Transcript Elbow/Wrist/Hand Unit

Elbow/Wrist/Hand Unit
Chapter 22
Advance Sports Medicine
Anatomy Of The
Elbow/Wrist/Hand
 1. Navicular
(scaphoid)
 2. Lunate
 3. Triquetral
 4. Pisiform
 5. Hamate
 6. Capitate
 7. Trapezoid
 8. Trapezium
 9. Ulnar styloid
 10. Radial Styloid
Phalanges
Metacarpals
Carpus
Radius
Ulna
HA ND , AN TER IOR VIE W
Anatomy cont.
• Bones of the elbow
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2
3
4
5
Olecranon
CapitulumTrochlea
Lateral epicondyle
Medial epicondyle
Muscles and Ligaments of the forearm/elbow
Ligaments of elbow
11.Extensor carpi ulnaris
1. Ulnar collateral
12. Extensor carpi
radialis
2. Radial collateral
13. Flexor digitorum
3. Annular lig.attaches to
ulna/radius of the
elbow
• Muscles
4. Biceps brachii
5. Tricep brachii
6. Brachial radialis
7. Supinator
8. Pronator teres
9. Flexor carpi radialis
10. Flexor carpi ulnaris
14. Extensor digitorum
15. Thumb-
16. Flexor pollicis
longus/brevis
17. Extensor pollicis
longus/brevis
18. Abductor pollicis
19. Adductor pollicis
20. Opponens pollicis
21. Opponens digiti
minimi (5th phalange
Thenar And Hypothenar Eminence
• Thenar eminence: thumb side
• Opponens pollicis
• Abductor pollicis brevis
• Flexor pollicis brevis
• Hypothenar eminence: pinky side
• Opponens digiti minimi
• Abductor digiti minimi
• Flexor digiti minimi brevis
Injuries to elbow
• Contusions
• May swell rapidly after an irritation of the olecranon bursa
or the synovial membrane
• RICE
• Olecranon bursitis
• Most frequently injured bursa in the elbow.
• Pain, point tenderness, severe swelling
• Ice and compression and possibility of aspiration
• Strains
• Usually caused by falling on an outstretched arm or
hyperextension. Test the biceps, triceps, brachialis,
pronators, supinators
Elbow Injuries cont.
• Sprains
• Caused by hyperextension or valgus forces. Point tender of the
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ulnar collateral lig.
Ice, compression and sling with the elbow in 45 degrees of flexion
• Lateral epicondylitis
• Chronic, or called tennis elbow, caused by repetitive microtrauma
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to the insertion of the extensor muscles, Hyperpronation is the
primary action.
RICE, and NSAID’s
• Medial epicondylitis
• same as above but most common in pitching, wrist flexors
Elbow injuries cont.
• Osteochondritis Dissecans
• Loose body in the joint, young athletes 10-15 yrs old.
• Sudden pain and locking of the joint
• RICE, NSAID’s, possible surgery
• Little League elbow
• Occurs in 10-25% of young pitchers, Injury onset is usually slow, may have
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joint tightness and triceps weakness, decreased ROM in pronation and
supination
RICE,NSAID’s and throwing is stopped.
• Cubital tunnel syndrome
• Ulnar nerve tunnel, traction injury from valgus force, irregularities
within the tunnel, subluxation of the ulnar nerve because of a lax
ligament, or a progressive compression of the ligament on the
nerve.
Posterior Elbow dislocation
Elbow Injuries cont.
• Elbow Dislocation
– Fall on an outstretched hand with elbow in a
hyperextension or twisted position
– Deformity with olecranon extending backward
beyond its normal alignment
– Rupture most of the stabilizing ligaments
– Profuse swelling, pain and disability
– Complications can include injury to major
nerves and blood vessels
– Rx: splint and refer to Dr. immediately for
reduction as soon as possible.
Elbow Injuries cont.
• Elbow Fracture
• Etiology: fall on an outstretched arm or a
direct blow to the olecranon.
• Fracture site: just above the epicondyles
of the humerus
• S/S: may or may not have visible
deformity, will have hemorrhage, swelling,
muscle spasm
• Rx: splint, ice and send to Dr. One
complication is decreased ROM
Volkmann’s contracture
• humeral supracondylar fx,
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which cause muscle
spasm, swelling, or bone
pressure on the brachial
artery, inhibition blood
circulation to the forearm,
wrist, and hand
S/S: pain in the forearm
which becomes greater
when the fingers are
passively extended.
Brachial/radial pulses
diminish which produce
cold hands
Rx: remove bandages
and elevate to relieve the
pressure. Dr.
Eval. Of elbow
• History:
• Is it caused by direct trauma,
throwing type of an inj?, look for
internal organ problem or ulnar
nerve impingement, is there is a
feeling of locking or crepitation?
• Observation
• Carrying angle, see if the bony
prominence form an isosceles
triangle with the elbow at 45
degrees.
• Palpation
• Special tests: see
Handout
Rehab of the elbow
• Stage 1
• RICE
• Early splinting and
Interferential for the pain
along with NSAID’s
• Stage 2 Maintain CV
• Early ROM exercises
• Joint mobilizations for
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increase ROM
Closed kinetic chain
exercises
PNF exercises
Strengthening exercises
after full ROM is obtained
• Stage 3
• Functional progression
• Open kinetic chain ex.
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W/controlled ROM
Open kinetic chain ex.
Through pain free ROM
PNF/closed kinetic ex.
Sports specific exercises.