1. Injuries to the Elbow, Forearm, Wrist & Hand

2. Bones and Joints of the Elbow
Humerus
Radius
Ulna
Joints
Humeroulna = humerus & ulna
Humeroradial = humerus & radius
Radioulna = radius & ulna

3. Nerves of the Elbow
3 Nerves of the Elbow
Radial
Median
Ulnar

5. Medial View Lateral View

6. ROM for Elbow Joint Tests for Active Range of Motion
ROM test for flexion
ROM test for extension
ROM test for elbow supination
ROM test for elbow pronation
Manual Muscle Tests for Elbow
Biceps, Triceps, Pronators, Supinators

7. Injuries to the Elbow & Forearm
Fractures
Mechanism of injury
1. falling on outstretched hand
2. direct blow
Usually affect lower end of humerus
Treatment
1. Splint and send to ER

8. Olecranon Process Fracture

10. Injuries to Elbow & Forearm
Dislocation/Subluxation
Mechanism of Injury
1. Falling on an outstretched arm
2. Limb is twisted severely
Rollerblading, football, skateboarding, hockey carry increased risk
Treatment
1. Immobilize and send to ER
2. Do not attempt to reduce

11. Elbow Dislocation

12. Injuries to Elbow & Forearm
Sprains
Mechanism of Injury
1. Hyperextension at elbow
Stress Tests for Joint Laxity
1. Valgus – apply lateral force (open joint up medially)
tests for laxity of ulnar collateral
ligament
2. Varus - apply medial force (open joint up laterally)
tests for laxity of radial collateral ligament
Perform both tests with elbow straight and 30°

14. Injuries to Elbow & Forearm
Impingement – pinching of soft tissue such as bursa, tendon, or nerve between the ends of 2 bones (Ulnar Nerve)
Mechanism of Injury
1. Repeated stress
2. Direct blows
Special Test
1. Tinel’s Sign – tap the ulnar nerve, tingling down arm indicates + sign

16. Injuries to Elbow & Forearm
Bursitis
Olecranon bursitis most common
Symptoms include pain, swelling, point tenderness
Treat with ICE technique

18. Injuries to Elbow & Forearm
Biceps Brachii Rupture
Mechanism of injury
1. Pulling motions (gymnastics, rowing, weight lifting
Symptoms
1. Pain
2. Swelling (bulge in biceps)
3. Loss of motion/strength
Treatment
1. Immobilize & send to physician

22. Injuries to Elbow & Forearm
Epicondylitis
Inflammation of the medial or lateral epicondyle of the humerus.
Lateral Epicondylitis
1. affects extensors
2. called “tennis elbow”
Medial Epicondylitis
1. affects flexors
2. called “little league elbow” or “golfer’s elbow”

23. Epicondylitis Mechanism of Injury
1. Chronic overuse of athletes who twist forearm during throwing or swinging
Symptoms
1. pain & tenderness around elbow
2. twisting motion will cause pain
Treatment
1. RICE
2. brace

25. Injuries to Elbow & Forearm
Volkmann’s Contracture
Damage to muscles of forearm due to injury to blood supply
Mechanism of injury
1. fracture, dislocation, muscle spasm, or swelling reduces blood supply
Treatment
1. Activate EMS

26. Anatomy of Wrist and Hand
Bones
Wrist
8 carpal bones
Hand
5 metacarpals
5 phalanges
Muscles
Flexors (anterior side)
Flexor carpi radialis
Flexor carpi ulnaris
Extensors (posterior side)
Extensor carpi ulnaris
Extensor carpi radialis longus

28. Anterior Posterior

29. Injuries to Wrist and Hand
Carpal Tunnel Syndrome
Inflammation of the median nerve of wrist/hand

30. Injuries to Wrist and Hand
Fractures
Mechanism of injury
1. Direct blows
2. Falling on outstretched hand
Colles’ Fracture – distal radial fracture
Navicular Fracture – navicular (schaphoid) bone of wrist
Pain in the anatomical “snuff box”
Slowest healing bone in body (low blood supply)

35. Injuries to Wrist and Hand
Dislocation/Subluxation
Mechanism of injury
1. direct blow from a ball or other object

38. Injuries to Wrist and Hand
Sprains
Wrist sprains caused by hyperextension or hyperflexion
Thumb (Gamekeeper’s thumb)
Sprain of ulnar (medial) collateral ligament
Caused by abduction of thumb
Gamekeeper’s Thumb Test – application of valgus stress on thumb joint

40. Injuries to Wrist and Hand
Impingement (median or ulnar nerve)
Caused by repeated stress
Phalen’s Test
1. Place athlete’s hands back to back
2. Grasp palms with one hand
3. Tingling or numbness + sign

42. Injuries to Wrist and Hand
Tendonitis
Caused by overuse
Finkelstein’s Test (thumb tendon)
1. make a fist with thumb under fingers
2. place hand around athletes fist
3. apply isometric resistance as they flex in an ulna direction

43. Injuries to Wrist and Hand
Mallet Finger (“baseball finger”)
Flexion of the distal phalangeal joint
Caused by direct blow to outstretched finger
Tears extensor tendon
Can’t actively extend finger
Splint & refer to physician

46. Injuries to Wrist and Hand
Boutonniere Deformity
Abnormal contracture of phalange where proximal joint flexes and distal extends due to tendon rupture