1. BELLWORK
List various injuries to the elbow, wrist, or hand.

2. The Elbow, Wrist, and Hand
Chapter 20
The Elbow, Wrist, and Hand

3. Objectives Upon completion of this chapter, you should be able to:
Define the major components of the elbow
List major injuries and conditions of the elbow, wrist, and hand
List the different bones of the hand

4. The Elbow, Wrist, and Hand
Many activities would be impossible without healthy functioning of the elbow, wrist, and hand
This area of the body is one of the most intricate, yet most vulnerable to injury

5. Elbow Anatomy
Bones:
Humerus
Ulna
Radius
hinge joint

6. Elbow Anatomy FLEXORS Biceps brachii Brachialis Brachioradialis
EXTENSORS
Triceps brachii
Anconeus

7. Common Injuries of the Elbow
Contusions
Involve forearm muscles and subcutaneous bony prominences of the elbow
Direct blows can result in bruising, bleeding, and stiffness
Treatment: RICE and protective padding

8. Common Injuries of the Elbow (cont’d.)
Olecranon bursitis
Inflammation of bursa located over olecranon process
Can be caused by direct blow or infection
Treatment: ice compresses, rest, and anti-inflammatory, pain medications, and occasionally aspiration of fluid

9. Common Injuries of the Elbow (cont’d.)
Ulnar nerve contusion
Blow or contusion to ulnar nerve
“hitting the funny bone”
Elbow strain
Acute or chronic
Acute occurs with sudden overload

10. Common Injuries of the Elbow (cont’d.)
Epicondylitis
Chronic strain commonly occurring in medial and/or lateral epicondyles (bony ends of the humerus)
Caused by overload, faulty techniques, weak muscle groups, inappropriate equipment
Tennis elbow (lateral epicondylitis)
Pitcher’s elbow, golfer’s elbow (medial epicondylitis)
Symptoms: local tenderness and resisted wrist motion causes pain
Treatment: prevention, appropriate equipment, limited stress, stretching, RICE, and activity modification

11. Common Injuries of the Elbow (cont’d.)
Elbow sprains
Commonly result from forced hyperextension or valgus/varus (side-to-side) forces
Symptoms: pain, a “pop”, tenderness, and swelling
Treatment: same as elbow strains
Dislocations of the elbow
Normally occurs as a result of a fall
Signs: obvious deformity, loss of function, and pain
Treatment: transport to medical facility

12. Ouch!!!

13. Common Injuries of the Elbow (cont’d.)
Fractures of the elbow and forearm
Result of direct trauma, or indirect stresses transmitted through upper extremity
“FOOSH” = Falling On Out-Stretched Hand
Symptoms: deformity, point tenderness, hemorrhaging, swelling, limited range of motion, disability, and pain
Treatment: immobilization, ice, elevation, and physician referral

14. Common Injuries of the Elbow (cont’d.)
Volkmann’s contracture
Absence of blood flow (ischemia) to the forearm
Caused by swelling, trauma, or fracture
 blood flow  shortens muscles  joint bends  cannot be straightened (contracture)
Mild, moderate, or severe
Symptoms: pain, swelling, decreased sensation, weakness, and skin paleness

15. Common Injuries of the Elbow (cont’d.)
Nerve injuries
Ulnar nerve
Symptoms: pain and tenderness
Radial nerve
Median nerve
Symptoms: pain, numbness and tingling

16. Wrist & Hand Anatomy Bones Phalanges (14) Metacarpals (5) Carpals (8)
Scaphoid (“anatomical snuffbox”)

17. Wrist & Hand Anatomy Wrist flexors Wrist extensors
Anterior portion of forearm
Originate at medial epicondyle
Wrist extensors
Posterior portion of forearm
Originate at lateral epicondyle
26 muscles move wrist, thumb, and fingers!

18. Hand and Wrist Injuries
Fractures
Finger fractures
Boxer’s fracture (5th metacarpal)
Mallet (Baseball) finger (tearing of extensor tendon)
Jersey finger (tearing of flexor tendon, normally ring finger)
Scaphoid fracture
Colles’s fracture (in radius, just above wrist)
Treatment: RICE, support, and medical evaluation

19. Fractures
Colles’s fracture
Jersey finger
Mallet finger

20. Hand and Wrist Injuries (cont’d.)
Dislocations and subluxations
Dislocation: displacement of any bone from normal position
Subluxation: abnormal movement of a bone that constitute a joint
Symptoms: pain, swelling, and unable to bend or straighten
Treatment: ice, immobilization, and immediate consultation with a physician

21. Hand and Wrist Injuries (cont’d.)
Contusions
Caused by direct blows or falling onto a hard surface
Sprains
Injury to a ligament
Gamekeeper’s thumb (tearing of ulnar collateral ligament at MCP joint)  thumb becomes very unstable
Medial & lateral collateral ligaments of fingers

22. BELLWORK What is the common name for lateral epicondylitis?
What does “FOOSH” stand for?
How many bones are in the hand?

23. Hand and Wrist Injuries (cont’d.)
Tendonitis
Inflammation of tendons
Caused by overuse or repetitive stress
deQuervain’s tenosynovitis (tendonitis at base of thumb)
Symptoms: aching or pain at the wrist
Treatment: rest, ice, and anti-inflammatory medication

24. Hand and Wrist Injuries (cont’d.)
Nerve impingement and carpel tunnel (passageway from forearm to wrist)
Carpal tunnel syndrome
Inflammatory disorder of tissues & nerves around median nerve
Caused by repetitive stress, physical injury, or conditions that cause median nerve tissue swelling
Symptoms: pain, numbness, tingling, and weakness
Treatment: rest, ice, splinting or bracing, and sometimes surgical decompression

25. Carpal Tunnel

26. Hand and Wrist Injuries (cont’d.)
Ganglion cyst of the wrist
Small, usually hard lump above a tendon or in the capsule that encloses a joint
Treatment: if painless, no treatment necessary

27. Hand and Wrist Injuries (cont’d.)
Boutonnière deformity
Extensor tendon injury affecting proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP)
Symptoms: inability to flex and extend the finger, pain, and tenderness
Treatment: immediate medical attention

28. Strengthening Exercises
Wrist flexion
Wrist extension

29. Special Tests Varus test (LCL) Valgus test (MCL)
Finkelstein’s test (deQuervain’s)
Tinel’s carpal tunnel
Phalen’s test (carpal tunnel)

30. Conclusion
The elbow, wrist, and hand contain some of the most intricate and complex joints in the body
Understanding the anatomy, biomechanics, and mechanisms of injury will ensure appropriate treatment
Elbow and forearm injuries are common
The elbow is prone to overuse injuries