secta sports medicine. bones humerus ulna radius ligaments ulnar collateral lig. annular lig....
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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