Injuries to the Elbow, Forearm, Wrist & Hand

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

Nerves of the ElbowNerves of the Elbow

• 3 Nerves of the Elbow– Radial– Median– Ulnar

Medial View Lateral View

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

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

Olecranon Process Fracture

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

Elbow Dislocation

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°

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

Injuries to Elbow & ForearmInjuries to Elbow & Forearm

• Bursitis– Olecranon bursitis most common– Symptoms include pain, swelling, point

tenderness– Treat with ICE technique

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

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”

• 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

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

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

Anterior Posterior

Injuries to Wrist and HandInjuries to Wrist and Hand

• Carpal Tunnel Syndrome– Inflammation of the

median nerve of wrist/hand

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)

Injuries to Wrist and HandInjuries to Wrist and Hand

• Dislocation/Subluxation– Mechanism of injury

1. direct blow from a ball or other object

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

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

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

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

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