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Wrist, Hand, Elbow & Shoulder Chapters 12, 11 & 10.

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Presentation on theme: "Wrist, Hand, Elbow & Shoulder Chapters 12, 11 & 10."— Presentation transcript:

1 Wrist, Hand, Elbow & Shoulder Chapters 12, 11 & 10

2 Anatomy of the Wrist and Hand  Looks a lot like the foot  Has similar bone structures: –Phalanges –Metatarsals –Carpals  There are 26 bones  There are many ligaments that hold the structure of the hand together

3 Carpal Bones Proximal: A=ScaphoidScaphoid B=LunateLunate C=TriquetralTriquetral D=PisiformPisiform Distal: E=TrapeziumTrapezium F=TrapezoidTrapezoid G=CapitateCapitate H=HamateHamate

4 The Scaphoid Bone  Find your anatomical snuff box  Only blood supply at one end of the bone  It has difficulty healing if the blood supply is interrupted

5 Joints of the wrist and hand  There are three phalanges in each finger and two in the thumb  Distal, middle and proximal  Joints: –Distal Interphalangeal jnt (DIP) –Proximal Iinterphalangeal jnt (PIP) –Metacarpal Phalangeal jnt (MCP) –Carpometacarpal jnt (CMP)

6 Muscles of the hand and forearm  There are two major groups of muscles at the wrist and forearm  Flexors: on the dorsal side of the hand  Extensors: on the ventral side of the hand

7 The Thumb  Testing the ulnar collateral ligament of the thumb  The collateral ligaments of the thumb provide the majority of its stability

8 Preventing injuries to the hand Boxing Batting Field hockey/ girls lacrosse Cycling

9 More Gloves Receiver/ Running back gloves Lineman Gloves

10 Splints

11 Wrist Sprains  Occur from twisting and overuse  Injured structure depends upon the stress placed on the wrist  Ulnar Deviation is movement towards the ulnar

12  Radial deviation is movement towards the radius

13 The Lunate  Dislocation of the lunate bone occurs more often than any other carpal dislocation  Presents as deformity, pain, swelling, and decreased range of motion

14 Ganglion Cyst  A pocket of fluid within the sheath  Should be referred to a physician  Sometimes is removed surgically

15 Gamekeepers/Skiers Thumb  Thumb is forced into abduction forcefully  Pain over the joint, swelling may be present  An x-ray may be necessary to rule out a fracture

16 A “Jammed” Finger  A sprain of the collateral ligaments in the finger

17 Finger Dislocations Don’t JUST “pop” it !!!!!  There could be underlying hidden issues going on at the joint  There could be a tendon rupture or a fracture!!!

18 Fractures  Boxer’s fracture is most common in athletes for many reasons

19 Fractures  Other fractures require the same care and treatment

20 Muscle and Tendon Injuries  Repetitive stress and stretching can cause injuries to these structures  Some of these include –Carpal tunnel –deQuervian’s tendinitis –Mallet Finger –Jersey finger –Boutonniere deformity

21 Carpal tunnel

22  Most common as an overuse injury –Tennis –Field hockey  Watch for acute carpal tunnel due to poor position in slings and casts

23 deQuervian’s tendinitis  Abductor pollicis longus & Extensor Pollicis brevis tendons  Prolonged or repetitive radial deviation (shot putters)  Swelling, crepitus and pain with abduction

24 Mallet Finger  An avulsion fracture of the distal phalanx.  Cannot extend the distal phalanx

25 Jersey finger  Avulsion fracture of flexor tendon  Unable to flex the DIP

26 Boutonniere deformity  Deformity arises when there is a rupture of the central slip of the extensor mechanism.  This is an uncommon sporting injury usually due to an end-on injury to the finger with sudden bending at the P.I.P. joint  Often in football or basketball

27 Boutonniere deformity

28 Elbow  This is a very bony joint  Common to have contusions all around the elbow.  Use PRICES

29 Elbow

30 Ligaments  There is thick joint capsule surrounding the elbow.  Relies on the ligaments for stability –Ulnar collateral –Radial collateral –Annular

31 Muscles  Biceps- elbow flexion  Triceps- elbow extension  Wrist flexors- medial epicondyle of humerus  Wrist extensors- lateral epicondyle of humerus

32 What it really looks like

33 Preventing Injuries to the Elbow  Not a frequently injured joint  Many of the injuries are caused by overuse  Most injuries occur in racket sports such as tennis, or overhead throwing sports such as baseball and softball.  Many times injuries are brought about by poor training

34 Preventing Injuries to the Elbow  Athletes train the “beach muscles”  Overwork the Biceps to get “ pipes” or “guns”  What about the Triceps???  What about the wrist flexors and extensors??

35 What about equipment?  Tennis players can cause themselves injuries if the grip is too small on the racket.  Throwers should have a strong tricep and lots of flexibility in the elbow to prevent injuries.

36 Sprains Ulnar collateral  More common in throwers  The stress of overhead activity strains the medial aspect of the elbow.  Wrestling?  Pain and swelling treat as any other ligament sprain Radial Collateral  These are rare  Treat the same as a ulnar collateral sprain.

37 Vascularity and Nerves  There are numerous blood vessels and three major nerves that pass though t he elbow

38 Epicondylitis Lateral Epicondylitis  aka: Tennis Elbow  Poor mechanics and overuse  Presents as pain and swelling at the lateral epicondyle  Treat with PRICES Medial Epicondylitis aka: Little League Elbow Repetitive Throwing Little league elbow may have an avulsion fracture at the epiphysis

39 Fractures  Elbow fractures are rare in athletics.  Often results from a forceful blow to the area or landing on hard surface.

40 Elbow Dislocation


42  One of the most commonly dislocated joints in the body  Doesn’t take a lot of force to dislocate the joint  MUST BE SEEN by MD immediately

43 Olecranon Bursitis

44  PRICES  Use a compression wrap or sleeve to alleviate swelling  May have to be drained by MD  Not always painful

45 Shoulder Anatomy A separation occurs here at the acromio-clavicular joint A dislocation occurs here at the gleno-humeral joint

46 Bony Anatomy  Three bones: –Humerus –Bicipital groove –Clavicle –S shape –Scapula –Corocoid process –Acromion process (a/c joint)  Many ligaments  Not a very stable joint

47 JOINTS  There are many joints at the shoulder  Most commonly injured joints are  Acromio-clavicular  Gleno-humeral –Each held together by many ligaments


49 Muscles of the shoulder  The Rotator Cuff –SITS muscles Supraspinatus Infraspiantus Teres minor Subscapularis  Deltoid –Lays over the head of the humerus  Pectoralis –Originate at sternum attach to the anterior portion of the humerus

50 Muscles Biceps- two heads  Originates at the Coracoid process and the Humerus  Distal attachment is a the radial head  Runs through the bicipital groove  ACTION: elbow flexion and forearm supination Triceps  Originates at the posterior humeral head and scapula  Distal attachment is distal humerus at the elbow  ACTION: Elbow extension and shoulder extension

51 Brachial Plexus



54 Rotator Cuff Strain  Characterized like any other strain –1st, 2nd, and 3rd degree  Common in throwing athletes  Occurs from excessive motion beyond the normal range

55 Impingement Syndrome  Overdoing it with overhead motions  Supraspinatus and Bicep run together beneath the acromion process  Space narrows because of swelling, poor posture, muscle imbalance  Not enough room for everything in the joint pain occurs with motion sometimes there is numbness along with the pain

56 Bicipital Tendonitis  Pain with overhead motions  Palpate crepitus  Inflammation of the tendon in the groove

57 Tendon rupture


59 Fractures  There is a tremendous amount of stress at the shoulder  Given its role in contact and collision sports fractures are common in athletics –Clavicular –Humeral –Scapular

60 Fractures

61 What does this mean?  Subluxation  Dislocation  Separation

62 Protection

63 Fitting Correctly

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