injuries to the elbow, forearm, wrist & hand. bones and joints of the elbow bones humerus radius...
TRANSCRIPT
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Injuries to the Elbow, Forearm, Wrist & Hand
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Bones and Joints of the ElbowBones and Joints of the Elbow
Bones• Humerus• Radius• Ulna
Joints• Humeroulna = humerus & ulna• Humeroradial = humerus & radius• Radioulna = radius & ulna
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Nerves of the ElbowNerves of the Elbow
• 3 Nerves of the Elbow– Radial– Median– Ulnar
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Medial View Lateral View
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ROM for Elbow JointROM 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
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Injuries to the Elbow & ForearmInjuries to the Elbow & Forearm
• FracturesMechanism of injury
1. falling on outstretched hand 2. direct blow
Usually affect lower end of humerus
Treatment1. Splint and send to ER
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Olecranon Process Fracture
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Injuries to Elbow & ForearmInjuries to Elbow & Forearm
• Dislocation/SubluxationMechanism 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
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Elbow Dislocation
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Injuries to Elbow & ForearmInjuries to Elbow & Forearm• Sprains
Mechanism of Injury1. Hyperextension at elbow
Stress Tests for Joint Laxity1. Valgus – apply lateral force (open joint up medially)
tests for laxity of ulnar collateral ligament2. Varus - apply medial force (open joint up laterally)
tests for laxity of radial collateral ligament
Perform both tests with elbow straight and 30°
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Injuries to Elbow & ForearmInjuries to Elbow & Forearm
• Impingement – pinching of soft tissue such as bursa, tendon, or nerve between
the ends of 2 bones (Ulnar Nerve)
Mechanism of Injury1. Repeated stress2. Direct blows
Special Test1. Tinel’s Sign – tap the ulnar nerve, tingling
down arm indicates + sign
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Injuries to Elbow & ForearmInjuries to Elbow & Forearm
• Bursitis– Olecranon bursitis most common– Symptoms include pain, swelling, point
tenderness– Treat with ICE technique
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Injuries to Elbow & ForearmInjuries to Elbow & Forearm
• Biceps Brachii RuptureMechanism of injury
1. Pulling motions (gymnastics, rowing, weight lifting
Symptoms1. Pain2. Swelling (bulge in biceps)3. Loss of motion/strength
Treatment1. Immobilize & send to physician
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Injuries to Elbow & ForearmInjuries 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”
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• EpicondylitisMechanism 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
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Injuries to Elbow & ForearmInjuries 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
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Anatomy of Wrist and HandAnatomy 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
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Anterior Posterior
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Injuries to Wrist and HandInjuries to Wrist and Hand
• Carpal Tunnel Syndrome– Inflammation of the
median nerve of wrist/hand
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Injuries to Wrist and HandInjuries to Wrist and Hand• Fractures
– Mechanism of injury1. 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)
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Injuries to Wrist and HandInjuries to Wrist and Hand
• Dislocation/Subluxation– Mechanism of injury
1. direct blow from a ball or other object
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Injuries to Wrist and HandInjuries 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
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Injuries to Wrist and HandInjuries 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
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Injuries to Wrist and HandInjuries 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
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Injuries to Wrist and HandInjuries 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
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Injuries to Wrist and HandInjuries 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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