The Elbow Wrist and Hand

Bones of the ElbowThree bones of the elbow:HumerusRadius- lateral boneUlna- medial bone

ElbowBonesHumerusUlnaRadiusMusclesBiceps BrachiiBrachioradialisTriceps BrachiiBrachialis

LigamentsUlnar CollateralRadial Collateral

Elbow AnatomyBiceps Brachii-Long head attached to coracoid process of scapula Short head attached to supraglenoid tubercle of scapula

AnatomyTriceps BrachiiLong head: infraglenoid tubercle of scapula; Lateral head: posterior surface of humerus, superior to radial groove; Medial head: posterior surface of humerus, inferior to radial groove

Elbow InjuriesContusions-Due to the nature of many contact sports contusions are common and if treated quickly with RICE can have a quick return to play.Pay close attention for myositis ossificans especially in the upper arm region.

Olecranon BursitisBursa are located near the tendons of the larger joints.Usually the result of a direct blow, but can be chronic. Small abrasions of elbow can cause infection to the bursa and swelling.Usually RICE but if there is infection aspiration may be needed.

Ulnar Nerve ContusionBlow or contusion to the ulnar nerve.It runs behind the medial epicondyle so there is little protection for it. Transiant pain and burning occur, numbness may persist if it is serious. If normal sensation does not return within 15 minutes a doctor visit is advisable.

StrainsCommon extensor tendon and common flexor tendon are the most common location.It can be chronic or acute.A chronic strain can result into an itis or rupture or torn muscle.

EpicondylitisOveruse of the tendon attached to the epicondyle of the humerus.Faulty technique/mechanics, weak muscles or improper equipment.Can be on lateral side- tennis or golfers elbowCan be on the medial side- pitchers elbow

Young Athletes Elbow InjuryLittle Leaguers elbow-repetitive action resulting in elbow pain in youngThe elbow area is the last epiphyseal center to close so injuries can occur.

Young Athletes Elbow InjuryLittle Leaguers elbow can result in in varies fractures or bone growths.

EpicondylitisSigns and SxPain over epicondyleIncrease pain with wrist flexion or extensionElbow contracture

TreatmentProper techniqueProper equipmentGood warm up with slow increase in intensityStretching RICE

Ulnar Collateral LigamentTommy Johns surgery- Replace the ulnar collateralLigament on the medialSide of the elbow. UsuallyThe ligament tears when Pitcher feels a pop. MRI isConfirming diagnosis.

Ulnar Ligament Injures

SprainsA result of forced hyperextension or valgus/varus forces.The elbow is a relatively stable joint so this is not a common injury.

SprainsSigns and SxClick or pop heardSharp pain at time of injuryLocalized swelling and painAthlete wants to flex elbowTreatmentBracing to limit painful motionsStrengthen muscles of the jointRICESpecial Tests?Lets Tape

DislocationsElbow is the second most commonly dislocated major joint.Most often the ulna/radius dislocate posterior to the humerus.MOI- fall of outstretched arm with elbow locked in extension.

DislocationsSigns and SxObvious deformityCheck circulation and nerve function

TreatmentImmobilizationWrist strengthening and then progress to elbow RICE

Fractures to Elbow/ForarmOften occurs due to a direct blow or a fall on outstretched arm.Most common childhood injury, often involves the epiphysis.

Fractures to Elbow/ForarmSigns and Sx Point tendernessPossible deformitySwellingLimited ROMTreatmentImmobilizationRICEStrengthening of the joints surrounding and then whole arm when cast is removed.

Splinting?

Wrist and Hand InjuriesFractures of the Wrist and HandFinger FracturesBoxers Fracture- fracture of 5th metacarpal. Hitting something with fisted hand.

Wrist and Hand InjuriesFractures of the Wrist and HandWrist FracturesColless fracture- fracture of the radius just above the wrist. A result of a fall with wrist extended.

Nerves of the Elbow/WristUlnar NerveMedian NerveRadial Nerve

Median Nerve InjuryCarpal Tunnel Syndrome- compression of the median nerve as it passes through the carpal tunnel as a result of repetitive use of the hand and wrist. The compression is a result of inflammation. Surgery may be needed.

Wrist and Hand AnatomyThe wrist is made up of 8 wrist bones called carpals.PisiformTriquetralHamateLunateTrapeziumTrapezoidCapitateScaphoidIn a group make up pneumonic

Wrist and Hand AnatomyThe metacarpals form the structure of the hand.The phalanges are the fingers.There are 27 bones in the hand including the wrist.Each finger has an extender tendon and a flexor tendon.

Wrist and Hand AnatomyThe wrist and hand have many muscles.Flexor muscles are on the anterior sideExtensor muscles are on the posterior side.Digitorum muscles control the fingersPollicis muscles control the thumb.

Wrist and Hand AnatomyThe wrist and hand have many muscles.Flexor muscles are on the anterior sideExtensor muscles are on the posterior side.Digitorum muscles control the fingersPollicis muscles control the thumb.

Wrist and Hand InjuriesFractures of the Wrist and HandFinger FracturesScaphoid Fracture- fracture of scaphoid which you call palpate in anatomical snuffbox. Occurs with fall on hand in extension.

Tendon Injuries Mallet Finger- hitting something with the tip of a finger and causing the extensor tendon to tear. Jersey Finger- grabbing something and tearing the flexor tendon.

Tendon Injuries Boutonniere deformity- extensor tendon injury affectingtwo joints of the finger. It isan injury to the central tendon on top of the finger.It may appear as a jammed finger that cannot be extended from the PIP joint.Treatment should be in an extended position so the tendon can heal.

Dislocations/Subluxations Dislocations occur in the fingers and wrist bones. Point tenderness and swelling, possible deformity. Physician intervention may be necessary.

Contusions There are various contusions to the wrist, hand and fingers. Most noted is the nail contusing where blood pools under the nail. Pressure can be painful and necessary to drain.

Sprains Can happen in fingers and wrist bones.Gamekeepers thumb- sprain of the ulnar collateral ligament of the thumb.Special TestTaping

TendonitisVarious kinds can occurdeQuervains tenosynovitis- inflammation at the base of the thumb on the back of the wrist and palm side of wrist. It is usually the result of repetitive wringing, grasping, turning and twisting .

Ganglion Cyst of the WristGanglion (synovial hernia or cyst)- small hard lump above a tendon or in the capsule that encloses a joint. It is a fluid filled cyst that is not cancerous.Unknown causeMay be necessary to drain or surgically remove if it becomes painful.

Wrist StrengtheningFlexionExtensionUlnar DeviationRadial DeviationPronationSupination