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Wrist, Hand, Elbow & Shoulder

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Presentation on theme: "Wrist, Hand, Elbow & Shoulder"— 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: Distal: A=Scaphoid B=Lunate C=Triquetral
D=Pisiform Distal: E=Trapezium F=Trapezoid G=Capitate H=Hamate

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 Cycling Field hockey/ girls lacrosse

9 More Gloves Lineman Gloves Receiver/ Running back 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 Carpal tunnel 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 Radial Collateral These are rare
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 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

41 Elbow Dislocation

42 Elbow Dislocation 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 Olecranon Bursitis 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: Many ligaments Not a very stable joint
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 Triceps 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

52 Brachial Plexus

53 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

58 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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