Presentation on theme: "Elbow/Wrist/Hand Unit"— Presentation transcript:
1 Elbow/Wrist/Hand Unit Chapter 22Advance Sports Medicine
2 Anatomy Of The Elbow/Wrist/Hand 1. Navicular (scaphoid)2. Lunate3. Triquetral4. Pisiform5. Hamate6. Capitate7. Trapezoid8. Trapezium9. Ulnar styloid10. Radial Styloid
3 Anatomy cont. Bones of the elbow 1 Olecranon 2 Capitulum- 3 Trochlea 4 Lateral epicondyle5 Medial epicondyle
4 Muscles and Ligaments of the forearm/elbow Ligaments of elbow11.Extensor carpi ulnaris12. Extensor carpi radialis13. Flexor digitorum14. Extensor digitorum15. Thumb-16. Flexor pollicis longus/brevis17. Extensor pollicis longus/brevis18. Abductor pollicis19. Adductor pollicis20. Opponens pollicis21. Opponens digiti minimi (5th phalangeUlnar collateralRadial collateralAnnular lig.- attaches to ulna/radius of the elbowMuscles4. Biceps brachii5. Tricep brachii6. Brachial radialis7. Supinator8. Pronator teres9. Flexor carpi radialis10. Flexor carpi ulnaris
5 Thenar And Hypothenar Eminence Thenar eminence: thumb sideOpponens pollicisAbductor pollicis brevisFlexor pollicis brevisHypothenar eminence: pinky sideOpponens digiti minimiAbductor digiti minimiFlexor digiti minimi brevis
6 Injuries to elbow Contusions Olecranon bursitis Strains May swell rapidly after an irritation of the olecranon bursa or the synovial membraneR I C EOlecranon bursitisMost frequently injured bursa in the elbow.Pain, point tenderness, severe swellingIce and compression and possibility of aspirationStrainsUsually caused by falling on an outstretched arm or hyperextension. Test the biceps, triceps, brachialis, pronators, supinators
7 Elbow Injuries cont. Sprains Lateral epicondylitis Caused by hyperextension or valgus forces. Point tender of the ulnar collateral lig.Ice, compression and sling with the elbow in 45 degrees of flexionLateral epicondylitisChronic, or called tennis elbow, caused by repetitive microtrauma to the insertion of the extensor muscles, Hyperpronation is the primary action.RICE, and NSAID’sMedial epicondylitissame as above but most common in pitching, wrist flexors
8 Elbow injuries cont. Osteochondritis Dissecans Little League elbow Loose body in the joint, young athletes yrs old.Sudden pain and locking of the jointRICE, NSAID’s, possible surgeryLittle League elbowOccurs in 10-25% of young pitchers, Injury onset is usually slow, may have joint tightness and triceps weakness, decreased ROM in pronation and supinationRICE,NSAID’s and throwing is stopped.Cubital tunnel syndromeUlnar 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 Elbow Dislocation Elbow Injuries cont. Fall on an outstretched hand with elbow in a hyperextension or twisted positionDeformity with olecranon extending backward beyond its normal alignmentRupture most of the stabilizing ligamentsProfuse swelling, pain and disabilityComplications can include injury to major nerves and blood vesselsRx: splint and refer to Dr. immediately for reduction as soon as possible.
11 Elbow Injuries cont.Elbow FractureEtiology: fall on an outstretched arm or a direct blow to the olecranon.Fracture site: just above the epicondyles of the humerusS/S: may or may not have visible deformity, will have hemorrhage, swelling, muscle spasmRx: splint, ice and send to Dr. One complication is decreased ROM
12 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 handS/S: pain in the forearm which becomes greater when the fingers are passively extended. Brachial/radial pulses diminish which produce cold handsRx: remove bandages and elevate to relieve the pressure. Dr.
13 Eval. Of elbow History: Observation Palpation 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?ObservationCarrying angle, see if the bony prominence form an isosceles triangle with the elbow at 45 degrees.PalpationSpecial tests: see Handout
14 Rehab of the elbow Stage 1 Stage 3 Stage 2 Maintain CV RICE Early splinting and Interferential for the pain along with NSAID’sStage 2 Maintain CVEarly ROM exercisesJoint mobilizations for increase ROMClosed kinetic chain exercisesPNF exercisesStrengthening exercises after full ROM is obtainedStage 3Functional progressionOpen kinetic chain ex. W/controlled ROMOpen kinetic chain ex. Through pain free ROMPNF/closed kinetic ex.Sports specific exercises.