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The Elbow Wrist and

Hand

Bones of the Elbow


Three bones of the
elbow:
Humerus
Radius- lateral
bone
Ulna- medial bone

Elbow
Bones
Humerus
Ulna
Radius

Muscles

Biceps Brachii
Brachioradialis
Triceps Brachii
Brachialis

Ligaments
Ulnar Collateral
Radial Collateral

Elbow Anatomy
Biceps Brachii Long head attached
to coracoid process
of scapula
Short head
attached to
supraglenoid
tubercle of scapula

Anatomy
Triceps Brachii
Long 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 Injuries
Contusions 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 Bursitis
Bursa 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 Contusion


Blow 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.

Strains
Common 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.

Epicondylitis
Overuse 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 elbow
Can be on the medial side- pitchers
elbow

Young Athletes Elbow


Injury

Little Leaguers elbowrepetitive action


resulting in elbow pain
in young
The elbow area is the
last epiphyseal center
to close so injuries can
occur.

Young Athletes Elbow


Injury

Little Leaguers elbow


can result in in varies
fractures or bone
growths.

Epicondylitis
Signs and Sx
Pain over
epicondyle
Increase pain with
wrist flexion or
extension
Elbow contracture

Treatment

Proper technique
Proper equipment
Good warm up with
slow increase in
intensity
Stretching
RICE

Ulnar Collateral
Ligament

Tommy Johns surgery-

Replace the ulnar collateral


Ligament on the medial
Side of the elbow. Usually
The ligament tears when
Pitcher feels a pop. MRI is
Confirming diagnosis.

Ulnar Ligament Injures

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

Sprains
Signs and Sx
Click or pop heard
Sharp pain at time of
injury
Localized swelling and
pain
Athlete wants to flex
elbow

Special Tests?
Lets Tape

Treatment
Bracing to limit
painful motions
Strengthen muscles
of the joint
RICE

Dislocations
Elbow 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.

Dislocations
Signs and Sx
Obvious deformity
Check circulation
and nerve function

Treatment
Immobilization
Wrist strengthening
and then progress
to elbow
RICE

Fractures to
Elbow/Forarm

Often occurs due to a direct blow or


a fall on outstretched arm.
Most common childhood injury, often
involves the epiphysis.

Fractures to
Elbow/Forarm

Signs and Sx

Point tenderness
Possible deformity
Swelling
Limited ROM

Splinting?

Treatment

Immobilization
RICE
Strengthening of
the joints
surrounding and
then whole arm
when cast is
removed.

Wrist and Hand Injuries


Fractures of the Wrist and Hand
Finger Fractures
Boxers Fracture- fracture of 5th metacarpal.
Hitting something with fisted hand.

Wrist and Hand Injuries


Fractures of the Wrist
and Hand
Wrist Fractures
Colless fracture- fracture
of the radius just above
the wrist. A result of a fall
with wrist extended.

Nerves of the
Elbow/Wrist

Ulnar Nerve
Median Nerve
Radial Nerve

Median Nerve Injury


Carpal Tunnel
Syndromecompression 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 Anatomy


The wrist is made
up of 8 wrist bones
called carpals.
Scaphoid

Lunate
Pisifor
m

Capitate
Trapezium
Trapezoid

Triquetral
Hamate

In a group make up pneumonic

Wrist and Hand Anatomy


The 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 Anatomy


The wrist and hand have many
muscles.
Flexor muscles are on the anterior
side
Extensor muscles are on the posterior
side.
Digitorum muscles control the fingers
Pollicis muscles control the thumb.

Wrist and Hand Anatomy


The wrist and hand have many
muscles.
Flexor muscles are on the anterior
side
Extensor muscles are on the posterior
side.
Digitorum muscles control the fingers
Pollicis muscles control the thumb.

Wrist and Hand Injuries


Fractures of the
Wrist and Hand
Finger Fractures
Scaphoid Fracturefracture 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 deformityextensor tendon injury affecting
two joints of the finger. It is
an 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/Subluxation
s

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 Test
Taping

Tendonitis

Various kinds can occur


deQuervains
tenosynovitisinflammation 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


Wrist

Ganglion (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 cause
May be necessary to drain or
surgically remove if it
becomes painful.

Wrist Strengthening
Flexion
Extension
Ulnar Deviation
Radial Deviation
Pronation
Supination

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