boxer’s Fracture Baseball (Mallet) Finger
Jersey Finger
Scaphoid Fracture
Colles’s Fracture

30. The Wrist & Hand- Fractures
Boxer’s Fracture
A break in the 5th metacarpal leading to the little finger
Caused by slamming a clenched fist against a solid object

31. The Wrist & Hand- Fractures
Baseball (mallet) Finger
Caused by an object hitting the tip of the finger
Finger is bent beyond its normal range of motion
The finger tendon is torn and cartilage is damaged

32. The Wrist & Hand- Fractures Mallet Finger
Finger tendon is torn due to over flexion
Damage to surrounding tissue due to over flexion and force of impact

33. The Wrist & Hand- Fractures Mallet Finger
Treatment
RICE
Support
Evaluation by physician

34. The Wrist & Hand- Fractures
Jersey Finger
Tearing of the flexor tendon to the fingertip
Usually caused during a tackle
Most often affects the ring finger

35. The Wrist & Hand- Fractures Jersey Finger
Inability to flex finger
Treatment consists of surgery to reattach tendon

36. The Wrist & Hand- Fractures
Scaphoid Fracture
Most commonly fractured bone in athletics
Caused by a fall on an outstretched hand
Palpation at the anatomical snuffbox will cause pain

37. The Wrist & Hand- Fractures
Colles’s Fracture
Common fracture of the lower radius just above the wrist

38. The Wrist & Hand- Fractures Colles’s Fracture
Treatment often requires surgery with hardware
CAUSED BY FALLING ON AN OUTSTRETCHED HAND AND THE WRIST ABSORBS THE FORCE OF IMPACT

39. The Wrist & Hand Carpal Tunnel Syndrome Anatomy:
The carpal tunnel is a passageway that run from the forearm through the wrist
Bones form the walls and a ligament bridges over them
The median nerve and 9 tendons pass through the tunnel

40. The Wrist & Hand Carpal Tunnel Syndrome
Causes:
Inflammation disorder caused by: repetitive stress, physical injury, or other conditions that caused tissues to swell
Inflammation of the protective linings of the tendons
Thickening & broadening of the ligament that forms the roof of the tunnel
High force
Repetition
Awkward joint posture
Direct pressure
Vibration
Prolonged constrained posture
Dislocation
Fractures
Rheumatoid arthritis
Diabetes
Hypothyroidism

41. The Wrist & Hand Carpal Tunnel Syndrome
Signs & Symptoms
Pain
Numbness
Tingling
Weakness- drop things
Loss of heat/cold sensation
Feeling of swollen hands though there is no swelling
Symptoms may occur at rest as well as during use

42. The Wrist & Hand Carpal Tunnel Syndrome
Treatment
Rest for at least 2 weeks
Ice
Splint or brace b
No real evidence they work
Some believe they make the problem worse
Surgery

43. The Wrist & Hand Ganglion Cyst
Small, hard lump above a tendon or in the capsule that encloses a joint
Also known as synovial hernia or synovial cyst

44. The Wrist & Hand Ganglion Cyst
Common condition for:
Bowlers
Handball players
Racquetball players
Squash players
Tennis players

45. The Wrist & Hand Ganglion Cyst
A ganglion can also appear:
Palm side of the wrist
Base of the fingers
Feet
Treatment
Small cysts need not be treated

46. The Wrist & Hand Boutonnière Deformity
A tear or slip of the extensor tendon of the proximal interphalangeal joint and the distal interphalangeal joint

47. The Wrist & Hand Boutonnière Deformity
Causes:
Finger is bent or hit forcibly
Jammed finger
Signs & Symptoms
Joints will be painful and tender
Unable to straighten finger

48. The Wrist & Hand Boutonnière Deformity
Treatment
Treatment must be relatively quick to be effective
If not treated tissues will lose their elasticity- making it difficult for them to return to normal