ELBOW, WRIST & HAND

SECTASports Medicine

The Elbow

Bones humerus ulna radius

Ligaments ulnar collateral lig. annular lig. radial collateral lig.

The Elbow

Muscles triceps brachii biceps brachii brachialis Anconeus

(posterior) brachioradialis

The Elbow

Common injuries of the elbow: Contusions Sprains/Strains Dislocations Fractures Nerve Injuries Epicondylitis Volkmann’s Contracture

The Elbow

Contusions Common Caused by a direct blow Bleeding & bruising

Treatment RICE Protective Padding

The Elbow - Contusions

NORMAL SKIN CONTUSION

The Elbow

Sprains Commonly result from

forced hyperextension or side to side forces

“click” or “pop” sound with sharp pain

Localized swelling & pain Arm will be held in a

flexed position

Treatment RICE Use of a specialty brace

may be suggested

The Elbow

Strain Result from the high

amounts of stress place on the elbow

Acute Sudden overload

Chronic Continued overuse

Treatment RICE Use of a specialty brace

may be suggested

The Elbow

Dislocation The 2nd most

frequently dislocated major joint

Most common- posterior displacement of the ulna Results from a fall on

an outstretched hand with the elbow hyperextended

The Elbow- Dislocation

Signs & Symptoms If displaced-

obvious deformity Loss of function Considerable pain

The Elbow- Dislocation

Treatment Properly

immobilized Transport to the

athlete’s physician or the nearest medical facility

The Elbow

Fractures Caused by direct trauma, indirect stress

(falling), excessive forces (throwing) Most common in children or skeletally

immature athletes Many involve the growth plate (epiphysis)

The Elbow- Fractures

Signs & Symptoms Point tenderness Swelling Limited range of

motion Disability at the

elbow or hand Increased pain at

the fracture site when attempting movement Olecranon Process Fracture

The Elbow- Fractures

Treatment Immobilization Ice Elevation Immediate referral

to medical facility

The Elbow

Nerve Injuries Not as common as musculoskeletal injuries

Ulnar Nerve Contusion Cubital Tunnel Syndrome Radial Tunnel Syndrome Pronator Teres Syndrome

The Elbow- Nerve Injuries

Ulnar Nerve Contusion

Blow or contusion to the ulnar nerve (funny bone)

Immediate pain & burning sensation shooting down the forearm to the ring and little fingers

Depending on the severity of the blow the pain may last from a few minutes to a longer period of time

The Elbow- Nerve Injuries

Cubital Tunnel Syndrome Ulnar nerve becomes trapped and compressed

in the cubital tunnel (posterior aspect of the medial epicondyle groove)

Due to repetitive movement (throwing or swimming)

Signs & Symptoms Pain along inner aspect of the elbow Tenderness over medial epicondylar groove Paresthesia in distrubution of ulnar nerve in the

hand

The Elbow- Nerve Injuries

Radial Tunnel Syndrome Radial nerve becomes trapped during

activities requiring repetitive pronation and supination of the forearm

Sign & Symptoms Pain over lateral aspect of the elbow Tenderness over anterior radial head

The Elbow- Nerve Injuries

Pronator Teres Syndrome Median nerve becomes trapped or

compressed due to hypertrophy of pronator teres or repetitive pronation of the forearm

Signs & Symptoms Pain radiating down the anterior forearm Numbness, tingling in the thumb, index and

middle fingers

The Elbow

Epicondylitis Chronic strain of the medial or lateral epicondyle Caused by faulty mechanics or techniques, weak

muscle groups, inappropriate equipment

Tennis Elbow Commonly given to pain on the lateral side of the

elbow Golfer’s Elbow

Commonly given to pain on the medial side of the elbow

Pitcher’s Elbow, Bowler’s Elbow, Javelin Thrower’s Elbow

The Elbow- Epicondylitis

Signs & Symptoms Local tenderness over epicondyle Pain with the use of the involved muscle Possible swelling

Treatment Preventive: proper equipment, proper

technique, limited stress Proper warm up and stretch RICE Modified activities

The Elbow

Volkmann’s Contracture Absence of blood flow (ischemia) to the

forearm From swelling, fracture, burns, excessive

exercise, injections in the forearm, animal bites

Muscles on the palm side of the forearm shorten Causes the fingers to form a fist and flex toward

the wrist

Mild, Moderate, Severe

The Elbow- Volkmann’s Contracture

Signs & Symptoms Severe pain when muscle is passively moved Swollen Shiny Pain when forearm is squeezed Pain gets worse with time Decreased sensation Weakness Paleness of the skin

The Elbow- Volkmann’s Contracture

The Wrist & Hand

Bones Ulna Radius Carpals Metacarpals Phalanges

The Wrist & Hand

Muscles Hand

Supinator Pronator teres Pronator quadratus

Thumb Flexor pollicis longus Flexor pollicis brevis Extensor pollicis longus Extensor pollicis brevis Adductor pollicis Abductor pollicis longus Abductor pollicis brevis Opponens pollicis

Fingers Flexor digitorum

profundus Flexor digiti mimimi

brevis Interossei dorsalis Flexor digitorum

superficialis Extensor indicis Interossei palmaris Abductor digiti minimi Oppenens digiti minimi Extensor digitorum

communis

The Wrist & Hand

The Wrist & Hand

The Wrist & Hand

Fractures Boxer’s Fracture Baseball (Mallet) Finger Jersey Finger Scaphoid Fracture Colles’s Fracture

The Wrist & Hand- Fractures

Boxer’s Fracture A break in the 5th

metacarpal leading to the little finger

Caused by slamming a clenched fist against a solid object

The Wrist & Hand- Fractures

Baseball (mallet) Finger Caused by an

object hitting the tip of the finger

Finger is bent beyond its normal range of motion

The finger tendon is torn and cartilage is damaged

The Wrist & Hand- FracturesMallet Finger

FINGER TENDON IS TORN DUE TO OVER FLEXION

DAMAGE TO SURROUNDING TISSUE DUE TO OVER FLEXION AND FORCE OF

IMPACT

The Wrist & Hand- FracturesMallet Finger

Treatment RICE Support Evaluation by

physician

The Wrist & Hand- Fractures

Jersey Finger Tearing of the

flexor tendon to the fingertip

Usually caused during a tackle

Most often affects the ring finger

The Wrist & Hand- FracturesJersey Finger

INABILITY TO FLEX FINGER TREATMENT CONSISTS OF SURGERY TO REATTACH TENDON

The Wrist & Hand- Fractures

Scaphoid Fracture Most commonly

fractured bone in athletics

Caused by a fall on an outstretched hand

Palpation at the anatomical snuffbox will cause pain

The Wrist & Hand- Fractures

Colles’s Fracture Common fracture

of the lower radius just above the wrist

The Wrist & Hand- FracturesColles’s Fracture

CAUSED BY FALLING ON AN OUTSTRETCHED HAND AND THE WRIST ABSORBS THE FORCE OF

IMPACT

TREATMENT OFTEN REQUIRES SURGERY WITH HARDWARE

The Wrist & Hand

Carpal Tunnel Syndrome Anatomy:

The carpal tunnel is a passageway that run from the forearm through the wrist

Bones form the walls and a ligament bridges over them

The median nerve and 9 tendons pass through the tunnel

The Wrist & HandCarpal Tunnel Syndrome

Causes: Inflammation disorder

caused by: repetitive stress, physical injury, or other conditions that caused tissues to swell

Inflammation of the protective linings of the tendons

Thickening & broadening of the ligament that forms the roof of the tunnel

High force Repetition Awkward joint

posture Direct pressure Vibration Prolonged

constrained posture Dislocation Fractures Rheumatoid arthritis Diabetes Hypothyroidism

The Wrist & HandCarpal Tunnel Syndrome

Signs & Symptoms Pain Numbness Tingling Weakness- drop things Loss of heat/cold

sensation Feeling of swollen

hands though there is no swelling

Symptoms may occur at rest as well as during use

The Wrist & HandCarpal Tunnel Syndrome

Treatment Rest for at least 2 weeks Ice Splint or brace b

No real evidence they work Some believe they make the problem worse

Surgery

The Wrist & Hand

Ganglion Cyst Small, hard lump

above a tendon or in the capsule that encloses a joint

Also known as synovial hernia or synovial cyst

The Wrist & HandGanglion Cyst

Common condition for: Bowlers Handball players Racquetball

players Squash players Tennis players

The Wrist & HandGanglion Cyst

A ganglion can also appear: Palm side of the

wrist Base of the fingers Feet

Treatment Small cysts need

not be treated

The Wrist & Hand

Boutonnière Deformity A tear or slip of the

extensor tendon of the proximal interphalangeal joint and the distal interphalangeal joint

The Wrist & HandBoutonnière Deformity

Causes: Finger is bent or hit

forcibly Jammed finger

Signs & Symptoms Joints will be

painful and tender Unable to

straighten finger

The Wrist & HandBoutonnière Deformity

Treatment Treatment must be

relatively quick to be effective

If not treated tissues will lose their elasticity- making it difficult for them to return to normal