1. © 2007 McGraw-Hill Higher Education. All rights reserved. The Elbow, Forearm, Wrist and Hand PE 236 Amber Giacomazzi MS, ATC © 2007 McGraw-Hill Higher Education. All rights reserved.

4. Prevention of Elbow, Forearm and Wrist Injuries Vulnerable to a variety of acute and chronic injuries Protective gear is always recommended to reduce severity of injury Chronic injury reduction –Limit repetitions (baseball, tennis) –Utilize _____________________ –Use equipment that is appropriate for skill level –Maintain appropriate levels of __________, ___________, and ___________for activity

5. © 2007 McGraw-Hill Higher Education. All rights reserved. Recognition and Management of Injuries to the Elbow Olecranon Bursitis –Cause of Injury _____________________ makes it extremely susceptible to injury (acute or chronic) --direct blow –Signs & Symptoms Pain, swelling, and point tenderness Swelling will appear almost _____________ ____________________________________

6. © 2007 McGraw-Hill Higher Education. All rights reserved.

7. Contusion –Cause of Injury Vulnerable area due to lack of padding Result of direct blow or repetitive blows –Signs & Symptoms Swelling (rapidly after irritation of bursa or synovial membrane) –Treatment Treat w/ RICE immediately for at least 24 hours If severe, refer for X-ray to determine presence of fracture

8. © 2007 McGraw-Hill Higher Education. All rights reserved. Elbow Sprains –Cause of Injury Elbow ________________or a ___________force (often seen in the cocking phase of throwing –Signs & Symptoms Pain along _________ aspect of elbow Inability to grasp objects Point tenderness over _____________ –Treatment Conservative treatment begins w/ RICE elbow fixed at ________in a sling for at least _____________ Should be concerned with gradually regaining elbow full ROM Athlete should modify activity –Gradual progression involving an increase in ________________ _____________________________________________

9. © 2007 McGraw-Hill Higher Education. All rights reserved. Ligament Injuries Ulnar Collateral Ligament tear –_______________ Signs and Symptoms –Medial elbow pain –Pop sensation –Medial elbow swelling Treatment –_________________________ Elbow ligament reconstruction

10. © 2007 McGraw-Hill Higher Education. All rights reserved. Lateral Epicondylitis (______________) –Cause of Injury Repetitive microtrauma to ____________________ _________________ of lateral epicondyle –Signs & Symptoms Aching pain in region of lateral epicondyle after activity Pain worsens and _________________ ____________________develop Elbow has ________________; pain w/ ________ _____________________

11. © 2007 McGraw-Hill Higher Education. All rights reserved. Lateral Epicondylitis –Treatment RICE, NSAID’s and analgesics ROM exercises and PRE, _________________, hand grasping while in supination, _____________ ____________________ Mobilization and stretching in pain free ranges Use of a counter force or neoprene sleeve _________________ and __________________is critically important

12. © 2007 McGraw-Hill Higher Education. All rights reserved. Medial Epicondylitis (_____________________) –Cause of Injury Repeated ___________________ of wrist and ____________ torque of elbow –Signs & Symptoms Pain produced w/ forceful flexion or extension Point tenderness and mild swelling ________________ of wrist seldom elicits pain, but _________________________ –Treatment Sling, ______, ______________or heat through ultrasound Analgesic and NSAID's _____________________ below elbow to reduce elbow stressing Severe cases may require splinting and complete rest for 7-10 days

13. © 2007 McGraw-Hill Higher Education. All rights reserved. Ulnar Nerve Injuries –Cause of Injury Pronounced _________________may cause deep friction problem Ulnar nerve _____________ –Signs & Symptoms Generally respond with _____________(numbness) in ____ and____fingers –Treatment Conservative management – avoid aggravating condition Surgery may be necessary if _______________ ________________________________

14. © 2007 McGraw-Hill Higher Education. All rights reserved. Dislocation of the Elbow –Cause of Injury High incidence in sports caused by _______________ _______w/ elbow _________or severe ___________ _______________ –Signs & Symptoms Swelling, severe pain, disability May be displaced ________, _________, or _________ Complications w/ ________and _________nerves and _______________ –Treatment _____________and refer to physician for reduction Following reduction, elbow should remain splinted in __________for ___________

15. © 2007 McGraw-Hill Higher Education. All rights reserved. Elbow Dislocation

16. © 2007 McGraw-Hill Higher Education. All rights reserved.

17. Fractures of the Elbow –Cause of Injury Fall on ___________ or from a _____________ Fracture can occur in any one or more of the bones Fall on ____________ often fractures __________ above ___________or _____________condyles –Signs & Symptoms May or may not result in ___________________ ______________________________________ –Treatment Ice and sling for support – ___________________

18. © 2007 McGraw-Hill Higher Education. All rights reserved.

19. Anatomy of the Forearm

20. © 2007 McGraw-Hill Higher Education. All rights reserved.

22. Recognition and Management of Injuries to the Forearm Contusion –Cause of Injury ____________receives majority of blows due to arm blocks Can be ____________________ Result of _______________________ –Signs & Symptoms Pain, swelling and hematoma If repeated blows occur, _____________and possibly _____________ could form w/in a ______________

23. © 2007 McGraw-Hill Higher Education. All rights reserved. Contusion –Treatment Proper care in acute stage involves ___________ __________ and followed up w/ additional _____________ _________is critical - full-length _________ ________can be used to provide protective covering

24. © 2007 McGraw-Hill Higher Education. All rights reserved. Forearm Fractures –Cause of Injury Common __________- due to falls and direct blows Fracturing ___________ singularly is ______than simultaneous fractures to both –Signs & Symptoms ___________ or ________followed by ________ to ___________, ________, and ____________ Edema, ______________w/ possible __________ _______________may experience extensive damage to soft tissue structures

25. © 2007 McGraw-Hill Higher Education. All rights reserved. –Treatment RICE, splint, immobilize and refer to physician Athlete is usually incapacitated for ___________

26. © 2007 McGraw-Hill Higher Education. All rights reserved. Colles’ Fracture –Cause of Injury Occurs in lower end of radius MOI is fall on outstretched hand, forcing radius and ulna into hyperextension

27. © 2007 McGraw-Hill Higher Education. All rights reserved.

29. –Signs & Symptoms Forward displacement of radius causing visible deformity (__________________) When no deformity is present, injury may be passed off as bad sprain Extensive bleeding and swelling Tendons may be torn/avulsed and there may be median nerve damage –Treatment Cold compress, splint wrist and refer to physician X-ray and immobilization ___________ complications a Colles’ fracture will keep an athlete out for ____________

30. © 2007 McGraw-Hill Higher Education. All rights reserved. Anatomy of the Wrist, Hand and Fingers

31. © 2007 McGraw-Hill Higher Education. All rights reserved.

34. Recognition and Management of Injuries to the Wrist, Hand and Fingers Wrist Sprains –Cause of Injury Most common wrist injury Arises from any __________, _________movement Falling on ________________, ___________or __________ –Signs & Symptoms Pain, swelling and difficulty w/ movement

35. © 2007 McGraw-Hill Higher Education. All rights reserved. –Treatment ____________________ for _______ if severe RICE, splint and analgesics Have athlete begin strengthening soon after injury Tape for support can benefit healing and prevent further injury

36. © 2007 McGraw-Hill Higher Education. All rights reserved. Scaphoid / Navicular Fracture –Cause of Injury Caused by force on outstretched hand, compressing scaphoid between _______ and _________of _________________ –Signs & Symptoms Swelling, severe pain in _____________________ –Treatment Must be splinted and referred for X-ray prior to casting –_____________________________________ ____________lasts __________and is followed by ______________ and _______________ Wrist requires protection against impact loading for 3 additional months Often fails to heal due to poor _________________

37. © 2007 McGraw-Hill Higher Education. All rights reserved.

38. Metacarpal Fracture –Cause of Injury _____________ force or ______________force Fractures of the ________________are associated w/ boxing or martial arts (______________) –Signs & Symptoms Pain and swelling; possible _______ or _________deformity Palpable defect is possible –Treatment RICE, refer to physician for ________ and _____________ Deformity is reduced, followed by splinting - _______________

39. © 2007 McGraw-Hill Higher Education. All rights reserved.

40. Recognition and Management of Finger Injuries Mallet Finger –Cause of Injury Caused by a blow that contacts tip of finger ________ ________________ from ___________ –Signs & Symptoms Pain at _____; X-ray shows avulsed bone on ______ _______________________ Unable to ________ distal end of finger (carrying at ___________angle) Point tenderness at sight of injury –Treatment RICE and splinting (in ___________) for 6-8 weeks

41. © 2007 McGraw-Hill Higher Education. All rights reserved. Boutonniere Deformity –Cause of Injury Rupture of ________tendon ________to the middle phalanx Forces _____ joint into extension and _____ into flexion –Signs & Symptoms Severe pain, obvious deformity and inability to _______DIP joint Swelling, point tenderness –Treatment Cold application, followed by _________of ____ Splinting must be continued for ________ Athlete is encouraged to ____________________

42. © 2007 McGraw-Hill Higher Education. All rights reserved. Gamekeeper’s Thumb –Cause of Injury Sprain of ____ of ____ joint of the thumb Mechanism is _____________ of ______________ occasionally combined w/ ______________ –Signs & Symptoms Pain over UCL in addition to ____ and painful _______ Tenderness and swelling over __________ aspect of thumb –Treatment Immediate follow-up must occur If ___________ exists, athlete should be referred to _________ If stable, X-ray should be performed to rule out ___________ _____________should be applied for protection for ________or until pain free

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44. Dislocation of Phalanges –Cause of Injury Blow to the tip of the finger (____________ __________________________ ) –Forces 1 st or 2 nd joint ______________ Results in tearing of ___________________and ____________________ Possible rupture of __________ or ____________tendon(s) and/or _________________may also occur –Treatment ____________ should be performed by physician X-ray to rule out fractures Splint for ________ in _________of __________ –Inadequate immobilization may lead to _________ ___________________________________ Buddy-tape for support upon return

45. © 2007 McGraw-Hill Higher Education. All rights reserved. –Treatment Special consideration must be given for ________ dislocations and ________ dislocations MCP joint of thumb dislocation occurs with thumb forced into _________________ Any MCP dislocation will require ________________ by a physician