Elbow, Hand & Fingersmrburkettscience.weebly.com/uploads/1/4/1/9/... · Little League Elbow...
Transcript of Elbow, Hand & Fingersmrburkettscience.weebly.com/uploads/1/4/1/9/... · Little League Elbow...
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