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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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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