2. 1 Injuries to the Arm, Wrist and Hand

3. 2 Elbow Bones Humerus Ulna Radus Ligaments Ulnar Collateral Annular Ligament Interossius Membrane Joints Humeroulnar, Humeroradial Radialulnar

4. 3 Elbow Movements Elbow Movements flexion/extension, pronation/supination flexion/extension, pronation/supination Wrist Movements Wrist Movements flexion/extension, radial & ulnar deviation flexion/extension, radial & ulnar deviation

5. 4 Soft Tissue Injuries Contusions and fractures common in contact sports common in contact sports muscle tissue compressed between skin and bone muscle tissue compressed between skin and bone Repeated episodes can result in myositis ossificans traumatica. Repeated episodes can result in myositis ossificans traumatica. chronic inflammation of the muscle and underlying periosteum resulting in development of bony mass within the muscle chronic inflammation of the muscle and underlying periosteum resulting in development of bony mass within the muscle develops over weeks or months and is often ignored during the early stages develops over weeks or months and is often ignored during the early stages

6. Fractures of the Humerus Signs/symptoms: Signs/symptoms: severe pain in upper arm severe pain in upper arm deformity & loss of function deformity & loss of function muscle spasm muscle spasm audible snap or pop audible snap or pop sensory loss in forearm sensory loss in forearm First Aid: application of ice & compression splint & sling/swathe monitor distal pulse treat for shock summon EMS

7. 8 Elbow Dislocation Mechanism for this injury includes falling either on a flexed or fully extended arm -- deformity is usually obvious

9. Elbow sprains and dislocations three joints of the elbow three joints of the elbow ulnar & radial collateral ligaments -- valgus/varus ulnar & radial collateral ligaments -- valgus/varus injury mechanism includes falling backwards with elbow in extension injury mechanism includes falling backwards with elbow in extension valgus/varus forces can result in sprains valgus/varus forces can result in sprains dislocations constitute extreme sprains dislocations constitute extreme sprains

10. 9 Elbow Sprains Signs/symptoms: Signs/symptoms: in minor sprains -- mild swelling & localized pain in minor sprains -- mild swelling & localized pain difficulty in gripping or making a fist difficulty in gripping or making a fist in dislocations -- gross deformity in dislocations -- gross deformity loss of function & severe pain loss of function & severe pain possible neurological symptoms possible neurological symptoms First Aid: application of ice & compression splint & sling/swathe monitor distal pulse treat for shock summon EMS

11. 10 Elbow Fractures generally involve the distal humerus generally involve the distal humerus danger to neurovascular structures danger to neurovascular structures injury mechanism similar to sprains and dislocations injury mechanism similar to sprains and dislocations fractures of the olecranon associated with direct blows fractures of the olecranon associated with direct blows if radial artery is compressed -- Volkmann’s contracture may result if radial artery is compressed -- Volkmann’s contracture may result

12. 12Epicondylitis Epicondylitis of the elbow lateral epicondyle attachment of the extensors Medial epicondyle Attachment of the flexors gripping combined with wrist movements

13. 13 Elbow Injuries Golf associated with medial epicondyle Golf associated with medial epicondyle Tennis elbow -- involves the lateral epicondyle Tennis elbow -- involves the lateral epicondyle excessive number of strokes excessive number of strokes incorrect technique incorrect technique racket handle too small racket handle too small change in racket materials change in racket materials grip too tight grip too tight muscle imbalance muscle imbalance

14. Elbow Injuries Signs/symptoms: Signs/symptoms: pain in the region of an epicondyle with swelling pain in the region of an epicondyle with swelling becomes worse with activity becomes worse with activity radiating pain into forearm muscles radiating pain into forearm muscles epicondylar pain associated with resisted wrist movements epicondylar pain associated with resisted wrist movements First Aid: First Aid: ice, compression, rest ice, compression, rest medical referral if pain persists medical referral if pain persists

15. 14 Osteochondritis Dissecans throwing mechanism can result in impingement between radial head and capitulum throwing mechanism can result in impingement between radial head and capitulum high velocity elbow extension - joint compression on the lateral side high velocity elbow extension - joint compression on the lateral side joint cartilage becomes inflamed & may fracture joint cartilage becomes inflamed & may fracture axial loading may also result in damage axial loading may also result in damage Signs/symptoms: Signs/symptoms: painful participation painful participation swelling 12-24 hrs. after swelling 12-24 hrs. after “locking” of joint “locking” of joint osteoarthritis in advanced cases osteoarthritis in advanced cases First Aid: First Aid: ice and compression ice and compression medical referral medical referral

16. 15 Contusions of the elbow blows to the elbow are common blows to the elbow are common majority result in temporary symptoms majority result in temporary symptoms exception involves the olecranon bursa exception involves the olecranon bursa repeated irritation of the bursa can result in inflammation (bursitis) repeated irritation of the bursa can result in inflammation (bursitis) Signs/symptoms: Signs/symptoms: swelling in the region of the olecranon process swelling in the region of the olecranon process pain/stiffness with movement pain/stiffness with movement elevated skin temperature elevated skin temperature First Aid: First Aid: ice and compression ice and compression in cases of bursitis -- medical referral in cases of bursitis -- medical referral

17. 16 Wrist and Forearm Injuries

20. 17 Anatomy of the wrist complex due to small size and large number of tendons that serve the wrist, thumb and fingers complex due to small size and large number of tendons that serve the wrist, thumb and fingers Tendons are held in place by retinaculum Tendons are held in place by retinaculum Retinaculum is small ligaments Retinaculum is small ligaments Major nerves and vessels pass through this region as well. They are: Major nerves and vessels pass through this region as well. They are: ulnar and radial arteries and veins ulnar and radial arteries and veins ulnar, median, radial nerves ulnar, median, radial nerves

21. 18 Colles’ Fracture rare in sports Colles’ Fracture is most serious. Signs/symptoms:Signs/symptoms: history of significant traumahistory of significant trauma snap or popping soundsnap or popping sound deformity, swelling into hand/fingersdeformity, swelling into hand/fingers severe pain and loss of sensation may occursevere pain and loss of sensation may occur

22. 19 Wrist Fractures Navicular navicular fracture most common generally occur at the “waist”

23. Navicular Fractures Signs/symptoms: Signs/symptoms: history of wrist trauma with popping or snapping history of wrist trauma with popping or snapping pain with movement/wrist feels locked, positive “snuffbox” test pain with movement/wrist feels locked, positive “snuffbox” test First Aid: First Aid: I.C.E. application I.C.E. application splint with sling & swathe, leave fingertips exposed (to observe circulation splint with sling & swathe, leave fingertips exposed (to observe circulation medical referral medical referral

24. 20 Wrist and Forearm Injuries A simple test for assessment of the integrity of the carpal navicular bone -- pressing lightly in the “anatomic snuffbox ”

25. 21

27. Wrist Sprains and Dislocations Wrist Sprains and Dislocations Mechanism is typically hyperextension, similar mechanism to fractures Mechanism is typically hyperextension, similar mechanism to fractures Signs/symptoms: Signs/symptoms: history combined with snapping/popping sensation history combined with snapping/popping sensation painful movement painful movement movement may be impossible movement may be impossible numbness and/or radiating pain numbness and/or radiating pain First Aid: First Aid: application of I.C.E. application of I.C.E. splint with sling & swathe splint with sling & swathe expose fingertips expose fingertips refer to a physician refer to a physician

28. 23 Nerve injuries in the wrist median is most commonly injured -- carpal tunnel median is most commonly injured -- carpal tunnel carpal tunnel related to inflammation of flexor tendons carpal tunnel related to inflammation of flexor tendons carpal tunnel related to sports requiring extensive gripping carpal tunnel related to sports requiring extensive gripping ulnar nerve injuries -- produce numbness in the hypothenar eminence ulnar nerve injuries -- produce numbness in the hypothenar eminence

29. Carpal Tunnel Signs/symptoms: Signs/symptoms: sensory loss to a portion of the hand/fingers sensory loss to a portion of the hand/fingers pain/tenderness in the wrist, associated tendonitis and symptoms increase with wrist flexion pain/tenderness in the wrist, associated tendonitis and symptoms increase with wrist flexion Care for carpal tunnel syndrome consist of treating the inflammation and rest. Care for carpal tunnel syndrome consist of treating the inflammation and rest.

30. 25 Ganglion Cyst Results from a herniation of the synovium surrounding a tendon herniated area becomes filled with fluid variable in appearance -- some soft, other hard and painful Ganglion s

31. Ganglion Cysts Signs/symptoms: Signs/symptoms: visible swelling visible swelling in advanced cases, painful, hardened nodule in advanced cases, painful, hardened nodule First Aid: First Aid: some spontaneously regress some spontaneously regress leave alone if possible leave alone if possible can be surgically removed can be surgically removed

32. 26 Hand Injuries 19 bones in the hand and wrist

33. 27 Metacarpals can be fractured by a crushing mechanism Phalangeal fractures common in sports Signs/symptoms: history of trauma associated dysfunction deformity broken skin (compound) significant inflammation Hand fractures Hand fractures Bennett fracture Bennett fracture mechanism includes blows with a clenched fist mechanism includes blows with a clenched fist

34. 28 Sprains & dislocations of the hand – any joint in the hand can be involved – most common forms are: – gamekeeper’s thumb – mallet finger – boutonniere deformity –

35. 29 Gamekeeper’s thumb involves sprain of the ulnar collateral lig. mechanism of injury is a valgus force thumb is unstable Signs/symptoms: history of an appropriate mechanism pain over the area of the ulnar collateral ligament snapping or popping at the time of injury swelling of the MP joint inability to move the thumb inability to grip tightly using the thumb Anatomy of a gamekeeper’s thumb

36. 30 Mallet (baseball) Finger involves distal phalanx, name comes from the deformity involves distal phalanx, name comes from the deformity mechanism -- blow to the fingertip while extending, can’t extend fingertip mechanism -- blow to the fingertip while extending, can’t extend fingertip Signs/symptoms: Signs/symptoms: deformity MOST important deformity MOST important recent trauma to fingertip recent trauma to fingertip point tender DIP point tender DIP

37. 32 Boutonniere deformity extensor tendon involved as it crosses the PIP mechanism is blow while the finger is flexed during active extension Signs/symptoms: violent flexion injury associated with feeling of tearing/popping significant weakness in finger extension PIP painful and swollen if uncorrected, deformity will develop characterized by hyperextension of MP & DIP with flexion of PIP

38. 31 Anatomy of the Finger Tendons

39. Splinting for fractures of the forearm, wrist and/or hand