3Articulations of the humerus, radius, and ulna Articulations of the humerus, radius, and ulna. [ olecranon process ] Medial collateral ligament: 3 portions, anterior, posterior, obliqueThe anterior fibers are tight in extension, while the posterior fibers are tight in flexion [ beyond 90 degrees ] The posterior fibers are fan shaped and thin when compared to the anterior fibers.
4Causes: Back Hand Swing (tennis); Painting ; Carrying heavy buckets
5Lateral Epicondylitis Symptoms: Point lateral epicondyle; radiating pain to mid forearm and into the middle and ring finger; stiffness in elbow.
7Movements of elbow Elbow: flexion - extension Wrist: supination - pronation - ulnar and radial deviation flexion and extensionFlexion and extension originate at the humeroradial and humeroulnar joints while pronation and supination occur from the radio scaphoid (Navicular)articulations at the wrist and the radioulnar joint at the elbow.
8Elbow Dislocations6. Dislocations (fractures of the coronoid process occur in approx % of elbow dislocations)Dislocations of the elbow are infrequent occurrences in intercollegiate athletics.However, when they do occur, the are often serious injuries due to the potential for fractures and impaired distal circulation.
9Muscles of elbow, wrist, & hand Biceps = primary supinator of the forearm also primary for elbow flexion.Brachial, originates on the humerus, extends anteriorly across the joint and inserts into the ulna.Triceps, 3 heads, Primary responsible for extension of elbow.Flexor - pronator group, originates on medial sideExtensor - supinator group,Olecranon bursae, separates the skin over the tip of the elbow from the pointed end of the ulna. [ Olecranon process ]Radial - humeral bursae, lies anteriorly between the radial head and the lateral epicondyle between the muscle attachments
10Hand & Wrist Injuries Gamekeeper’s Thumb Mallet Finger Jersey Finger Central Slip Injury / Boutenniere DeformitySwan Neck DeformityColles Fracture / Smith FractureScaphoid FractureBennet’s FractureBoxer’s FractureDislocated FingersSmash/Avulsion Injuries
11Gamekeeper’s Thumb Normal thumb Normal Carrying Angle Gamekeeper’s Sprain(Notice the opening of joint
12Mallet Finger How ? S/S? Tx? Hit on tip of finger with ball Tip of Finger DropsBlood under nailSwellingTx?PRICE, Splint into ext., Need to refer within a week
17Swan Neck Deformity DIP goes into extension PIP goes into flexion Look now, there is only one tendon that is responsible for extending the both the joints of the finger. This is in contrast to the flexor tendons that are two in number. This extensor tendon divides into three slips (branches). The central one extends the proximal joint and the remaining two (one on each side of the finger) join further up and extend the distal joint.Now if the lateral slips that extend the distal joint stop functioning for whatever reason, then the distal joint will remain flexed. The central slip continues to function (in fact it over functions because you still continue trying to extend the distal joint with your non functioning lateral slips) and this results in excessive extension of the proximal joint. This eventually produces swan neck deformity.Causes of this deformity includerheumatoid arthritis (most common)mallet finger (due to rupture of lateral slips at their junction with bone)cerebral palsy (due to muscle imbalance)congenital joint laxity
18Central Slip Injury / Boutenniere Deformity How?PIP forceabley flexed and same timeCommon in Basketball PlayersS/S?Unable to actively extend the jointTenderness over the dorsal aspect of the middle phalanxTx?Splint in full extension x 6 weeks
20Colles Fracture TX? What? How? S/S? PRICE Distal Radial Fracture Refer to MDCast if no surgerySurgery possibleWhat?Distal Radial FractureMost common arm fractureHow?Fall on outstretched handWrist goes into extensionS/S?immediate (acute) pain,tenderness, bruising, and swellingFrequently, the wrist hangs in an odd or bent way (deformity).
22Smith Fracture What? How? S/S? TX? Distal Radial Fracture Fall on flexed handS/S?Same as Colles FractureTX?
23Scaphoid Fracture What? How? S/S? TX? Fracture small carpal bone 2nd most common wrist fractureHow?Fall on outstretched handS/S?SwellingPoint tenderness (anatomicalsnuff box)TX?Refer for xray – CYA!!!
24Bennett’s Fracture Fracture of 1st MCP jt Fall on outstretched hand Dropped objectTXRefer for xraySplint
25Boxer’s Fracture Break in the small end of the 5th metacarpal What caused it? Punching something harder than the hand, such as a wall or another person's head.TX?PRICEREFERThe end of the metacarpal bone takes the brunt of the impact, which usually breaks through the narrowest area near the end (the "neck"), and bends down toward the palm
26Dislocated FingersDuring sports activities, a basketball or baseball may strike the tip of an outstretched finger.Your finger might get caught in equipment such as a game jersey or pads.You might fall onto your outstretched hand.
27Dislocated Finger S/S Do Not Try to Reduce! Splint Refer Obvious DeformityPainSwellingDo Not Try to Reduce!SplintRefer