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Wrist, Hand, Elbow & Shoulder
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  1. Wrist, Hand, Elbow & Shoulder Chapters 12, 11 & 10

  2. Anatomy of the Wrist and Hand • Looks a lot like the foot • Has similar bone structures: • Phalanges • Metatarsals • Carpals • There are 26 bones • There are many ligaments that hold the structure of the hand together

  3. Carpal Bones Proximal: A=Scaphoid B=Lunate C=Triquetral D=Pisiform Distal: E=Trapezium F=Trapezoid G=Capitate H=Hamate

  4. The Scaphoid Bone • Find your anatomical snuff box • Only blood supply at one end of the bone • It has difficulty healing if the blood supply is interrupted

  5. Joints of the wrist and hand • There are three phalanges in each finger and two in the thumb • Distal, middle and proximal • Joints: • Distal Interphalangeal jnt (DIP) • Proximal Iinterphalangeal jnt (PIP) • Metacarpal Phalangeal jnt (MCP) • Carpometacarpal jnt (CMP)

  6. Muscles of the hand and forearm • There are two major groups of muscles at the wrist and forearm • Flexors: on the dorsal side of the hand • Extensors: on the ventral side of the hand

  7. The Thumb • Testing the ulnar collateral ligament of the thumb • The collateral ligaments of the thumb provide the majority of its stability

  8. Preventing injuries to the hand Boxing Batting Cycling Field hockey/ girls lacrosse

  9. More Gloves Lineman Gloves Receiver/ Running back gloves

  10. Splints

  11. Wrist Sprains • Occur from twisting and overuse • Injured structure depends upon the stress placed on the wrist • Ulnar Deviation is movement towards the ulnar

  12. Radial deviation is movement towards the radius

  13. The Lunate • Dislocation of the lunate bone occurs more often than any other carpal dislocation • Presents as deformity, pain, swelling, and decreased range of motion

  14. Ganglion Cyst • A pocket of fluid within the sheath • Should be referred to a physician • Sometimes is removed surgically

  15. Gamekeepers/Skiers Thumb • Thumb is forced into abduction forcefully • Pain over the joint, swelling may be present • An x-ray may be necessary to rule out a fracture

  16. A “Jammed” Finger • A sprain of the collateral ligaments in the finger

  17. Finger Dislocations Don’t JUST “pop” it !!!!! • There could be underlying hidden issues going on at the joint • There could be a tendon rupture or a fracture!!!

  18. Fractures • Boxer’s fracture is most common in athletes for many reasons

  19. Fractures • Other fractures require the same care and treatment

  20. Muscle and Tendon Injuries • Repetitive stress and stretching can cause injuries to these structures • Some of these include • Carpal tunnel • deQuervian’s tendinitis • Mallet Finger • Jersey finger • Boutonniere deformity

  21. Carpal tunnel

  22. Carpal tunnel • Most common as an overuse injury • Tennis • Field hockey • Watch for acute carpal tunnel due to poor position in slings and casts

  23. deQuervian’s tendinitis • Abductor pollicis longus & Extensor Pollicis brevis tendons • Prolonged or repetitive radial deviation (shot putters) • Swelling, crepitus and pain with abduction

  24. Mallet Finger • An avulsion fracture of the distal phalanx. • Cannot extend the distal phalanx

  25. Jersey finger • Avulsion fracture of flexor tendon • Unable to flex the DIP

  26. Boutonniere deformity • Deformity arises when there is a rupture of the central slip of the extensor mechanism. • This is an uncommon sporting injury usually due to an end-on injury to the finger with sudden bending at the P.I.P. joint • Often in football or basketball

  27. Boutonniere deformity

  28. Elbow • This is a very bony joint • Common to have contusions all around the elbow. • Use PRICES

  29. Elbow

  30. Ligaments • There is thick joint capsule surrounding the elbow. • Relies on the ligaments for stability • Ulnar collateral • Radial collateral • Annular

  31. Muscles • Biceps- elbow flexion • Triceps- elbow extension • Wrist flexors- medial epicondyle of humerus • Wrist extensors- lateral epicondyle of humerus

  32. What it really looks like

  33. Preventing Injuries to the Elbow • Not a frequently injured joint • Many of the injuries are caused by overuse • Most injuries occur in racket sports such as tennis, or overhead throwing sports such as baseball and softball. • Many times injuries are brought about by poor training

  34. Preventing Injuries to the Elbow • Athletes train the “beach muscles” • Overwork the Biceps to get “ pipes” or “guns” • What about the Triceps??? • What about the wrist flexors and extensors??

  35. What about equipment? • Tennis players can cause themselves injuries if the grip is too small on the racket. • Throwers should have a strong tricep and lots of flexibility in the elbow to prevent injuries.

  36. Ulnar collateral More common in throwers The stress of overhead activity strains the medial aspect of the elbow. Wrestling? Pain and swelling treat as any other ligament sprain Radial Collateral These are rare Treat the same as a ulnar collateral sprain. Sprains

  37. Vascularity and Nerves • There are numerous blood vessels and three major nerves that pass though t he elbow

  38. Epicondylitis Lateral Epicondylitis • aka: Tennis Elbow • Poor mechanics and overuse • Presents as pain and swelling at the lateral epicondyle • Treat with PRICES Medial Epicondylitis aka: Little League Elbow Repetitive Throwing Little league elbow may have an avulsion fracture at the epiphysis

  39. Fractures • Elbow fractures are rare in athletics. • Often results from a forceful blow to the area or landing on hard surface.

  40. Elbow Dislocation

  41. Elbow Dislocation

  42. Elbow Dislocation • One of the most commonly dislocated joints in the body • Doesn’t take a lot of force to dislocate the joint • MUST BE SEEN by MD immediately

  43. Olecranon Bursitis

  44. Olecranon Bursitis • PRICES • Use a compression wrap or sleeve to alleviate swelling • May have to be drained by MD • Not always painful

  45. Shoulder Anatomy A separation occurs here at the acromio-clavicular joint A dislocation occurs here at the gleno-humeral joint

  46. Bony Anatomy • Three bones: • Humerus • Bicipital groove • Clavicle • S shape • Scapula • Corocoid process • Acromion process (a/c joint) • Many ligaments • Not a very stable joint

  47. There are many joints at the shoulder Most commonly injured joints are Acromio-clavicular Gleno-humeral Each held together by many ligaments JOINTS

  48. JOINTS

  49. Muscles of the shoulder • The Rotator Cuff • SITS muscles • Supraspinatus • Infraspiantus • Teres minor • Subscapularis • Deltoid • Lays over the head of the humerus • Pectoralis • Originate at sternum attach to the anterior portion of the humerus

  50. Biceps- two heads Originates at the Coracoid process and the Humerus Distal attachment is a the radial head Runs through the bicipital groove ACTION: elbow flexion and forearm supination Triceps Originates at the posterior humeral head and scapula Distal attachment is distal humerus at the elbow ACTION: Elbow extension and shoulder extension Muscles