The Elbow, Forearm, Wrist, and Hand

1
The Elbow, Forearm, Wrist, and Hand

• Chapter 19

2
Elbow Anatomy

• Bones
• Articulations
• Ligaments and Capsule
• Synovium and Bursa
• Musculature
• Nerve Supply
• Blood Supply
• Functional Anatomy

3
Preventing/Assessing ElbowInjuries

• History
• Observation
• Palpation (bony and soft tissue)
• Special Tests
• Tinel sign
• Test for capsular injury
• Valgus and Varus tests
• Medial and Lateral Epicondylitis Test
• Pinch Grip test
• Pinch Grip Test
• Pronator Test syndrome test
• Functional Evaluation

4
Recognition and Management of Injuries

• Contusion
• Etiology
• Signs and Symptoms
• Management
• Olecranon Bursitis
• Etiology
• Signs and Symptoms
• Management
• Strains
• Etiology
• Signs and Symptoms
• Management

• Elbow Sprains
• Etiology
• Signs and Symptoms
• Management
• Lateral Epicondylitis
• Etiology
• Signs and Symptoms
• Management
• Medial Epicondylitis
• Etiology
• Signs and Symptoms
• Management

5
Recognition and Management of Injuries (contd.)

• Elbow Osteochondritis Dissecans
• Etiology
• Signs and Symptoms
• Management
• Little League Elbow
• Etiology
• Signs and Symptoms
• Management
• Cubital Tunnel Syndrome
• Etiology
• Signs and Symptoms
• Management

• Elbow Dislocation
• Etiology
• Signs and Symptoms
• Management
• Fracture of the Elbow
• Etiology
• Signs and Symptoms
• Management
• Volkmanns Contracture
• Etiology
• Signs and Symptoms
• Management

6
Rehabilitation Principles for the Elbow

• Phase I - immobilization (maintain wrist and
  hand strength) - 6 weeks
• Phase II - Increase ROM (after cast removal)
• Therapy Ice (5 to 15 minutes)
• Exercise PREs in all directions
• General Body Conditioning
• Joint mobilization
• Flexibility
• Strengthening
• Functional Progression
• Return to Activity
• Protective Taping and Bracing

7
Forearm Anatomy

• Radius and Ulna Elbow
• Joints radioulnar joint (superior, middle,
  and distal)
• Bone proximal radial head, olecranon process,
  radial shaft, ulnar shaft, distal radius, radial
  styloid process, ulnar head, ulnar styloid
• Musculature Forearm, flexors, pronators,
  extensors, and supinators
• Nerve/Blood Supply median and radial nerve and
  brachial, radial, and ulnar artery

8
Forearm Assessment

• History
• Observation
• Palpation
• Special Tests

9
Recognition and Management of Forearm Injuries

• Contusion
• Etiology
• Signs and Symptoms
• Management
• Forearm Splints
• Etiology
• Signs and Symptoms
• Management

• Colles fracture
• Etiology
• Signs and Symptoms
• Management
• Forearm Splints
• Etiology
• Signs and Symptoms
• Management

10
Wrist, Hand, and Finger Anatomy

• Bones carpals and metacarpals
• Joints radiocarpal, carpal, metacarpal, and
  phalangeal joints
• Ligaments many at each joint in the hand
• Musculature many intrinsic and extrinsic
  muscles
• Blood and Nerve Supply ulnar, median, radial
  nerve and radial and ulnar superficial and deep
  palmar arch arteries

11
Assessment of Wrist, Hand, and Finger Injuries

• History
• Observation
• Palpation
• Special Tests Finklesteins test, Tinels Sign,
  Phalens test, valgus and varus stress test,
  Glide test, Lunotriquetral Ballotment test
• Circulatory and Neurological Evaluation
• Allen test
• Functional Evaluation

12
Recognition and Management of Wrist, Hand, and
Finger Injuries

• Wrist Sprain
• Etiology
• Signs and Symptoms
• Management
• Triangular Fibrocartilage Complex Injury
• Etiology
• Signs and Symptoms
• Management
• Carpal tunnel syndrome
• Etiology
• Signs and Symptoms
• Management

• Tenosynovitis
• Etiology
• Signs and Symptoms
• Management
• Tendinitis
• Etiology
• Signs and Symptoms
• Management
• Nerve Compression, Entrapment, Palsy
• Etiology
• Signs and Symptoms
• Management

13
Recognition and Management of Wrist, Hand, and
Finger Injuries

• De Quervains Disease
• Etiology
• Signs and Symptoms
• Management
• Dislocation of the Lunate Bone
• Etiology
• Signs and Symptoms
• Management

• Scaphoid Fracture
• Etiology
• Signs and Symptoms
• Management
• Hamate Fracture
• Etiology
• Signs and Symptoms
• Management
• Wrist Ganglion
• Etiology
• Signs and Symptoms
• Management

14
Recognition and Management of Wrist, Hand, and
Finger Injuries

• Contusion to hand and fingers
• Etiology
• Signs and Symptoms
• Management
• Bowlers Thumb
• Etiology
• Signs and Symptoms
• Management
• Jersey finger
• Etiology
• Signs and Symptoms
• Management

• Trigger finger or thumb
• Etiology
• Signs and Symptoms
• Management
• Mallet finger
• Etiology
• Signs and Symptoms
• Management
• Boutonniere deformity
• Etiology
• Signs and Symptoms
• Management

15
Recognition and Management of Wrist, Hand, and
Finger Injuries

• Dupuytrens Contracture
• Etiology
• Signs and Symptoms
• Management
• Sprains, Dislocations, and Fractures
• Etiology
• Signs and Symptoms
• Management
• Gamekeepers Thumb
• Etiology
• Signs and Symptoms
• Management

• Sprains PIP and DIP joint
• Etiology
• Signs and Symptoms
• Management
• Swan neck deformity
• Etiology
• Signs and Symptoms
• Management
• PIP Dorsal dislocation
• Etiology
• Signs and Symptoms
• Management

16
Recognition and Management of Wrist, Hand, and
Finger Injuries

• MCP dislocation
• Etiology
• Signs and Symptoms
• Management
• Metacarpal fracture
• Etiology
• Signs and Symptoms
• Management
• Bennetts Fracture
• Etiology
• Signs and Symptoms
• Management

• Distal/Middle/Proximal phalangeal fracture
• Etiology
• Signs and Symptoms
• Management
• Fingernail deformity
• Etiology
• Signs and Symptoms
• Management

17
Rehabilitation Principles for the Forearm, Wrist,
Hand, and Fingers

• General Body Conditioning
• Joint Mobilization
• Flexibility
• Strength
• Neuromuscular Control
• Return to Activity