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Injuries to the Elbow, Forearm, Wrist & Hand

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Presentation on theme: "Injuries to the Elbow, Forearm, Wrist & Hand"— Presentation transcript:

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


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