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

48. JOINTS

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