Elbow, Wrist, Hand & Fingers Anatomy & Injuries

Anatomy of the Elbow

• Radius

– Head of Radius

• Ulna

– Olecranon

• Humerus

Anatomy of the Elbow

Anatomy of the elbow

Anatomy of the Elbow

• Ulnar (Medial)

Collateral Ligament

• Radial (Lateral)

Collateral Ligament

• Joint Capsule

• Annular Ligament

Anatomy of the Elbow

Anatomy of the Elbow

-Olecranon Bursa (Letter L)

Anatomy of the Elbow

• Triceps Brachii - Extensor

• Bicep Brachii – Flexion & Supination

• Brachialis - Flexion

• Brachioradialis – Flexion

• Pronator Teres – Pronation

• Pronator Quadratus – Pronation

• Supinator - Supination

Anatomy of the Elbow

Anatomy of the Elbow

Functional Anatomy of the Elbow

• Movements

– Flexion

– Extension

– Pronation

– Supination

Functional Anatomy of the Elbow

-Crossing of bones in forearm for

pronation/supination

Anatomy of the Wrist/Hand

• Ulna

• Radius

• Carpals

– 8 bones

(Navicular/scaphoid)

• Metacarpals

– 5 bones

• Phalanges

– 14 bones (proximal,

middle, distal)

Anatomy of the Wrist/Hand

Ligaments of the Wrist

Musculature of the Arm/Wrist/Hand

Musculature of the Wrist/Arm/Hand

Musculature of the arm/wrist/hand

Musculature of the Arm/Wrist/Hand

Functional Anatomy/Movements of Hand

Elbow Injuries

Olecranon Bursitis

• Mechanism

– Superficial area leaves susceptible to injury

– Direct Blow

• Signs & Symptoms

– Immediate swelling with no heat

– Pain and point tenderness

Olecranon Bursitis

• Management

– Compression

– Aspiration

– Padding

Elbow Hyperextension

• Mechanism – Typical

– Forced hyperextension or lateral motion.

– Foosh injury.

• Signs & Symptoms

– Hear click or pop

– Pain, tenderness and swelling

– Deformity

– Loss of function – typically hold in flexion and resists attempt to extend elbow

Elbow Hyperextension

• Management

– Ice to control bleeding and swelling

– Compression if can tolerate it

– Immobilization – sling and swathe

– Rehabilitation – restore normal motion and

strength

– Taping/bracing – to prevent hyperextension

Lateral Epicondylitis (Tennis Elbow)

• Mechanism

– Repetitive microtrauma to insertion of

extensor muscles on lateral epicondyle

• Signs & Symptoms

– Pain along lateral elbow

– Pain worsens and weakness in wrist and

hand develops

– Elbow has decreased ROM; pain w/ resistive

wrist extension

Lateral Epicondylitis (Tennis Elbow)

Management • RICE, NSAID’s and

analgesics

• ROM exercises and PRE, deep friction massage, hand grasping while in supination, avoidance of pronation motions

• Mobilization and stretching in pain free ranges

• Use of a counter force or neoprene sleeve

• Mechanics and skills training in order to avoid recurrence

Medial Epicondylitis (Golfers Elbow)

• Opposite of Lateral Epicondylitis

• Pain on Medial Aspect of Elbow

Little League Elbow

– Mechanism

• Caused by repetitive microtraumas that occur from throwing

(not type of pitch)

• May result in numerous disorders of growth in the pitching

elbow

• Linked to:

– Accelerated apophyseal growth region and delay in medial

epicondyle growth plate

– Traction apophysitis with possible fragmentation of medial

epicondylar apophysis

– Avulsion of medial epicondyle or radial head

– Osteochondrosis of humeral capitellum

– Non-union stress fracture of olecranon epiphysis

Little League Elbow

– Signs and Symptoms

• Onset is slow; slight

flexion contracture,

including tight anterior

joint capsule and

weakness in triceps

• Patient may complain of

locking or catching

sensation

• Decreased ROM of

forearm pronation and

supination

Little League Elbow

– Management

• RICE, NSAID’s and

analgesics

• Throwing stops until pain

resolved and full ROM is

regained

• Gentle stretching and triceps

strengthening

• Throwing under supervision

w/ good technique to

prevent recurrence

Elbow Dislocation

– Mechanism

• Caused by foosh w/ elbow extended or severe

twist while flexed

• Bones can be displaced backward, forward, or

laterally

• Distinguishable from fracture because lateral and

medial epicondyles are normally aligned w/ shaft of

humerus

Elbow Dislocation

Elbow Dislocation

Signs and

Symptoms

• Severe pain

• Deformity

• “Splinting”

• Will hear pop or

snap

Elbow Dislocation

– Treatment

• Refer to Orthoped surgeon

• Relocation,

• X-ray for possible fracture

• Surgery???

• Rehab to Increase Strength and Flexibility

Elbow Dislocation

Brian Butch injury vs Ohio State

• http://www.youtube.com/watch?v=XZiLPZ

XjZd4&feature=related

Stewart Bradley Injury

• http://www.youtube.com/watch?v=YFTwW

sj7v2s

Radial Tunnel Syndrome

• Numbness in hand/fingers or pain 4 cm beyond the bony prominence on outside of elbow. Pain worsens when bend wrist backward, turn palm upward or hold something with a stiff wrist.

• Nerve is compressed or pinched.

• Posterior interosseous nerve

• EMG may be used to diagnose, but does not always show issues.

• Causes: repetitive motions

Radial Tunnel Syndrome

• Treatment

– Non surgical: Rest

then movement

training. Wrist strap &

night elbow pad

– Surgical: Last resort.

Make incision and

then cut around

pressure spots on

nerve to relieve

pressure.

Other Elbow Injuries

• Muscle Strains

• Ligament Sprains

• Contusion

• Fracture

• Cubital Tunnel Syndrome

– Irritation of Nerve

• Elbow Osteochondritis Dissecans

– Deterioration of articular cartilage

Hand & Wrist Injuries

Navicular (Scaphoid) Fracture

• Mechanism

– Any abnormal forced motion of wrist

– Often missed and diagnosed as wrist sprain

until pain does not go away

– DOES NOT HEAL!!!!!

Navicular (Scaphoid) Fracture

• Signs and Symptoms

– Swelling

– Loss of function – pain

increased by upward

pressure on the thumb

and extension of the

wrist

– Pain at base of thumb

in “anatomical

snuffbox”

Navicular Fracture

• Treatment/Management

– Ice

– Splinting

– Rehabilitation –to restore normal strength and

flexibility of wrist

– Taping and padding once return to activity

– Surgery???

Gamekeepers Thumb

• Mechanism

– Catch thumb in some type of shirt, etc and thumb is abducted and hyperextended back toward the hand

• Signs and Symptoms

– Pain in metacarpophalangeal joint and with abduction and hyperextension of the thumb

– Instability of thumb

– Disability of normal pinching and gripping skills

Gamekeepers Thumb

• Management

– Ice

– Splinting

– Rehabilitation

– Taping for

participation

– Surgery???

Sprained Fingers

• Typically can just “buddy tape” and play

• Need to take into consideration which fingers

are “buddy” taping

• When is this an issue

– If can’t fully bend or straighten finger

– Jersey Finger – Ruptured Flexor Digitorum Profundus

• need surgical repair

– Mallet finger – Avulsion of Extensor tendon

• Need to be in splint for 5-8 weeks

Mallet Finger

• Deformity at DIP

(Distal

interphalangeal joint)

• Must splint for 6

weeks.

Carpal Tunnel

• Nerves and tendons get caught under the Carpal Ligament.

• Signs & Symptoms: Hands go numb. Drop things. Can’t feel things (cold, what is in hand)

• Treatment: Immobilize initially. Surgery if needed.

Other Hand/Finger Injuries

• Contusions

• Fractures

• Black Finger Nail

• Trigger Finger or Thumb

• Dislocation

• Wrist Ganglion (Bible Bump)

– cyst on joint capsule or synovial sheath

Fingernail Deformities

Changes in appearance of fingernail can

indicate a number of different diseases

• Scaling or ridging = psoriasis

• Ridging and poor development = nutritional

deficiencies

• Clubbing and cyanosis (blue color) = congenital

heart disorders or chronic respiratory disease

• Spooning or depression = thyroid problems, iron

deficiency anemia