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Elbow/Wrist/Hand Unit Chapter 22 Advance Sports Medicine.

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Presentation on theme: "Elbow/Wrist/Hand Unit Chapter 22 Advance Sports Medicine."— Presentation transcript:

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2 Elbow/Wrist/Hand Unit Chapter 22 Advance Sports Medicine

3 Anatomy Of The Elbow/Wrist/Hand X 1. Navicular (scaphoid) X 2. Lunate X 3. Triquetral X 4. Pisiform X 5. Hamate X 6. Capitate X 7. Trapezoid X 8. Trapezium X 9. Ulnar styloid X 10. Radial Styloid

4 Anatomy cont. Bones of the elbow Bones of the elbow 1 Olecranon 1 Olecranon 2 Capitulum- 2 Capitulum- 3 Trochlea 3 Trochlea 4 Lateral epicondyle 4 Lateral epicondyle 5 Medial epicondyle 5 Medial epicondyle

5 Muscles and Ligaments of the forearm/elbow 1. Ulnar collateral 2. Radial collateral 3. Annular lig.- attaches to ulna/radius of the elbow Muscles Muscles 4. Biceps brachii 5. Tricep brachii 6. Brachial radialis 7. Supinator 8. Pronator teres 9. Flexor carpi radialis 10. Flexor carpi ulnaris 11.Extensor carpi ulnaris 12. Extensor carpi radialis 13. Flexor digitorum 14. Extensor digitorum 15. Thumb- 16. Flexor pollicis longus/brevis 17. Extensor pollicis longus/brevis 18. Abductor pollicis 19. Adductor pollicis 20. Opponens pollicis 21. Opponens digiti minimi (5 th phalange Ligaments of elbow

6 Thenar And Hypothenar Eminence Thenar eminence: thumb side Thenar eminence: thumb side Opponens pollicis Opponens pollicis Abductor pollicis brevis Abductor pollicis brevis Flexor pollicis brevis Flexor pollicis brevis Hypothenar eminence: pinky side Hypothenar eminence: pinky side Opponens digiti minimi Opponens digiti minimi Abductor digiti minimi Abductor digiti minimi Flexor digiti minimi brevis Flexor digiti minimi brevis

7 Injuries to elbow Contusions Contusions May swell rapidly after an irritation of the olecranon bursa or the synovial membrane May swell rapidly after an irritation of the olecranon bursa or the synovial membrane R I C E R I C E Olecranon bursitis Olecranon bursitis Most frequently injured bursa in the elbow. Most frequently injured bursa in the elbow. Pain, point tenderness, severe swelling Pain, point tenderness, severe swelling Ice and compression and possibility of aspiration Ice and compression and possibility of aspiration Strains Strains Usually caused by falling on an outstretched arm or hyperextension. Test the biceps, triceps, brachialis, pronators, supinators Usually caused by falling on an outstretched arm or hyperextension. Test the biceps, triceps, brachialis, pronators, supinators

8 Elbow Injuries cont. Sprains Sprains Caused by hyperextension or valgus forces. Point tender of the ulnar collateral lig. Caused by hyperextension or valgus forces. Point tender of the ulnar collateral lig. Ice, compression and sling with the elbow in 45 degrees of flexion Ice, compression and sling with the elbow in 45 degrees of flexion Lateral epicondylitis Lateral epicondylitis Chronic, or called tennis elbow, caused by repetitive microtrauma to the insertion of the extensor muscles, Hyperpronation is the primary action. Chronic, or called tennis elbow, caused by repetitive microtrauma to the insertion of the extensor muscles, Hyperpronation is the primary action. RICE, and NSAID’s RICE, and NSAID’s Medial epicondylitis Medial epicondylitis same as above but most common in pitching, wrist flexors same as above but most common in pitching, wrist flexors

9 Elbow injuries cont. Osteochondritis Dissecans Osteochondritis Dissecans Loose body in the joint, young athletes yrs old. Loose body in the joint, young athletes yrs old. Sudden pain and locking of the joint Sudden pain and locking of the joint RICE, NSAID’s, possible surgery RICE, NSAID’s, possible surgery Little League elbow Little League elbow Occurs in 10-25% of young pitchers, Injury onset is usually slow, may have joint tightness and triceps weakness, decreased ROM in pronation and supination Occurs in 10-25% of young pitchers, Injury onset is usually slow, may have joint tightness and triceps weakness, decreased ROM in pronation and supination RICE,NSAID’s and throwing is stopped. RICE,NSAID’s and throwing is stopped. Cubital tunnel syndrome Cubital tunnel syndrome Ulnar nerve tunnel, traction injury from valgus force, irregularities within the tunnel, subluxation of the ulnar nerve because of a lax ligament, or a progressive compression of the ligament on the nerve. Ulnar nerve tunnel, traction injury from valgus force, irregularities within the tunnel, subluxation of the ulnar nerve because of a lax ligament, or a progressive compression of the ligament on the nerve.

10 Posterior Elbow dislocation

11 Elbow Injuries cont. Elbow Dislocation Elbow Dislocation –Fall on an outstretched hand with elbow in a hyperextension or twisted position –Deformity with olecranon extending backward beyond its normal alignment –Rupture most of the stabilizing ligaments –Profuse swelling, pain and disability –Complications can include injury to major nerves and blood vessels –Rx: splint and refer to Dr. immediately for reduction as soon as possible.

12 Elbow Injuries cont. Elbow Fracture Elbow Fracture Etiology: fall on an outstretched arm or a direct blow to the olecranon. Etiology: fall on an outstretched arm or a direct blow to the olecranon. Fracture site: just above the epicondyles of the humerus Fracture site: just above the epicondyles of the humerus S/S: may or may not have visible deformity, will have hemorrhage, swelling, muscle spasm S/S: may or may not have visible deformity, will have hemorrhage, swelling, muscle spasm Rx: splint, ice and send to Dr. One complication is decreased ROM Rx: splint, ice and send to Dr. One complication is decreased ROM

13 Volkmann’s contracture humeral supracondylar fx, which cause muscle spasm, swelling, or bone pressure on the brachial artery, inhibition blood circulation to the forearm, wrist, and hand humeral supracondylar fx, which cause muscle spasm, swelling, or bone pressure on the brachial artery, inhibition blood circulation to the forearm, wrist, and hand S/S: pain in the forearm which becomes greater when the fingers are passively extended. Brachial/radial pulses diminish which produce cold hands S/S: pain in the forearm which becomes greater when the fingers are passively extended. Brachial/radial pulses diminish which produce cold hands Rx: remove bandages and elevate to relieve the pressure. Dr. Rx: remove bandages and elevate to relieve the pressure. Dr.

14 Eval. Of elbow History: History: Is it caused by direct trauma, throwing type of an inj?, look for internal organ problem or ulnar nerve impingement, is there is a feeling of locking or crepitation? Is it caused by direct trauma, throwing type of an inj?, look for internal organ problem or ulnar nerve impingement, is there is a feeling of locking or crepitation? Observation Observation Carrying angle, see if the bony prominence form an isosceles triangle with the elbow at 45 degrees. Carrying angle, see if the bony prominence form an isosceles triangle with the elbow at 45 degrees. Palpation Palpation Special tests: see Handout Special tests: see Handout

15 Rehab of the elbow Stage 1 Stage 1 RICE RICE Early splinting and Interferential for the pain along with NSAID’s Early splinting and Interferential for the pain along with NSAID’s Stage 2 Maintain CV Stage 2 Maintain CV Early ROM exercises Early ROM exercises Joint mobilizations for increase ROM Joint mobilizations for increase ROM Closed kinetic chain exercises Closed kinetic chain exercises PNF exercises PNF exercises Strengthening exercises after full ROM is obtained Strengthening exercises after full ROM is obtained Stage 3 Stage 3 Functional progression Functional progression Open kinetic chain ex. W/controlled ROM Open kinetic chain ex. W/controlled ROM Open kinetic chain ex. Through pain free ROM Open kinetic chain ex. Through pain free ROM PNF/closed kinetic ex. PNF/closed kinetic ex. Sports specific exercises. Sports specific exercises.


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