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Injuries to the Arm, Wrist and Injuries to the Arm, Wrist and HandHand

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ElbowElbow BonesBones

HumerusHumerus UlnaUlna RadusRadus

LigamentsLigaments Ulnar CollateralUlnar Collateral Annular LigamentAnnular Ligament Interossius Interossius

MembraneMembrane JointsJoints

Humeroulnar,Humeroulnar, HumeroradialHumeroradial RadialulnarRadialulnar

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Elbow Elbow MovementsMovements flexion/extension, flexion/extension,

pronation/supinatpronation/supinationion

Wrist MovementsWrist Movements flexion/extension, flexion/extension,

radial & ulnar radial & ulnar deviationdeviation

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Soft Tissue InjuriesSoft Tissue InjuriesContusions and fracturesContusions and fractures

common in contact sportscommon in contact sports muscle tissue compressed between muscle tissue compressed between

skin and boneskin and bone Repeated episodes can result in Repeated episodes can result in

myositis ossificans traumaticamyositis ossificans traumatica.. chronic inflammation of the muscle and chronic inflammation of the muscle and

underlying periosteum resulting in underlying periosteum resulting in development of bony mass within the development of bony mass within the musclemuscle

develops over weeks or months and is develops over weeks or months and is often ignored during the early stagesoften ignored during the early stages

Fractures of the Fractures of the HumerusHumerus

Signs/symptoms:Signs/symptoms: severe pain in severe pain in

upper armupper arm deformity & loss deformity & loss

of functionof function muscle spasmmuscle spasm audible snap or audible snap or

poppop sensory loss in sensory loss in

forearmforearm

First Aid:First Aid: application of ice application of ice

& compression& compression splint & splint &

sling/swathesling/swathe monitor distal monitor distal

pulsepulse treat for shocktreat for shock summon EMSsummon EMS

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Elbow DislocationElbow Dislocation

Mechanism for this Mechanism for this injury includes injury includes falling either on a falling either on a flexed or fully flexed or fully extended arm -- extended arm -- deformity is deformity is usually obvioususually obvious

Elbow sprains and dislocationsElbow sprains and dislocations three joints of the elbowthree joints of the elbow ulnar & radial collateral ligaments -- ulnar & radial collateral ligaments --

valgus/varusvalgus/varus injury mechanism includes falling backwards injury mechanism includes falling backwards

with elbow in extensionwith elbow in extension valgus/varus forces can result in sprainsvalgus/varus forces can result in sprains dislocations constitute extreme sprainsdislocations constitute extreme sprains

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Elbow SprainsElbow Sprains Signs/symptoms:Signs/symptoms:

in minor sprains -- mild swelling & in minor sprains -- mild swelling & localized painlocalized pain

difficulty in gripping or making a fistdifficulty in gripping or making a fist in dislocations -- gross deformityin dislocations -- gross deformity loss of function & severe painloss of function & severe pain possible neurological symptomspossible neurological symptoms

First Aid:First Aid:application of ice & compressionapplication of ice & compressionsplint & sling/swathesplint & sling/swathemonitor distal pulsemonitor distal pulsetreat for shocktreat for shocksummon EMSsummon EMS

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Elbow FracturesElbow Fractures generally involve the distal humerusgenerally involve the distal humerus danger to neurovascular structuresdanger to neurovascular structures injury mechanism similar to sprains and injury mechanism similar to sprains and

dislocationsdislocations fractures of the olecranon associated fractures of the olecranon associated

with direct blowswith direct blows if radial artery is compressed -- if radial artery is compressed --

Volkmann’s contracture may resultVolkmann’s contracture may result

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EpicondylitisEpicondylitisEpicondylitis of the Epicondylitis of the

elbowelbow lateral epicondyle lateral epicondyle

attachment of the attachment of the extensorsextensors

Medial epicondyleMedial epicondyle Attachment of the Attachment of the

flexorsflexors gripping combined gripping combined

with wrist with wrist movementsmovements

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Elbow InjuriesElbow Injuries

Golf associated with medial epicondyleGolf associated with medial epicondyle Tennis elbow -- involves the lateral Tennis elbow -- involves the lateral

epicondyleepicondyle excessive number of strokesexcessive number of strokes incorrect techniqueincorrect technique racket handle too smallracket handle too small change in racket materialschange in racket materials grip too tightgrip too tight muscle imbalancemuscle imbalance

Elbow InjuriesElbow Injuries Signs/symptoms:Signs/symptoms:

pain in the region of an epicondyle pain in the region of an epicondyle with swellingwith swelling

becomes worse with activitybecomes worse with activity radiating pain into forearm musclesradiating pain into forearm muscles epicondylar pain associated with epicondylar pain associated with

resisted wrist movementsresisted wrist movements First Aid:First Aid:

ice, compression, restice, compression, rest medical referral if pain persistsmedical referral if pain persists

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Osteochondritis DissecansOsteochondritis Dissecans throwing mechanism can result in impingement throwing mechanism can result in impingement

between radial head and capitulumbetween radial head and capitulum high velocity elbow extension - joint high velocity elbow extension - joint

compression on the lateral sidecompression on the lateral side joint cartilage becomes inflamed & may joint cartilage becomes inflamed & may

fracturefracture axial loading may also result in damageaxial loading may also result in damage

Signs/symptoms:Signs/symptoms: painful participationpainful participation swelling 12-24 hrs. afterswelling 12-24 hrs. after ““locking” of jointlocking” of joint osteoarthritis in advanced casesosteoarthritis in advanced cases

First Aid:First Aid: ice and compressionice and compression medical referralmedical referral

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Contusions of the elbowContusions of the elbow blows to the elbow are commonblows to the elbow are common majority result in temporary symptomsmajority result in temporary symptoms exception involves the olecranon bursaexception involves the olecranon bursa repeated irritation of the bursa can repeated irritation of the bursa can

result in inflammation (bursitis)result in inflammation (bursitis) Signs/symptoms:Signs/symptoms:

swelling in the region of the olecranon swelling in the region of the olecranon processprocess

pain/stiffness with movementpain/stiffness with movement elevated skin temperatureelevated skin temperature

First Aid:First Aid: ice and compressionice and compression in cases of bursitis -- medical referralin cases of bursitis -- medical referral

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Wrist and Forearm Wrist and Forearm InjuriesInjuries

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Anatomy of the wristAnatomy of the wrist complex due to small size and large complex due to small size and large

number of tendons that serve the number of tendons that serve the wrist, thumb and fingerswrist, thumb and fingers

Tendons are held in place by Tendons are held in place by retinaculumretinaculum Retinaculum is small ligaments Retinaculum is small ligaments

Major nerves and vessels pass through Major nerves and vessels pass through this region as well. They are:this region as well. They are: ulnar and radial arteries and veinsulnar and radial arteries and veins ulnar, median, radial nervesulnar, median, radial nerves

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Colles’ Fracture•rare in sports•Colles’ Fracture is most serious.

•Signs/symptoms:Signs/symptoms:•history of significant traumahistory of significant trauma•snap or popping soundsnap or popping sound•deformity, swelling into hand/fingersdeformity, swelling into hand/fingers•severe pain and loss of sensation may occursevere pain and loss of sensation may occur

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Wrist FracturesWrist Fractures

Navicular•navicular fracture most common•generally occur at the “waist”

Navicular FracturesNavicular Fractures Signs/symptoms:Signs/symptoms:

history of wrist trauma with popping or history of wrist trauma with popping or snappingsnapping

pain with movement/wrist feels locked, pain with movement/wrist feels locked, positive “snuffbox” testpositive “snuffbox” test

First Aid:First Aid: I.C.E. applicationI.C.E. application splint with sling & swathe, leave splint with sling & swathe, leave

fingertips exposed (to observe circulationfingertips exposed (to observe circulation medical referralmedical referral

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Wrist and Forearm Wrist and Forearm InjuriesInjuries

A simple test for assessment of the integrity of the carpal navicular bone -- pressing lightly in the “anatomic snuffbox”

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Wrist Sprains and DislocationsWrist Sprains and Dislocations Mechanism is typically hyperextension, Mechanism is typically hyperextension,

similar mechanism to fracturessimilar mechanism to fractures Signs/symptoms:Signs/symptoms:

history combined with snapping/popping history combined with snapping/popping sensationsensation

painful movementpainful movement movement may be impossiblemovement may be impossible numbness and/or radiating painnumbness and/or radiating pain

First Aid:First Aid: application of I.C.E.application of I.C.E. splint with sling & swathesplint with sling & swathe expose fingertips expose fingertips refer to a physicianrefer to a physician

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Nerve injuries in the Nerve injuries in the wristwrist median is most median is most

commonly injured -- commonly injured -- carpal tunnelcarpal tunnel

carpal tunnel related carpal tunnel related to inflammation of to inflammation of flexor tendonsflexor tendons

carpal tunnel related carpal tunnel related to sports requiring to sports requiring extensive grippingextensive gripping

ulnar nerve injuries -- ulnar nerve injuries -- produce numbness in produce numbness in the hypothenar the hypothenar eminenceeminence

Carpal TunnelCarpal Tunnel

Signs/symptoms:Signs/symptoms: sensory loss to a portion of the sensory loss to a portion of the

hand/fingershand/fingers pain/tenderness in the wrist, pain/tenderness in the wrist,

associated tendonitis and symptoms associated tendonitis and symptoms increase with wrist flexionincrease with wrist flexion

Care for carpal tunnel syndrome Care for carpal tunnel syndrome consist of treating the inflammation consist of treating the inflammation and rest.and rest.

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• Ganglion CystGanglion Cyst• Results from a Results from a

herniation of herniation of the synovium the synovium surrounding a surrounding a tendon tendon herniated area herniated area becomes filled becomes filled with fluidwith fluid

• variable in variable in appearance -- appearance -- some soft, other some soft, other hard and painfulhard and painful

Ganglions

Ganglion CystsGanglion Cysts Signs/symptoms:Signs/symptoms:

visible swellingvisible swelling in advanced cases, painful, hardened in advanced cases, painful, hardened

nodulenodule First Aid:First Aid:

some spontaneously regresssome spontaneously regress leave alone if possibleleave alone if possible can be surgically removedcan be surgically removed

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Hand InjuriesHand Injuries

19 bones in the hand and wrist

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Metacarpals can be Metacarpals can be fractured by a fractured by a crushing crushing mechanismmechanism

Phalangeal Phalangeal fractures common fractures common in sportsin sports

Signs/symptoms:Signs/symptoms: history of traumahistory of trauma associated associated

dysfunctiondysfunction deformitydeformity broken skin broken skin

(compound)(compound) significant significant

inflammationinflammation

Hand fracturesHand fractures

Bennett fractureBennett fracture mechanism includes mechanism includes

blows with a clenched blows with a clenched fistfist

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Sprains & dislocations of the hand– any joint in the hand can be involved– most common forms are:

– gamekeeper’s thumb– mallet finger– boutonniere deformity

–

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Gamekeeper’s thumb involves sprain of the ulnar

collateral lig. mechanism of injury is a

valgus force thumb is unstable

Signs/symptoms:Signs/symptoms: history of an history of an

appropriate mechanismappropriate mechanism pain over the area of pain over the area of

the ulnar collateral the ulnar collateral ligamentligament

snapping or popping at snapping or popping at the time of injurythe time of injury

swelling of the MP jointswelling of the MP joint inability to move the thumbinability to move the thumb inability to grip tightly using inability to grip tightly using

the thumbthe thumbAnatomy of a gamekeeper’s thumb

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Mallet (baseball) Mallet (baseball) FingerFinger involves distal involves distal

phalanx, name phalanx, name comes from the comes from the deformitydeformity

mechanism -- blow mechanism -- blow to the fingertip to the fingertip while extending, while extending, can’t extend can’t extend fingertipfingertip

Signs/symptoms:Signs/symptoms: deformity MOST deformity MOST

importantimportant recent trauma to recent trauma to

fingertipfingertip point tender DIPpoint tender DIP

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Boutonniere deformityBoutonniere deformity extensor tendon extensor tendon

involved as it crosses involved as it crosses the PIPthe PIP

mechanism is blow mechanism is blow while the finger is flexed while the finger is flexed during active extensionduring active extension

Signs/symptoms:Signs/symptoms: violent flexion injury violent flexion injury

associated with feeling of associated with feeling of tearing/poppingtearing/popping

significant weakness in significant weakness in finger extensionfinger extension

PIP painful and swollenPIP painful and swollen if uncorrected, deformity will if uncorrected, deformity will

developdevelop characterized by characterized by

hyperextension of MP & DIP hyperextension of MP & DIP with flexion of PIPwith flexion of PIP

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Anatomy of the Finger Tendons

Splinting for fractures of the forearm, wrist and/or hand