The elbow wrist and hand
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The Elbow, Wrist, and Hand. Chapter 20. Skeletal Anatomy – Wrist and Hand. The Wrist and Hand Made up of 27 bones 8 carpal bones make up the wrist 5 metacarpals from the structure of the hand 14 phalanges 2 for the thumb 3 for each other 4 fingers. Skeletal Anatomy - Elbow.

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The Elbow, Wrist, and Hand

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The elbow wrist and hand

The Elbow, Wrist, and Hand

Chapter 20


Skeletal anatomy wrist and hand

Skeletal Anatomy – Wrist and Hand

  • The Wrist and Hand

    • Made up of 27 bones

      • 8 carpal bones make up the wrist

      • 5 metacarpals from the structure of the hand

      • 14 phalanges

        • 2 for the thumb

        • 3 for each other 4 fingers


Skeletal anatomy elbow

Skeletal Anatomy - Elbow

  • 3 bones of the elbow joint

    • Humerus

    • Radius

    • Ulna

  • Many structures surround the elbow

    • Ligaments

    • Nerves

    • Muscles

    • Bursa sacs


Muscles of the elbow

Muscles of the Elbow

  • Forearm Flexors

    • Brachialis

    • Biceps Brachii

    • Brachioradialis

  • Forearm Extensors

    • Triceps Brachii

    • Anconeus


Common injuries of the elbow

Common injuries of the Elbow

  • Several causes for a variety of athletic injuries

    • Direct trauma

    • Indirect trauma

    • Acute/Chronic stresses

  • These MOIs can result in several injuries

    • Contusions

    • Sprains

    • Strains

    • Dislocations

    • Fractures

    • Nerve involvement


Contusions

Contusions

  • Common injury that may involve the muscles of the forearm and subcutaneous bony prominences of the elbow

    • Usually caused by a direct blow

  • Symptoms

    • Bruising

    • Subsequent bleeding

    • Stiffness during function or

      active motion

  • Treatment

    • PRICE

      • Prevents myositisossificans


Olecranon bursitis

Olecranon Bursitis

  • Inflammation of the olecranon bursitis

    • Caused by direct blows to the olecranon process

    • Can be accompanied by infection due to the frequent abrasions that occur over the tip of the elbow

  • Treatment

    • Depends on whether infection is involved

    • Uninfected bursitis

      • Ice compresses

      • Rest

    • Anti-inflammatory meds

    • Pain meds

    • Aspiration of the bursa


Ulnar nerve contusion

Ulnar Nerve Contusion

  • Caused by a direct blow the medial epicondyle of the humerus

    • Athlete complaints of immediate pain and burning sensation down the ulnar side of the forearm to the ring and little fingers

      • Also known as hitting the “funny bone”

  • Treatment

    • None is usually necessary


Elbow strains

Elbow Strains

  • Normally occur with a sudden overload to the elbow joint

    • can acute or chronic

  • Acute Strains

    • Sudden excessive overload

    • Tenderness over the affected area

    • Pain on function or resisted motion

  • Chronic Strains

    • Result of continued overuse

    • Overuse syndrome

    • Chronic degenerative processes

  • Common areas of acute strains

    • Common flexor tendon

      • Medial epicondyle

    • Common extensor tendon

      • Lateral epicondyle


Elbow sprains

Elbow Sprains

  • Usually due to forced hyperextension or valgus/varus forces

  • Symptoms

    • Click or pop

    • Sharp pain at injury

    • Tenderness

    • Localized swelling

    • Pain when repeating MOI

      • Usually relieved by bending the elbow


Epicondylitis

Epicondylitis

  • Usually caused by repetitive overload of the attached musculotendinous units

    • Occurs in the region of the medial and lateral epicondyle of the humerus

    • Called “tennis elbow” if lateral

    • Called “golfer’s elbow” if medial

    • If it occurs in younger patients, called “little leaguer elbow”

    • Can also accompany an injury to the growth plate of the epiphysis


Epicondylitis cont d

Epicondylitis cont’d

  • Symptoms

    • Pain when used

    • Possible swelling

    • Local tenderness

    • Pain with resisted wrist motion

  • Without proper treatment condition

    may worsen

    • May develop into prolonged degenerative changes

    • Causes chronic epicondylitis

    • Contractures of the elbow

    • Reduced friction

    • Possible rupture of muscle tendon unit

  • Treatment

    • RICE

    • Modifying activities that aggravate conditions

  • Preventive measures

    • Using proper technique/equipment

    • Limiting stress

    • Adequately warming up

    • stretching


Dislocations of the elbow

Dislocations of the Elbow

  • Most commonly involves the posterior displacement of the ulna and radius in relationship to the humerus

    • Often caused by a fall onto an outstretched hand with elbow in extension

  • Symptoms

    • Obvious deformity

    • Loss of elbow function

    • Considerable pain

    • Initial exam should include evaluation

      of nerve function of hand and fingers

  • Treatment

    • Immobilzation

    • Immediate referral to physician of medical facility

    • Possible vascular and neurological damage


Forearem elbow fractures

Forearem/Elbow Fractures

  • The result of either direct trauma or indirect stresses transmitted through the upper extremity by falling on an outstretched arm

    • Fractures in younger athletes commonly

      involve epiphyseal plate fractures

  • Symptoms

    • Directly related to degree of severity

    • Point tenderness

    • Hemorrhaging

    • Swelling

    • Limited ROM

    • Disability at elbow or hand

    • Increased pain with movement

  • Treatment

    • Immobilization

    • Ice

    • Prompt referral to physician or medical clinic


Volkmann s contracture

Volkmann’s Contracture

  • Occurs in the absence of blood flow (ischemia) to the forearm

    • Can lead to contracture, where joint remains bent and cannot straighten

  • Causes

    • Increased pressure from swelling or trauma

    • Fracture

  • 3 Levels of severity in Volkmann’s Contracture

    • Mild

      • Involves contracture of 2 or 3 fingers

      • No limited loss of sensation

    • Moderate

      • Involves all fingers being flexed

      • Thumb stuck in palm

      • Wrist may be stuck in flexion

      • Usually loss of sensation in the hand

    • Severe

      • Involves all muscles in forearm (flexors and extensors)

      • Fingers

      • Severely disabling condition


Volkmann s contracture cont d

Volkmann’s Contracture cont’d

  • Symptoms

    • Severe pain when a muscle running through a compartment is passively moved

    • Forearm may be swollen

    • Shiny

    • Painful when squeezed

    • Pain does not improve with rest, but continues to worsen with time

    • If condition is not corrected

      • Decreased sensation

      • Weakness

      • Paleness of the skin


Ulnar nerve injury

Ulnar Nerve Injury

  • Repetitive throwing and/or swinging can cause irritation, compression, or entrapment in the cubital tunnel

    • Called cubital tunnel syndrome

  • Symptoms

    • Pain along the inner aspect of the elbow

    • Tenderness of the medial epicondylar groove

    • Paresthesia (numbness or tingling) of ring and little finger


Radial nerve injury

Radial Nerve Injury

  • Usually caused by entrapment of the nerve which passes through a tunnel formed by several muscles and tendons

    • Also called radial tunnel syndrome

  • Symptoms

    • Pain over lateral aspect of the elbow

    • Pain over radial head


Median nerve injury

Median Nerve Injury

  • Includes entrapment or compression due to hypertrophy of the pronatorteres or repetitive pronation of the forearm

    • Called pronatorteres syndrome

  • Symptoms

    • Pain radiating down the anterior forearm

    • Numbness and tingling in the thumb, index, and middle fingers

    • Resistive pronation may increase the pain


Muscles of the hand and wrist

Muscles of the hand and wrist

  • Muscles that move the Wrist

    • 2 Flexor Carpi muscles

    • 2 Extensor Carpi muscles

    • 2 Palmaris muscles

  • Muscles that move the Hand

    • 1 Supinator muscles

    • 2 Pronator muscles

  • Muscles that move the Thumb

    • 2 Flexors

    • 2 Extensors

    • 1 adductor

    • 2 abductors

    • 1 opponens

  • Muscles that move the Fingers

    • 3 flexors

    • 2 extensors

    • 3 abductors

    • 1 adductor


Injuries to the hand and wrist

Injuries to the hand and wrist

  • Common injuries

    • Fractures

    • Dislocations

    • Contusions

    • Sprains

    • Tendonitis

    • Nerve Impingements


Finger fractures

Finger Fractures

  • Can involve any of the 14 phalange bones.

    • Most can be treated with a finger splint

  • Boxer’s Fracture

    • A break of the 5th metacarpal leading to the little finger

  • Baseball (mallet) finger

    • Painful injury that occurs when a ball or other object strikes the tip of the finger, bending it beyond its normal ROM which tears the finger tendon and damages cartilage


Finger fractures cont d

Finger Fractures cont’d

  • Jersey Finger

    • Caused by tearing the flexor tendon to the fingertip

      • Usually occurs from grabbing a jersey during a tackle.

        • Ring finger is the most often affected

  • Scaphoid fracture

    • Affects the scaphoid bone

    • Paplpation of the anatomical snuffbox will cause pain, indicates a fracture may be present


Finger fractures cont d1

Finger Fractures cont’d

  • Colles Fracture

    • A break of the radius just above the wrist

  • Treatment for all fractures

    • RICES (rest, ice, compression, elevation, support)

    • Evaluation by a physician


Dislocations and subluxations

Dislocations and subluxations

  • Fairly common injuries

  • Causes

    • Ball striking fingertip

    • Finger getting hooked into equipment

  • Symptoms

    • Immediate pain

    • Swelling

    • Crooked finger

      • Usually can’t be bent or straightened

  • Treatment

    • Ice

    • Immobilization

    • Immediate treatment by physician


Contusions1

Contusions

  • Usually caused by direct blows or falling onto a hard surface

    • With nails become contused, pressure may cause a physician to drain blood from beneath the nail


Sprains of the wrist and hand

Sprains of the wrist and hand

  • Gamekeeper’s thumb

    • Sprain of the ulnar collateral ligament of the metacarpalphalangeal joint (MPJ)

      • Common in alpine skiiing

    • Caused by force applied to the medial side of the thumb, forcing the MPJ to stretch, tear, or even rupture


Tendonitis

Tendonitis

  • The inflammation of the tendons caused by overuse or repetitive stress

  • Symptoms

    • Ache or pain at the wrist

      • Worsens forceful gripping, rapid wrist movements or moving the wrist or fingers to an extreme position

  • Treatment

    • The same as other forms of tendonitis

    • Most common sites in the wrist

      • Base of the thumb near anatomical snuffbox

        • deQuervian’stenosynovitis


Nerve impingement

Nerve Impingement

  • Also called Carpal Tunnel syndrome

  • An inflammatory disorder caused by the following

    • Repetitive stress

    • Physical injury

    • Other conditions that cause swelling around the median nerve near the carpal tunnel

  • Symptoms

    • Pain

    • Numbness

    • Tingling in the wrist, hand, fingers (except little finger)

    • Tendency to drop things

    • Loss of sense of heat or cold

    • Feeling of swelling, even though it is visibly swollen

    • Symptoms may occur only when the hand is being used or only when at rest

  • Treatment

    • RICE

    • In severe cases, surgery to decompress the median nerve


Ganglion cyst

Ganglion Cyst

  • A small, usually hard lump above a tendon or in a capsule that encloses a joint

    • Also called a synovial hernia or synovial cyst

  • It is common in handball, racquetball, squash and tennis

    • Cause of the cyst is unknown


Boutonniere deformity

Boutonniere Deformity

  • An injury to the extensor tendon affecting the proximal interphalangeal joint (PIP) at the middle of the finger or the distal interphalangeal joint at the end of the finger

    • Caused by a direct blow to a bent finger

  • Symptoms

    • Problems flexing and extending the finger

    • Physician should be contacted immediately

    • Joints will be painful and tender

    • Finger misshapen or deformed

    • The athlete will not be able to straighten it

  • Treatment

    • Must be done promptly

    • Athlete may not regain normal use of the finger


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