The Elbow Wrist and Hand

1
The Elbow Wrist and Hand
2
Elbow

• Bones
• Humerus
• Ulna
• Radius

• Muscles
• Biceps Brachii
• Brachioradialis
• Triceps Brachii
• Brachialis
• Bones
• Humerus
• Ulna
• Radius

3
Elbow Anatomy

• Biceps Brachii-
• Long head attached to coracoid process of scapula
  
• Short head attached to supraglenoid tubercle of
  scapula

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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

5
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.

6
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.

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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.

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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.

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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

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Epicondylitis

• Little Leaguers elbow-repetitive action
  resulting in elbow pain in young
• The elbow area is the last epiphyseal center to
  close so injuries can occur.

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Epicondylitis

• Little Leaguers elbow can result in in varies
  fractures or bone growths.

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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

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Sprains

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

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Sprains

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

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

Special Tests?
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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.

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Dislocations

• Signs and Sx
• Obvious deformity
• Check circulation and nerve function

• Treatment
• Immobilization
• Wrist strengthening and then progress to elbow
• RICE

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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.

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Fractures to Elbow/Forarm

• Signs and Sx
• Point tenderness
• Possible deformity
• Swelling
• Limited ROM

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

Splinting?
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Nerves of the Elbow/Wrist

• Ulnar Nerve
• Median Nerve
• Radial Nerve

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Ulnar Nerve Injuries

• Cubital Tunnel Syndrome- irritation of the ulnar
  nerve as it passes through the cubital tunnel
  caused by repetitive throwing and swinging.
• Pain is in medial elbow and paresthesia in ulnar
  nerve region of hand.

21
Radial Nerve Injury

• Radial Tunnel Syndrome- irritation of the radial
  nerve as it passes through the muscles of the
  anterior lateral elbow. It is caused by
  repetitive pronation and supination.
• Pain over the anterior radial head, with
  supination with elbow at 90, and extension of
  middle finger with elbow extended.
• Can be the cause of lateral elbow pain.

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Median Nerve Injury

• Pronator Teres Syndrome- median nerve passes
  between the heads of the pronator teres where it
  can be entraped due to repetitive pronation of
  the forarm.
• Pain will radiate down anterior forearm, increase
  with resisted pronation. There will be numbness
  in the thumb, index and middle finger.

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Median Nerve Injury

• Carpal Tunnel Syndrome- compression 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.

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Wrist and Hand Anatomy

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

Lunate

• Pisiform

Scaphoid
Capitate
Triquetral
Trapezium
Trapezoid
Hamate
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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.

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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.

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Wrist and Hand Injuries

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

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Wrist and Hand Injuries

• Fractures of the Wrist and Hand
• Finger Fractures
• Scaphoid Fracture- fracture of scaphoid which you
  call palpate in anatomical snuffbox. Occurs
  with fall on hand in extension.

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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.

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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.

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Tendon Injuries

• Boutonniere deformity-
• extensor 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.

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Dislocations/Subluxations

• Dislocations occur in the fingers and wrist
  bones.
• Point tenderness and swelling, possible
  deformity.
• Physician intervention may be necessary.

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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.

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Sprains

• Can happen in fingers and wrist bones.
• Gamekeepers thumb- sprain of the ulnar
  collateral ligament of the thumb.
• Special Test
• Taping

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Tendonitis

• Various kinds can occur
• deQuervains tenosynovitis- inflammation 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 .

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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.

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Wrist Strengthening

• Flexion
• Extension
• Ulnar Deviation
• Radial Deviation
• Pronation
• Supination