Elbow, Wrist, Hand, and Fingers

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Elbow, Wrist, Hand, and Fingers
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• Elbow Anatomy
• A. The elbow joint is an intricate collection of
  bones, muscles, ligaments, and nerves. It permits
  movements which are used in numerous sports. From
  this joint run the muscle and nerves that control
  and the detailed movements of the hand, wrist,
  and fingers. The elbow and forearm are important
  functional links between the shoulder and the
  intricate mechanisms of the hand. The ability to
  perform athletic skills involving the upper
  extremities is dependant on the integrity on the
  bones, ligaments and muscles of the elbow and
  forearm. The upper limb is prone to acute and
  overuse syndromes.
• B. Bones
• 1. The elbow joint is composed of three bones
  the HUMERUS is the largest bone of the arm and is
  similar to the femur of the leg, in that it has
  two articulating condyles at its lower end these
  are known and the LATERAL and MEDIAL EPICONDYLES.

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• 2. Just as knee ligaments and tendons attach to
  the femurs condyles, arm ligaments and tendons
  use the distal knobs of the humerus as a base of
  attachment the lateral distal end of the humerus
  forms the CAPITULUM, and the medial end forms the
  TROCHLEA the capitulum is a rounded knob that
  articulates with the head of the radius the
  trochlea is a spool-shaped projection that fits
  into the notch of the head of the ulna.
• 3. In anatomical position the ULNA is located on
  the medial (little finger) side and the RADIUS on
  the lateral (thumb) side of the forearm in this
  position, both bones are nearly parallel the
  ulna acts as a stationary axil as the radius
  turns around it as the forearm and hand rotate
  the ulna is a large bone proximally but becomes
  narrower as it extends distally towards the
  wrist the OLECRANON process of the ulna extends
  posteriorly, preventing hyperextension of the
  elbow the radius is much larger distally at the
  wrist and narrows as it extends proximally to the
  radial head the radius is closely approximated
  to the ulna distally and proximally however, it
  has a radial bow in its mid-portion separating it
  from the ulna.

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• 4. An INTEROSSEOUS MEMBRANE connects the two
  bones in the forearm the distal ends of both the
  radius and ulna are known as the STYLOID
  PROCESSES .
• C. Ligaments
• 1. The elbow is considered to have very strong
  ligamentous and muscular support the elbow is
  stabilized by MEDIAL (ULNAR) and LATERAL (RADIAL)
  COLLATERAL LIGAMENTS the MCL is attached to the
  humerus and the ulna, and the LCL is attached to
  the humerus and the radius.
• 2. Adding further to the elbow stability is the
  ANNULAR ligament this ligament attaches to the
  ulna and completely encircles the head of the
  radius the annular ligament keeps the radius and
  ulna from separating.

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• D. Muscles and Tendons
• 1. The BICEPS muscle extends from the humerus and
  scapula to the radius the primary function of
  the biceps group is flexion of the elbow.
• 2. The TRICEPS muscle also originates from the
  humerus(two sites) and scapula and attaches to
  the ulna this muscle groups primary function is
  extension of the elbow.
• 3. The BRACHIALIAS attaches on the humerus and
  inserts on the ulna the brachialias group
  assists in elbow flexion.
• 4. The BRACHIORADIALIS also assists with flexion
  and originates on the lateral humerus and
  attaches to the medial radius.
• 5. The elbow permits not only flexion and
  extension but also supination and pronation of
  the forearm and hand. Pronation is produced
  primarily by the PRONATORS (Pronator Teres and
  Pronator Quadratas) supination is performed by
  the supinator muscles.

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• E. Other Structures
• 1. The BICIPITAL BURSA and the OLECRANON BURSA
  are closed, fluid filled sacs that cushion the
  tendons of the biceps muscle. And the area
  between the olecranon process and the skin,
  respectively.
• F. RANGE OF MOTION
• 1. As discussed previously, the elbow moves in
  flexion and extension the elbow in connection
  with the forearm moves in supination and
  pronation.
• G. Blood and Nerves Supply
• 1. Deep within the elbow lie the BRACHIAL and
  MEDIAL ARTERIES that supply the area with
  oxygenated blood.
• 2. The nerves that innervate the elbow are the
  RADIAL AND MEDIAN NERVES.

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• A. The wrist is that area of articulation between
  the forearm and hand precise functioning of the
  hand and wrist is essential to almost every type
  of athletic activity functional anatomists
  sometimes refer to the hand and wrist as the
  reason for the upper extremity both structures
  are frequently used during athletic activity and
  often function as a single unit together they
  permit a incredible array of intricate movements
  and also observe to absorb or transmit forces
  caused by falls or traumatic contact.
• B. Bones
• 1. The wrist contains the CARPAL BONES, the
  distal ends of the RADIUS and ULNA, and the
  proximal ends of the metacarpals.
• 2. The eight carpal bones of the wrist are named
  according to their general shape and appearance
  they are arranged in two rows, proximal and
  distal, each consisting of four bones the
  proximal row from radial(thumb) side to ulnar
  (little finger) side is composed of the NAVICULAR
  OR SCAPHOID (boat-shaped), the LUNNATE(moon-shaped
  ) the TRIQUETRUM (greater multangular),

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• TRAPEZIOD (lesser multangular), CAPITATE
  (head-shaped), and HAMMATE (hooked) bones.
• 3. THE METACARPALS of the hand are identified by
  numbers 1-5, beginning on the lateral side with
  the metacarpal of the thumb each metacarpal has
  a slightly curved shaft and two extremities a
  base, which articulates proximally with the
  carpals, and a head, which articulates distally
  with the phalanges the heads of the metacarpals
  form the knuckles on the back of the hand,
• 4. THE PHALANGES form the bony skeleton of the
  fingers or digits there are 14 phalanges in each
  hand two for the thumb and three for each of the
  remaining four fingers the bony anatomy of all
  five fingers essentially the same starting
  proximally, middle, and distal phalanges, or as
  the first, second and third phalanges they
  resemble the metacarpals in shape and appearance.

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• 5. The proximal joint between phalanges is
  referred to as the PROXIMAL INTERPHALANGEAL JOINT
  (PIP),while the distal joint it known as the
  DISTAL INTERPHALANGEAL JOINT(DIP) the joint
  between the metacarpals and phalanges is the
  METACARPAL PHALANGEAL JOINT (MIP)
• C. Ligaments
• 1. The wrist is composed of many ligaments that
  bind the carpal bones to one another, to the ulna
  and radius, and to the proximal metacarpal bones
  the ULNAR COLLATERAL LIGAMENT extends from the
  tip of the styloid process of the ulna to the
  medial carpal bones The RADIAL COLLATERAL
  LIGAMENT extends from the styloid process of the
  radius to the navicular bone.
• 2. Located on the palmar surface of the wrist is
  the CARPAL TUNNEL, formed by the arched carpal
  bones and numerous ligaments, through which pass
  nerves and tendons.

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• 3. Ulnar collateral ligaments and radial
  collateral ligaments are found at each MCP, PIP,
  and DIP joint also, VOLAR PLATE LIGAMENTS are
  found on the pulnar surface of each of the above
  joints.
• D. Muscle Tendons
• 1.crossing the palmar surface of the wrist and
  passing through the carpal tunnel are the FLEXOR
  TENDONS.
• 2. Crossing the dorsal surface of the wrist are
  the EXTENSOR TENDONS of the fingers.
• E. Other Structures
• 1. Of particular portions is a landmark called
  the ANATOMIC SNUFFBOX, which is formed by three
  extensor tendons the tendons forming the
  snuffbox become prominent, when the thumb is
  extended the navicular lies just below the
  anatomic snuffbox and this surface landmark is
  used to locate and palpate this most frequently
  fractured carpal bone.

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• F. Range of Motion
• 1. The wrist can move in both flexion and
  extension as well as abduction (radial
  deviation), adduction (ulnar deviation),and
  circumduction
• 2. The four fingers flex, extend, abduct, and
  adduct, whereas the thumb the most important
  digit) can perform flexion,extension,abduction,add
  uction, and opposition(thumb to finger).
• G. Blood and Nerve Supply
• 1. The arteries that supply the wrist, hand, and
  fingers are the RADIAL and ULNAR ARTERIES.
• 2. The three major nerves of the wrist, hand, and
  fingers are the ULNAR, RADIAL, AND THE MEDIAN
  NERVES.

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• A. injuries involving the elbow and forearm are
  common in athletic activity. The elbow is subject
  to injury because of its broad range of motion,
  weak lateral bone arrangement, and relative
  exposure to soft-tissue damage. Many different
  types of force and stress are applied about the
  elbow during the various activities involved in
  different sports. A variety of athletic injuries
  can result from direct trauma to the area,
  indirect trauma such as falling on an
  outstretched hand, or acute and chronic stresses
  associated with throwing and swinging activities.
• B. Common Injuries
• 1. Contusions because of its lack of padding and
  its general vulnerability, the elbow often
  becomes contused during contact sports.
• A. direct blows to the tissue around the elbow
  can result in bruising and subsequent
  bleeding,producing stiffness during function and
  active range of motion, and swelling
• b. the contusion should be treated immediately
  with cold and pressure for at least 24 hours.

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• 2. Elbow Hypertension hypertension injury occurs
  when the elbow is fully extended and is then
  forced past its normal range of motion this
  often happens when the athlete tries to stop a
  fall by landing on an outstretched hand with the
  elbow locked.
• A. the ahtlete will hold the elbow in a bent
  position and will be apprehensive about trying to
  straighten the arm signs and symptoms include
  swelling throughout the joint, general
  tenderness, and pain.
• B. initial treatment consists of cold,
  compression, and elevation when the athlete is
  allowed to resume activity, the joint must be
  protected from reaching full extension one way
  to do this is with a restrictive tape job.
• 3. Elbow Dislocation dislocationof the elbow has
  a high incidence in sports activity and is caused
  most often by a fall on the outstretched hand
  with the elbow in a position of hyperextension or
  by severe twist while it is in a flexed position
  the bones of the ulna and radius may be displaced
  backward, forward, or laterally most commonly
  both the ulna and radius are forced
  backwardligaments are stretched and torn

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• Because so many arteries and nerves pass through
  the elbow joint, dislocation of a bone could
  cause serious damage to circulation or to the
  nervous system permanent paralysis of the
  fingers, hand and arm is a possibility with elbow
  dislocations.

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Elbow Dislocations

• Signs and symptoms are immediate pain with a
  total loss of function in the elbow and obvious
  deformity numbness along the medial side of the
  elbow and forearm is often present, indicating
  neurological injury frequently there are
  associated fractures.
• All elbow dislocations should be properly
  immobilized and referred to a physician
  immediately

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Tennis Elbow (lateral epicondylitis)

• Tennis elbow is, in most cases, an inflammation
  of the lateral epicondyle of the humerus that is
  caused by overuse, weakness, poor technique, lack
  of flexibility, or inadequate warm-up in tennis
  a racquet that is strung too tightly or that has
  improper hand grip size can lead to tennis elbow

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Tennis Elbow (cont.)

• Besides treating the symptoms of tennis elbow,
  the cause of the problem also needs to be
  corrected
• There may be little swelling with tennis elbow
  the athlete may experience general weakness of
  the muscles of the lower arm pain may be
  centered at the epicondyle or it may radiate down
  the arm
• Management of this condition usually includes use
  of a sling, rest, and ice

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Little League Elbow

• Numerous muscular-related injuries can be grouped
  under the heading little league elbow besides
  young baseball players, athletes in other sports
  can also suffer from this condition the cause is
  often too much stress on the elbow in younger
  athletes, when the muscle is stronger than the
  bone to which it is attached, a chip of bone can
  be pulled away by the muscle it is also possible
  for the ulnar nerve, which crosses the medial
  epicondyle of the humerus, to be injured

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Little League Elbow (cont.)

• In this case, the athlete will feel numbness,
  tingling, or weakness in the forearm, hand, and
  fingers this injury can occur to either the
  medial or lateral side of the elbow
• Treatment is similar to tennis elbow

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Forearm Fractures

• Fractures of the forearm are particularly common
  among active children and occur as the result of
  a blow or fall on the outstretched hand
  fractures to the ulna or the radius singly are
  much rarer than simultaneous fractures to both
• The break usually presents all the signs and
  symptoms of any fracture including pain,
  swelling, and deformity
• Treatment consists of ice, immobilization, and
  referral to a physician

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Colles Fracture

• This particular fracture is a fracture of the
  distal radius and/or ulna the mechanism of
  injury is usually a fall on the outstretched hand
• In most cases there is a visible deformity to the
  wrist, extensive swelling, and pain
• Management is consistent with treatment for any
  fracture

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Wrist Sprain

• A sprain is by far the most common wrist injury
  and in most cases is the most poorly managed
  injury in sports it can be caused by any
  abnormal, forced movement of the wrist falling
  on the hyperextended wrist is the most common
  cause repeated sprains may disrupt the blood
  supply and consequently the nutrition to the
  carpal bones

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Wrist Sprain (cont.)

• Signs and symptoms include generalized wrist
  swelling, tenderness, inability to flex the
  wrist, and absence of appreciable pain or
  irritation over the navicular bone
• Initial treatment consists of ice and
  compression it is important to have the athlete
  begin hand strengthening exercises as soon as
  possible taping the wrist for support can
  benefit healing and help prevent further injury

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Wrist Fractures

• The same mechanism or injury for wrist sprains
  will often cause a fracture wrist fractures
  occur most often to three bones the radius, the
  ulna and the navicular fractures of the radius
  and ulna are more obvious than a fractured
  navicular in a navicular fracture there is
  normally no displacement of fragments and such an
  injury may be erroneously evaluated as a wrist
  sprain

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Wrist Fractures (cont.)

• A fractured navicular will cause pain just distal
  to the radius and point tenderness will be found
  upon palpation of the anatomical snuffbox
• Lack of treatment can leave the athlete with a
  permanently painful wrist any athlete who has
  had a wrist injury and has tenderness in the area
  of he navicular should be considered to have a
  fracture until proven otherwise
• Management includes ice and splinting for
  referral to a physician

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De Quervains Disease

• This condition is a common form of tenosynovitis
  (inflammation of the tendon and its surrounding
  synovial sheath) of the wrist
• Repetitive ulnar deviation(adduction) and
  gripping(very common in racquet sports) can
  inflame these tendons in their closed space
  resulting in pain when using the thumb,
  stiffness, and pinch weakness swelling and
  tenderness are present along the athletes radial
  aspect of the wrist
• Treatment includes immobilization, rest, and ice

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Wrist Ganglion Cyst

• The wrist ganglion is often seen in sports it is
  considered by many to be herniation of a sheath
  of a tendon which permits a portion of the
  underlying tissue to come through it the
  herniated sac forms a cystic enlargement that
  gradually fills with fluid and may become quite
  large it usually appears slowly after a wrist
  sprain but can occur without any trauma a
  ganglion generally appears on the dorsal side of
  the wrist but can also occur on the palmar side

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Contd

• The cystic mass may vary in consistency from very
  soft to very firm and is generally not painful to
  the touch as it increases in size, it may be
  accompanied by mild pressure discomfort a
  ganglion that is painful or limits motion should
  be examined by a physician
• Most methods of treatment do not prevent the
  ganglion from returning surgical removal is the
  best of the various methods of treatment

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Carpal Tunnel Syndrome

• The carpal tunnel is a canal in the palmar
  surface of the wrist formed by the arched carpal
  bones and various ligaments this tunnel contains
  the median nerve and nearly all the flexor
  tendons constriction or narrowing within the
  carpal tunnel and subsequent pressure on the
  median nerve are called Carpal Tunnel Syndrome
  this condition can result from swelling secondary
  to trauma or more commonly by repeated wrist
  muscular activity constriction of the median
  nerve can restrict motor function and sensation
  along the nerve distribution of the hand

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Contd

• Referral to a physician is appropriate
  occasionally, a persistent nerve compression
  requires surgical decompression
• Athletes suffering from this condition often
  complain of numbness and tingling that increase
  with use and may occur at night

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Hand and Finger Injuries and Injury Management

• There are few sports in which the hands are not
  used in some manner and athletes hands are
  constantly exposed to various types of forced
  movements and direct trauma as a result, a wide
  variety of athletic injuries to the hands can
  occur many are relatively minor and are never
  reported because there is a tendency by many
  athletes to underestimate or minimize injury to
  this area of the body, injuries to the hands can
  develop into long-term disability if not
  recognized and cared for properly

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Subungual Hematoma

• The hand and phalanges, having an irregular bony
  structure combined with little protective fat and
  muscle padding, are prone to bruising in sports
  a particularly common contusion of the
  fingernail this is an extremely painful
  condition because of the accumulation of blood
  underneath the fingernail

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• The athlete should place the finger in ice water
  until the bleeding ceases and the pressure of
  blood should then be released a common method
  for releasing the pressure of the subunununungual
  hematoma is to use either a needle or the
  straightened end of a paper clip heat the tip
  until red-hot and then do something to it to help
  the pain go away to the side of the bleeding you
  should be having fun highlighting trapped the
  blood all the blood is released the nail should
  be kept clean and dry

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Mallet Finger

• Mallet finger is common in sports particularly in
  baseball where the finger looks like a mallet
  hammer it is caused by playing girly sports like
  baseball where the ball strikes the tip of the
  finger and avulses or something like that the
  extensor tendon from its insertion along with a
  piece of bone

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Contd

• This injury is characterized by pain, swelling,
  and tenderness at the IHOP joint, as well as the
  inability of the athlete to actively flex at this
  joint while the proximal and middle finger joints
  are held straight
• The finger should immediately be cut off or
  splinted in extension cold should be applied so
  you look cool see a physician

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Finger Sprains

• The phalanges, particularly the thumb are prone
  to sprains caused by a blow to the tip of the
  finger or by twisting
• Signs and symptoms include pain, marked swelling,
  and bleeding into the joint as well as tenderness
  at the site of the injury and an increase in pain
  on reproduction of the stress that caused the
  injury

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Contd

• A sprain can occur at any of the fingers joints
  (MCP, PIP, or DIP) and involve troy thomas
  wearing dresses with skylar summers putting on
  his mothers make up any of the ligaments at each
  joint (UCL, RCL, or Volar Plate) the joint most
  commonly sprained is the elbow this is the
  finger joint with the greatest amount of flexion
  and estension Jammed Fingers or spraines are
  very painful right after they occur but the pain
  usually subsides quickley. Longer lasting pain
  above and below the joint may indicate a fracture.

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First aid

• Normal first aid procedures are appropriate for
  finger sprains the finger may be taped to a
  non-injured one for protective support.

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• Gamekeepers Thumb A sprain of the ulnar
  collateral ligament of the MCP joint of the
  thumb is commonly among athletes, especially
  really gay ones, like derek spackman the
  mechanism of injury is usually a forceful
  abduction of the proximal phalange, which is
  occasionally combined with hyperextension this
  ligament provides the stability necessary for
  normal gripping and pitching this injury is
  often overlooked or dismissed as a sprained
  thumb. If it is not cared for, weakness and
  swelling will occur.

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• Signs and symptoms are local tenderness, swelling
  and increased and increased pain on abduction of
  the thumb. Instability will be present if the
  ligament is torn.
• The thumb will be splinted to above the wrist and
  referral to a physician should be made.

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Finger Dislocations

• Finger dislocations the same mechanisms causing
  finger sprains may result in dislocations. This
  happened to troy thomas once and he peed in his
  pants for he was exceedingly angry. These
  dislocations may remain displaced or may reduce
  spontaneously.

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• It is good practice to refer all athletes with
  dislocations to a physician, no matter how minor
  thte injury may seem inadequate treatment may
  lead to permanent instability and deformity of
  the joint.

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Metacarpal Fractures

• Fractures of the hand frequently occur in
  athletics and result from the same mechanisms of
  injury previously described because these
  fractures involve small bones, they are often
  thought to be minor injuries and this treated
  casually

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• Finger stiffness, mal-alignment and functional
  disability may be consequences of hand fractures
  fractures of the metacarpals usually result from
  a direct blow to the area or to the metacarpal
  head, which transmits the force down the shaft of
  the bone
• Signs and symptoms include pain, deformity,
  swelling and abnormal mobility in some cases no
  deformity occurs
• All suspected fractures should be examined by a
  physician

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• Boxers fracture a fracture of the neck of the
  fifth metacarpal usually results from a punch
  leading with the little finger
• Bennetts fracture a fracture of the base of the
  1st metacarpal

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Elbow Injury Evaluation

• History
• What happened? How? Position?
• Characteristics of pain? Local or General?
• Previous Injuries?
• What makes it better or worse?
• Numbness? Or stuff like that?
• Locking or crepitus during movement?
• Were symptoms immediate or gradual?

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• Inspection
• Swelling
• Dislocation
• Deformities
• Whenever confornted with an injured elbow,
  inspect and compare both elbows to note any
  differences in symmetry. Note exactly where the
  swelling is located. Note the alignment of both
  arms and the ability for full extension.

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• Palpation
• Bony and soft tissue
• Palpation of the injured elbow or forearm is used
  to identify specific structures that may be
  involved in the injury. This is accomplished by
  accurately locating all areas of tenderness and
  swelling, as well as any other physical signs
  that may assist in recognizing the injury. Begin
  palpation away from the suspected area of injury.
  

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• Palpate the following structures
• Humerus
• Medial and lateral epicondyles
• Olecranon process
• Ulna
• Radius
• Biceps
• Triceps
• Brachialis
• Brachioradialis
• Pronators
• Supinators
• Medial collateral Ligament
• Lateral Collateral Ligament
• Annular Ligament

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Special Tests

• Range of motion
• Active
• Active movements should be performed first to
  evaluate the range of motion and the integrity of
  the muscles

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• Passive
• Generally the only passive movements that are
  performed with elbow injuries are those that
  evaluate the integrity of the medial and lateral
  collateral ligaments these valgus and varus
  tests will be discussed under stress tests

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• Resistive
• Resistive movements are used to further evaluate
  the integrity of muscles to apply resistance
  against elbow flexion, stabilize the arm or elbow
  with one hand and apply resistance to the
  movement proximal to the wrist with the other hand

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• Strength
• Resistive movements should be used to compare
  muscular strength between extremities weaknesses
  should be noted

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Stress Tests

• Stress tests should never be used until you are
  sure there is no associated fracture or
  dislocation
• Valgus test testing for integrity of the medial
  collateral ligament cup injured elbow of the
  athlete in one hand and grasp the wrist with the
  other hand flex the elbow to 15 to 20 degrees.
  Instruct the athlete to relax the muscles of the
  upper extremity place a force inward in an
  attempt to open up the medial side of the elbow

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• Varus test
• Testing for integrity of the lateral collateral
  ligament exact same as valgus test except apply
  force outward.

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• Tennis elbow test testing for tennis elbow
  (lateral epicondylitis) the examiner should
  apply resistance to the athletes extended hand
  with the elbow flexed to 45 degrees a positive
  tennis elbow test will be moderate to severe pain
  at the lateral epicondyle

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Wrist, Hand, and Finger Injury Evaluation

• History
• What happened? How? Position?
• Characteristics of pain? Local or general?
• Previous injuries?
• What makes better or worse?
• Numbness or other stuff like that?
• Were symptoms immediate or gradual?

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• Inspection
• Swelling
• Discoloration
• Deformities
• Notice the positioning and functioning of the
  injured hand as you talk with the athlete. Are
  there any postural deviations? Carefully inspect
  the injured hand for signs of trauma that can
  indicate what type of force has been applied.

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• Palpation
• Bony and soft tissue
• Gently palpate those areas suspected of being
  injured to locate such physical signs as
  tenderness deformity, swelling, or crepitus.

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• Palpate the following structures
• Radial styloid process
• All eight carpal bones,
• Ulnar styloid proccess
• Metacarpal bones
• Phalanges
• Webbed space between thumb and index finger

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• Moving in continuous motion ask the injured
  athlete to make a tight fist and then straighten
  the fingers notice u whether each digit moves
  easily through a complete range of motion at each
  joint finger abduction and adduction can be
  elevated be instructing the athlete to spread
  their fingers apart and bring them back together
  again each of the digits and each motion of the
  finger can be evaluated separately if necessary
  the active range of motion of the finger can be
  evaluated separately if necessary the active
  range of motion for the thumb consists of
  flexion, extension, abduction, adduction, and
  opposition instruct the athlete to perform each
  of these motions and observe the movement.
• B. Passive
• passive range of motion can be used to further
  evaluate the integrity of a joint whenever
  active range of motion is limited or restricted,
  passive motion may be implemented to evaluate the
  available range as with all areas of the body,
  passive range of motion must be performed gently
  and cautiously so no further damage results all
  motions described under active movements can be
  evaluated passively

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• C. Resistive
• resistive movements are used to further evaluate
  to integrity of muscles apply resistance against
  the active movements to assist in identifying
  specific painful areas to apply resistance
  against wrist flexion, stabilize athletes forearm
  with one hand and apply resistance to movement
  against the palm of the athletes hand with your
  other hand to evaluate wrist extension apply
  resistance against the back of the athletes hand
  it is not necessary to resist radial and ulnar
  deviation because these muscles are evaluated
  during flexion and extension. Finger flexion is
  often resisted as a functional unit instruct the
  athlete to flex all fingers into a fist as you
  curl and lock your fingers into theirs to attempt
  to pull the fingers into extension to resist
  finger extension, curl your fingers over the
  athletes fist and instruct the athlete to extend
  to fingers as you apply resistance to resist
  finger abduction, instruct the athlete to spread
  his/her fingers as far apart as possible attempt
  to push each set of to fingers together to test
  finger adduction, instruct the athlete to keep
  the fingers together as you

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• Attempt to pull them apart resistance can be
  applied in a similar manner to each individual
  joint resistance to thumb opposition can be
  accomplished by instructing the athlete to touch
  the top of the little finger with the top of the
  thumb attempt to pull the two apart with your
  index finger.
• 2. Strength
• A. resistive movements should be used to compare
  muscular strength between extremities weaknesses
  should be noted

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Stress Tests

• A. stress tests are used to facilitate the
  assessment of athletic injuries of the wrist and
  hand because of the delicate and intricate
  makeup of this area of the body, various types of
  stress are usually necessary to complete to
  assessment process.
• (1) Finklesteins test testing for de Quervains
  disease the athlete makes a fist with the thumb
  tucked inside the wrist is then deviated into
  ulnar flexion

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• Sharp pain is a positive sign for Quervains
• (2)Phalens test testing for carpal tunnel
  syndrome the athlete is instructed to flex both
  wrists as far as possible and press them
  together this position is held for approximately
  one minute if this test is positive, pain will
  be produced in the region of the carpal tunnel.
• (3) ganglion cyst test testing for a ganglion
  cyst the athlete should flex his/her wrist and
  the examiner should provide resistance against
  extension if pain is elicited the test is
  positive.
• (4) valgus test testing for integrity of the
  medial collateral ligaments at each joint of the
  fingers with the injured finger extended, the
  examiner should hold the end of the finger with
  his/her fingers and place a gentle force at each
  joint inward with the thumb in attempt to open
  the medial side of that joint differences in the
  laxity of the MCL should be noted.
• (5) varus test testing for integrity in the
  lateral collateral ligaments at each joint of the
  fingers

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• With the injured finger extended the examiner
  should hold the end of the finger with his/her
  thumb and place a gentle force at each joint
  outward with a finger in an attempt to open the
  lateral side of that joint differences in the
  laxity of the LCL should be noted.
• (6) gamekeepers thumb test testing for a sprain
  of the ulnar collateral ligament of the thumb
  the examiner should resist thumb abduction the
  test is positive if the procedure elicits pain.
• (7) percussion test testing for metacarpal and
  phalangeal fracture the examiner should give a
  percussive blow to an extended phalange and
  metacarpal with the vibratory force traveling
  straight down the shaft of the bones pain is a
  positive sign for this test.
• 4. Functional Tests
• A. functional movements or activities can be
  beneficial to the assessment of wrist, hand, and
  finger injuries often observing an athlete
  perform those activities that reproduce painful
  symptoms will be helpful

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• However, for the most part, functional movements
  are used to determine when an athlete with a
  wrist, hand, or finger injury can return to full
  activity.
• 5. Neurological
• A. reflexes the brachioradialis (C6) reflex can
  be tested for wrist, hand, and finger injuries
  to test this reflex, place the athletes elbow in
  flexion and support the forearm using a reflex
  hammer, tap the brachioradialis tendon at the
  distal end of the radius the normal response is
  slight elbow flexion.
• B. you may also test the biceps and triceps
  reflexes compare the reflex responses
  bilaterally and note any differences between the
  two sides
• C. sensations sharp and dull sensations should
  be compared bilaterally note any differences
  between the two sides.

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• 6. Circulatory
• A. pulse A pulse should be taken at the brachial
  artery and the radial artery. Normal pulse rate
  for adults is 60 to 80 beats per minute.
• B. nail bed perfusion fingernails
• C. blood pressure normal blood pressure is
  120/80.