The Wrist and Hand◦ Made up of 27 bones
8 carpal bones make up the wrist 5 metacarpals from the structure of the hand 14 phalanges
2 for the thumb 3 for each other 4 fingers
Skeletal Anatomy – Wrist and Hand
3 bones of the elbow joint◦ Humerus◦ Radius ◦ Ulna
Many structures surround the elbow◦ Ligaments◦ Nerves◦ Muscles◦ Bursa sacs
Skeletal Anatomy - Elbow
Forearm Flexors◦ Brachialis◦ Biceps Brachii◦ Brachioradialis
Forearm Extensors◦ Triceps Brachii◦ Anconeus
Muscles of the Elbow
Several causes for a variety of athletic injuries◦ Direct trauma◦ Indirect trauma◦ Acute/Chronic stresses
These MOIs can result in several injuries◦ Contusions◦ Sprains◦ Strains◦ Dislocations◦ Fractures◦ Nerve involvement
Common injuries of the Elbow
Common injury that may involve the muscles of the forearm and subcutaneous bony prominences of the elbow◦ Usually caused by a direct blow
Symptoms◦ Bruising◦ Subsequent bleeding◦ Stiffness during function or active motion
Treatment◦ PRICE
Prevents myositis ossificans
Contusions
Inflammation of the olecranon bursitis◦ Caused by direct blows to the olecranon process◦ Can be accompanied by infection due to the frequent
abrasions that occur over the tip of the elbow Treatment
◦ Depends on whether infection is involved◦ Uninfected bursitis
Ice compresses Rest
◦ Anti-inflammatory meds◦ Pain meds◦ Aspiration of the bursa
Olecranon Bursitis
Caused by a direct blow the medial epicondyle of the humerus◦ Athlete complaints of
immediate pain and burning sensation down the ulnar side of the forearm to the ring and little fingers Also known as hitting the “funny
bone” Treatment
◦ None is usually necessary
Ulnar Nerve Contusion
Normally occur with a sudden overload to the elbow joint◦ can acute or chronic
Acute Strains◦ Sudden excessive overload◦ Tenderness over the affected area◦ Pain on function or resisted motion
Chronic Strains◦ Result of continued overuse◦ Overuse syndrome◦ Chronic degenerative processes
Common areas of acute strains◦ Common flexor tendon
Medial epicondyle◦ Common extensor tendon
Lateral epicondyle
Elbow Strains
Usually due to forced hyperextension or valgus/varus forces
Symptoms◦ Click or pop◦ Sharp pain at injury◦ Tenderness◦ Localized swelling◦ Pain when repeating MOI
Usually relieved by bending the elbow
Elbow Sprains
Usually caused by repetitive overload of the attached musculotendinous units◦ Occurs in the region of the
medial and lateral epicondyle of the humerus
◦ Called “tennis elbow” if lateral ◦ Called “golfer’s elbow” if
medial◦ If it occurs in younger
patients, called “little leaguer elbow”
◦ Can also accompany an injury to the growth plate of the epiphysis
Epicondylitis
Symptoms◦ Pain when used◦ Possible swelling◦ Local tenderness◦ Pain with resisted wrist motion
Without proper treatment condition may worsen
◦ May develop into prolonged degenerative changes◦ Causes chronic epicondylitis◦ Contractures of the elbow◦ Reduced friction ◦ Possible rupture of muscle tendon unit
Treatment◦ RICE◦ Modifying activities that aggravate conditions
Preventive measures◦ Using proper technique/equipment◦ Limiting stress◦ Adequately warming up◦ stretching
Epicondylitis cont’d
Most commonly involves the posterior displacement of the ulna and radius in relationship to the humerus◦ Often caused by a fall onto an outstretched hand with
elbow in extension Symptoms
◦ Obvious deformity◦ Loss of elbow function◦ Considerable pain◦ Initial exam should include evaluation of nerve function of hand and fingers
Treatment◦ Immobilzation◦ Immediate referral to physician of medical facility◦ Possible vascular and neurological damage
Dislocations of the Elbow
The result of either direct trauma or indirect stresses transmitted through the upper extremity by falling on an outstretched arm◦ Fractures in younger athletes commonly involve epiphyseal plate fractures
Symptoms ◦ Directly related to degree of severity◦ Point tenderness◦ Hemorrhaging ◦ Swelling◦ Limited ROM◦ Disability at elbow or hand◦ Increased pain with movement
Treatment◦ Immobilization◦ Ice◦ Prompt referral to physician or medical clinic
Forearem/Elbow Fractures
Occurs in the absence of blood flow (ischemia) to the forearm◦ Can lead to contracture, where joint remains bent and cannot straighten
Causes◦ Increased pressure from swelling or trauma ◦ Fracture
3 Levels of severity in Volkmann’s Contracture◦ Mild
Involves contracture of 2 or 3 fingers No limited loss of sensation
◦ Moderate Involves all fingers being flexed Thumb stuck in palm Wrist may be stuck in flexion Usually loss of sensation in the hand
◦ Severe Involves all muscles in forearm (flexors and extensors) Fingers Severely disabling condition
Volkmann’s Contracture
Symptoms◦ Severe pain when a muscle running through a
compartment is passively moved◦ Forearm may be swollen◦ Shiny◦ Painful when squeezed◦ Pain does not improve with rest, but continues to
worsen with time◦ If condition is not corrected
Decreased sensation Weakness Paleness of the skin
Volkmann’s Contracture cont’d
Repetitive throwing and/or swinging can cause irritation, compression, or entrapment in the cubital tunnel◦ Called cubital tunnel syndrome
Symptoms◦ Pain along the inner aspect of the
elbow◦ Tenderness of the medial
epicondylar groove◦ Paresthesia (numbness or tingling)
of ring and little finger
Ulnar Nerve Injury
Usually caused by entrapment of the nerve which passes through a tunnel formed by several muscles and tendons◦ Also called radial tunnel
syndrome Symptoms
◦ Pain over lateral aspect of the elbow
◦ Pain over radial head
Radial Nerve Injury
Includes entrapment or compression due to hypertrophy of the pronator teres or repetitive pronation of the forearm◦ Called pronator teres syndrome
Symptoms◦ Pain radiating down the anterior
forearm◦ Numbness and tingling in the
thumb, index, and middle fingers
◦ Resistive pronation may increase the pain
Median Nerve Injury
Muscles that move the Wrist◦ 2 Flexor Carpi muscles◦ 2 Extensor Carpi muscles◦ 2 Palmaris muscles
Muscles that move the Hand◦ 1 Supinator muscles◦ 2 Pronator muscles
Muscles that move the Thumb◦ 2 Flexors◦ 2 Extensors◦ 1 adductor◦ 2 abductors◦ 1 opponens
Muscles that move the Fingers◦ 3 flexors◦ 2 extensors◦ 3 abductors◦ 1 adductor
Muscles of the hand and wrist
Common injuries◦ Fractures◦ Dislocations◦ Contusions◦ Sprains◦ Tendonitis◦ Nerve Impingements
Injuries to the hand and wrist
Can involve any of the 14 phalange bones.◦ Most can be treated with a finger
splint Boxer’s Fracture
◦ A break of the 5th metacarpal leading to the little finger
Baseball (mallet) finger◦ Painful injury that occurs when a
ball or other object strikes the tip of the finger, bending it beyond its normal ROM which tears the finger tendon and damages cartilage
Finger Fractures
Jersey Finger◦ Caused by tearing the flexor
tendon to the fingertip Usually occurs from grabbing a
jersey during a tackle. Ring finger is the most often affected
Scaphoid fracture◦ Affects the scaphoid bone◦ Paplpation of the anatomical
snuffbox will cause pain, indicates a fracture may be present
Finger Fractures cont’d
Colles Fracture◦ A break of the radius just above the wrist
Treatment for all fractures◦ RICES (rest, ice, compression, elevation, support)◦ Evaluation by a physician
Finger Fractures cont’d
Fairly common injuries Causes
◦ Ball striking fingertip◦ Finger getting hooked into
equipment Symptoms
◦ Immediate pain◦ Swelling◦ Crooked finger
Usually can’t be bent or straightened Treatment
◦ Ice◦ Immobilization◦ Immediate treatment by physician
Dislocations and subluxations
Usually caused by direct blows or falling onto a hard surface◦ With nails become
contused, pressure may cause a physician to drain blood from beneath the nail
Contusions
Gamekeeper’s thumb◦ Sprain of the ulnar
collateral ligament of the metacarpalphalangeal joint (MPJ) Common in alpine skiiing
◦ Caused by force applied to the medial side of the thumb, forcing the MPJ to stretch, tear, or even rupture
Sprains of the wrist and hand
The inflammation of the tendons caused by overuse or repetitive stress
Symptoms◦ Ache or pain at the wrist
Worsens forceful gripping, rapid wrist movements or moving the wrist or fingers to an extreme position
Treatment◦ The same as other forms of
tendonitis◦ Most common sites in the wrist
Base of the thumb near anatomical snuffbox deQuervian’s tenosynovitis
Tendonitis
Also called Carpal Tunnel syndrome An inflammatory disorder caused by the
following◦ Repetitive stress◦ Physical injury◦ Other conditions that cause swelling around the
median nerve near the carpal tunnel Symptoms
◦ Pain ◦ Numbness◦ Tingling in the wrist, hand, fingers (except little
finger)◦ Tendency to drop things◦ Loss of sense of heat or cold◦ Feeling of swelling, even though it is visibly
swollen◦ Symptoms may occur only when the hand is
being used or only when at rest Treatment
◦ RICE◦ In severe cases, surgery to decompress the
median nerve
Nerve Impingement
A small, usually hard lump above a tendon or in a capsule that encloses a joint◦ Also called a synovial
hernia or synovial cyst It is common in
handball, racquetball, squash and tennis◦ Cause of the cyst is
unknown
Ganglion Cyst
An injury to the extensor tendon affecting the proximal interphalangeal joint (PIP) at the middle of the finger or the distal interphalangeal joint at the end of the finger◦ Caused by a direct blow to a bent finger
Symptoms◦ Problems flexing and extending the finger◦ Physician should be contacted
immediately◦ Joints will be painful and tender◦ Finger misshapen or deformed◦ The athlete will not be able to straighten it
Treatment◦ Must be done promptly◦ Athlete may not regain normal use of the
finger
Boutonniere Deformity