1. Elbow, Forearm, wrist, and hand
Chapter 12
Elbow, Forearm, wrist, and hand

2. Educational Objectives
Understand
Anatomy of the elbow, forearm, wrist, and hand
Principles of rehab exercises
Preventive/supportive techniques and protective devices
Identify components of evaluation format
Recognize the common injuries

3. Anatomy
ELBOW
Permits movements of flexion, extension, pronation, and supination.
Delivers and receives accidental blows that can cause bruising, fracture, dislocation or nerve damage.
Excessive stress are placed on elbow in throwing and racquet sports

4. Anatomy Humerus- largest bone of the upper extremity.
-two articulating condyles at distal end
Ulna- remains stationary
Radius-rotates on the ulna as the forearm, wrist, and hand pronate and supinate. The proximal end has a bony protuberance called the olecranon process. olecranon process articulates with the proximal radius.

5. Ligaments, Tendons, Joints
Very strong ligamentous and muscular support
Attach at the condyles of the humerus
Medial condyle articulates with the ulna for flexion and extension
Lateral condyle articulates with the radius for pronation and supination

6. Ligaments, Tendons, Joints
Humeroulnar
Humeroradial
-LIGAMENTS
Ulnar collateral
Radial collateral
Annular ligaments-adds elbow stability, attaches to the ulna and completely encircles the head of the radius. Helps keep the radius and ulna from separating.
Medial collateral-attached to the humerus and the ulna
Lateral collateral-attached to the humerus and the radius

7. Muscles- control forearm and elbow’s movement
Control elbow- Originate above the elbow on the humerus and the scapula.
Biceps
Triceps
Brachialis
Control forearm, wrist, and fingers -originate on the two epicondyles of the humerus.
Flexor carpi radialis (flexion and pronation)
Flexor carpi ulnaris (flexion and pronation)
Flexor digitorum sublimis (flexion and pronation)
Flexor pollicis longus (flextion and pronation)
Extensor digitorum communis (extension and supination)
Extensor carpi radials longus and brevis (extension and supination)
Extensor carpi ulnaris (extension and supination)
Extensor pollicis longus (extension and supination)

8. Tests Elbow Test for collateral ligaments stability
Valgus or abduction stress-(medial collateral)
Varus or adduction stress-(lateral collateral)
Epicondylitis tests-lateral
Resisted wrist extension
Resisted long finger extension
Palmar flexion-pronation stretch
Epicondylitis tests-medial
Resisted wrist flexion
Wrist extension-supination stretch

9. Wrist test Bony integrity tests
Anatomical snuffbox compression-fracture of scaphoid
Murphy’s sign-dislocation of lunate

10. Common injuries sprains: 1st, 2nd, and 3rd degrees
Olecranon brusitis: inflammation to the olecranon bursa. (direct blow or overuse) Referral, after evaluated basic treatment.
Carpal tunnel syndrome: pressure on the median nerve caused by constriction in the carpal tunnel. Treatment: wrist splints, rest, and medication. Medical re-evaluation is doesn’t get better.
Scaphoid fracture: (navicular) fall extended wrist. Poor blood supply. Severe pain, medical treatment required.
Dislocation/subluxation: force placed on a outstretched hand with elbow in extension. Always suspect a fracture. Medical referral.
Epicondylitis: inflammation of the epicondyle and the tissues adjoining the humerus. Elbow joint medial (pitches elbow) and lateral (tennis elbow)
Contusion
Subungual hematoma: fingernail receives a contusion (bruise), accumulation of blood under the fingernail. Ice and medical referral if swelling is severe.

11. Rehabilitation ROM Elbow: flexion, extension, supination, pronation
Wrist: flexion, extension, radial deviation, ulnar deviation, supination, pronation
Fingers: flexion, extension, abduction, adduction, opposition
Resistance/strengthening exercises
Elbow: arm flexion (bicep curls) arm extension (triceps extension)
wrist, hand, fingers: hand squeeze, finger abduction, pinch grip, lateral/key pinch grip
Return to competition guidelines
Full ROM
Strength, power, and endurance according to athlete and sport
No pain in upper extremity during running, jumping, or cutting