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Chapter 20.  The Wrist and Hand ◦ Made up of 27 bones  8 carpal bones make up the wrist  5 metacarpals from the structure of the hand  14 phalanges.

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Presentation on theme: "Chapter 20.  The Wrist and Hand ◦ Made up of 27 bones  8 carpal bones make up the wrist  5 metacarpals from the structure of the hand  14 phalanges."— Presentation transcript:

1 Chapter 20

2  The Wrist and Hand ◦ Made up of 27 bones  8 carpal bones make up the wrist  5 metacarpals from the structure of the hand  14 phalanges  2 for the thumb  3 for each other 4 fingers

3  3 bones of the elbow joint ◦ Humerus ◦ Radius ◦ Ulna  Many structures surround the elbow ◦ Ligaments ◦ Nerves ◦ Muscles ◦ Bursa sacs

4  Forearm Flexors ◦ Brachialis ◦ Biceps Brachii ◦ Brachioradialis  Forearm Extensors ◦ Triceps Brachii ◦ Anconeus

5  Several causes for a variety of athletic injuries ◦ Direct trauma ◦ Indirect trauma ◦ Acute/Chronic stresses  These MOIs can result in several injuries ◦ Contusions ◦ Sprains ◦ Strains ◦ Dislocations ◦ Fractures ◦ Nerve involvement

6  Common injury that may involve the muscles of the forearm and subcutaneous bony prominences of the elbow ◦ Usually caused by a direct blow  Symptoms ◦ Bruising ◦ Subsequent bleeding ◦ Stiffness during function or active motion  Treatment ◦ PRICE  Prevents myositis ossificans

7  Inflammation of the olecranon bursitis ◦ Caused by direct blows to the olecranon process ◦ Can be accompanied by infection due to the frequent abrasions that occur over the tip of the elbow  Treatment ◦ Depends on whether infection is involved ◦ Uninfected bursitis  Ice compresses  Rest ◦ Anti-inflammatory meds ◦ Pain meds ◦ Aspiration of the bursa

8  Caused by a direct blow the medial epicondyle of the humerus ◦ Athlete complaints of immediate pain and burning sensation down the ulnar side of the forearm to the ring and little fingers  Also known as hitting the “funny bone”  Treatment ◦ None is usually necessary

9  Normally occur with a sudden overload to the elbow joint ◦ can acute or chronic  Acute Strains ◦ Sudden excessive overload ◦ Tenderness over the affected area ◦ Pain on function or resisted motion  Chronic Strains ◦ Result of continued overuse ◦ Overuse syndrome ◦ Chronic degenerative processes  Common areas of acute strains ◦ Common flexor tendon  Medial epicondyle ◦ Common extensor tendon  Lateral epicondyle

10  Usually due to forced hyperextension or valgus/varus forces  Symptoms ◦ Click or pop ◦ Sharp pain at injury ◦ Tenderness ◦ Localized swelling ◦ Pain when repeating MOI  Usually relieved by bending the elbow

11  Usually caused by repetitive overload of the attached musculotendinous units ◦ Occurs in the region of the medial and lateral epicondyle of the humerus ◦ Called “tennis elbow” if lateral ◦ Called “golfer’s elbow” if medial ◦ If it occurs in younger patients, called “little leaguer elbow” ◦ Can also accompany an injury to the growth plate of the epiphysis

12  Symptoms ◦ Pain when used ◦ Possible swelling ◦ Local tenderness ◦ Pain with resisted wrist motion  Without proper treatment condition may worsen ◦ May develop into prolonged degenerative changes ◦ Causes chronic epicondylitis ◦ Contractures of the elbow ◦ Reduced friction ◦ Possible rupture of muscle tendon unit  Treatment ◦ RICE ◦ Modifying activities that aggravate conditions  Preventive measures ◦ Using proper technique/equipment ◦ Limiting stress ◦ Adequately warming up ◦ stretching

13  Most commonly involves the posterior displacement of the ulna and radius in relationship to the humerus ◦ Often caused by a fall onto an outstretched hand with elbow in extension  Symptoms ◦ Obvious deformity ◦ Loss of elbow function ◦ Considerable pain ◦ Initial exam should include evaluation of nerve function of hand and fingers  Treatment ◦ Immobilzation ◦ Immediate referral to physician of medical facility ◦ Possible vascular and neurological damage

14  The result of either direct trauma or indirect stresses transmitted through the upper extremity by falling on an outstretched arm ◦ Fractures in younger athletes commonly involve epiphyseal plate fractures  Symptoms ◦ Directly related to degree of severity ◦ Point tenderness ◦ Hemorrhaging ◦ Swelling ◦ Limited ROM ◦ Disability at elbow or hand ◦ Increased pain with movement  Treatment ◦ Immobilization ◦ Ice ◦ Prompt referral to physician or medical clinic

15  Occurs in the absence of blood flow (ischemia) to the forearm ◦ Can lead to contracture, where joint remains bent and cannot straighten  Causes ◦ Increased pressure from swelling or trauma ◦ Fracture  3 Levels of severity in Volkmann’s Contracture ◦ Mild  Involves contracture of 2 or 3 fingers  No limited loss of sensation ◦ Moderate  Involves all fingers being flexed  Thumb stuck in palm  Wrist may be stuck in flexion  Usually loss of sensation in the hand ◦ Severe  Involves all muscles in forearm (flexors and extensors)  Fingers  Severely disabling condition

16  Symptoms ◦ Severe pain when a muscle running through a compartment is passively moved ◦ Forearm may be swollen ◦ Shiny ◦ Painful when squeezed ◦ Pain does not improve with rest, but continues to worsen with time ◦ If condition is not corrected  Decreased sensation  Weakness  Paleness of the skin

17  Repetitive throwing and/or swinging can cause irritation, compression, or entrapment in the cubital tunnel ◦ Called cubital tunnel syndrome  Symptoms ◦ Pain along the inner aspect of the elbow ◦ Tenderness of the medial epicondylar groove ◦ Paresthesia (numbness or tingling) of ring and little finger

18  Usually caused by entrapment of the nerve which passes through a tunnel formed by several muscles and tendons ◦ Also called radial tunnel syndrome  Symptoms ◦ Pain over lateral aspect of the elbow ◦ Pain over radial head

19  Includes entrapment or compression due to hypertrophy of the pronator teres or repetitive pronation of the forearm ◦ Called pronator teres syndrome  Symptoms ◦ Pain radiating down the anterior forearm ◦ Numbness and tingling in the thumb, index, and middle fingers ◦ Resistive pronation may increase the pain

20  Muscles that move the Wrist ◦ 2 Flexor Carpi muscles ◦ 2 Extensor Carpi muscles ◦ 2 Palmaris muscles  Muscles that move the Hand ◦ 1 Supinator muscles ◦ 2 Pronator muscles  Muscles that move the Thumb ◦ 2 Flexors ◦ 2 Extensors ◦ 1 adductor ◦ 2 abductors ◦ 1 opponens  Muscles that move the Fingers ◦ 3 flexors ◦ 2 extensors ◦ 3 abductors ◦ 1 adductor

21  Common injuries ◦ Fractures ◦ Dislocations ◦ Contusions ◦ Sprains ◦ Tendonitis ◦ Nerve Impingements

22  Can involve any of the 14 phalange bones. ◦ Most can be treated with a finger splint  Boxer’s Fracture ◦ A break of the 5 th metacarpal leading to the little finger  Baseball (mallet) finger ◦ Painful injury that occurs when a ball or other object strikes the tip of the finger, bending it beyond its normal ROM which tears the finger tendon and damages cartilage

23  Jersey Finger ◦ Caused by tearing the flexor tendon to the fingertip  Usually occurs from grabbing a jersey during a tackle.  Ring finger is the most often affected  Scaphoid fracture ◦ Affects the scaphoid bone ◦ Paplpation of the anatomical snuffbox will cause pain, indicates a fracture may be present

24  Colles Fracture ◦ A break of the radius just above the wrist  Treatment for all fractures ◦ RICES (rest, ice, compression, elevation, support) ◦ Evaluation by a physician

25  Fairly common injuries  Causes ◦ Ball striking fingertip ◦ Finger getting hooked into equipment  Symptoms ◦ Immediate pain ◦ Swelling ◦ Crooked finger  Usually can’t be bent or straightened  Treatment ◦ Ice ◦ Immobilization ◦ Immediate treatment by physician

26  Usually caused by direct blows or falling onto a hard surface ◦ With nails become contused, pressure may cause a physician to drain blood from beneath the nail

27  Gamekeeper’s thumb ◦ Sprain of the ulnar collateral ligament of the metacarpalphalangeal joint (MPJ)  Common in alpine skiiing ◦ Caused by force applied to the medial side of the thumb, forcing the MPJ to stretch, tear, or even rupture

28  The inflammation of the tendons caused by overuse or repetitive stress  Symptoms ◦ Ache or pain at the wrist  Worsens forceful gripping, rapid wrist movements or moving the wrist or fingers to an extreme position  Treatment ◦ The same as other forms of tendonitis ◦ Most common sites in the wrist  Base of the thumb near anatomical snuffbox  deQuervian’s tenosynovitis

29  Also called Carpal Tunnel syndrome  An inflammatory disorder caused by the following ◦ Repetitive stress ◦ Physical injury ◦ Other conditions that cause swelling around the median nerve near the carpal tunnel  Symptoms ◦ Pain ◦ Numbness ◦ Tingling in the wrist, hand, fingers (except little finger) ◦ Tendency to drop things ◦ Loss of sense of heat or cold ◦ Feeling of swelling, even though it is visibly swollen ◦ Symptoms may occur only when the hand is being used or only when at rest  Treatment ◦ RICE ◦ In severe cases, surgery to decompress the median nerve

30  A small, usually hard lump above a tendon or in a capsule that encloses a joint ◦ Also called a synovial hernia or synovial cyst  It is common in handball, racquetball, squash and tennis ◦ Cause of the cyst is unknown

31  An injury to the extensor tendon affecting the proximal interphalangeal joint (PIP) at the middle of the finger or the distal interphalangeal joint at the end of the finger ◦ Caused by a direct blow to a bent finger  Symptoms ◦ Problems flexing and extending the finger ◦ Physician should be contacted immediately ◦ Joints will be painful and tender ◦ Finger misshapen or deformed ◦ The athlete will not be able to straighten it  Treatment ◦ Must be done promptly ◦ Athlete may not regain normal use of the finger


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