Elbow, Wrist, Elbow, Wrist, & Hand & Hand InjuriesInjuries

Elbow AnatomyElbow Anatomy

• Hinge Joint- Hinge Joint- Moves in flexion Moves in flexion and extensionand extension

• 3 Bones – 3 Bones – Humerus, radius Humerus, radius and ulnaand ulna

• Radius allows the Radius allows the forearm to pronate forearm to pronate and supinateand supinate

Ligaments of the ElbowLigaments of the Elbow

Radial Collateral LigamentRadial Collateral Ligament Ulnar Collateral LigamentUlnar Collateral Ligament

Anatomy Cont.Anatomy Cont.

MusclesMuscles• TricepsTriceps perform elbow extension perform elbow extension• BicepsBiceps perform elbow flexion perform elbow flexion• Wrist flexorsWrist flexors attach to the medial attach to the medial

epicondyle of the humerus and run toward epicondyle of the humerus and run toward the hand and perform flexion of the wristthe hand and perform flexion of the wrist

• Wrist extensorsWrist extensors attach the lateral attach the lateral epicondyle of the humerus and run toward epicondyle of the humerus and run toward the hand and perform extension of the the hand and perform extension of the wrist. wrist.

Muscles of the ElbowMuscles of the Elbow

Treating Elbow InjuriesTreating Elbow Injuries

Ulnar Collateral Lig. SprainUlnar Collateral Lig. Sprain– More prone to sprains than other ligaments of the More prone to sprains than other ligaments of the

elbowelbow– Caused by repetitive movementsCaused by repetitive movements– Caused by a direct blowCaused by a direct blow

Signs & SymptomsSigns & Symptoms– Medial elbow painMedial elbow pain– SwellingSwelling

TreatmentTreatment– RICERICE– Moderate or Severe may need to be splintedModerate or Severe may need to be splinted– Strengthen wrist flexorsStrengthen wrist flexors

Radial Collateral Lig. Radial Collateral Lig. SprainsSprains

Signs & SymptomsSigns & Symptoms• Same as ulnar except for pain is on the Same as ulnar except for pain is on the

lateral sidelateral side

TreatmentTreatment– Same as UCLSame as UCL– Strengthen wrist extensorsStrengthen wrist extensors

Treating Elbow InjuriesTreating Elbow Injuries

Muscle and Tendon InjuriesMuscle and Tendon Injuries – Most often caused by – Most often caused by

either excessive resistive either excessive resistive forces or overuseforces or overuse

Common Common InjuriesInjuries

Mechanism of Injury

Signs and Symptoms

Treatment Prevention Strategies

Repetitive extension of the wrist.

Aching pain in lateral elbow during and after activity.

RICE, anti-inflammatory medications, strengthening exercises.

Proper technique, progressive increase in frequency/intensity of training.

Lateral epicondylitis – “Tennis Elbow”

Common Common InjuriesInjuries

Mechanism of Injury

Signs and Symptoms

Treatment Prevention Strategies

Repetitive flexion of the wrist.

Pain in medial elbow, could radiate down arm; point tenderness, mild swelling.

RICE, anti-inflammatory medications, strengthening exercises

Proper technique, progressive increase in frequency/intensity of training.

Medial epicondylitis – “Little Leaguer’s or Golfer’s Elbow”

Review!Review!

Wrist and Hand AnatomyWrist and Hand Anatomy

• RadiusRadius• UlnaUlna• 8 Carpal bones8 Carpal bones• 5 Metacarpal 5 Metacarpal

bonesbones• 14 Phalanges14 Phalanges

Wrist and Hand JointsWrist and Hand Joints

• Metacarpal Phalengeal • MCP

• Thumb

• Interphalengeal • PIP• DIP

Common Common InjuriesInjuries

Mechanism of Injury

Signs and Symptoms

Treatment

Blow to the tip of the finger.

Pain, deformity, no ROM.

Splint in position found, immediate referral to a physician.

Interphalengeal Dislocation

Taping Taping Injuries of Injuries of

Wrist & HandWrist & Hand

Prophylactic Wrist Taping Prophylactic Wrist Taping (Circular)(Circular)

1.1. First apply pre-wrap below the First apply pre-wrap below the wrist joint, around the wrist, and wrist joint, around the wrist, and the heel of the hand. the heel of the hand.

2.2. Make sure that you keep the Make sure that you keep the fingers spread and hand flat fingers spread and hand flat while applying the tape. while applying the tape.

3.3. Place the first strip of tape just Place the first strip of tape just below the wrist joint, pulling the below the wrist joint, pulling the tape in a circle around the wrist, tape in a circle around the wrist, from the outside toward the from the outside toward the inside of the arm.  inside of the arm. 

4.4. Apply 3 – 4 additional strips Apply 3 – 4 additional strips moving up the wrist toward the moving up the wrist toward the hand.  Each strip should overlap hand.  Each strip should overlap about half of the strip before it. about half of the strip before it.

5.5. For additional support, continue For additional support, continue back down the wrist in the same back down the wrist in the same pattern. pattern.

Prophylactic Wrist Taping Prophylactic Wrist Taping (Figure 8 – Through the hand)(Figure 8 – Through the hand)

1.1.Complete steps 1-4 of Complete steps 1-4 of “Prophylactic Wrist taping (Circular)”..

2.2.The next strip should start on the first strip, and cross over The next strip should start on the first strip, and cross over the back of the hand, then continue through the space the back of the hand, then continue through the space between the thumb and finger, the across the palm.  It may between the thumb and finger, the across the palm.  It may help to fold the tape when it crosses the thumb web to make help to fold the tape when it crosses the thumb web to make it more comfortable.  it more comfortable. 

3.3.Continue pulling the same strip of tape back across the back Continue pulling the same strip of tape back across the back of the hand and back to the point of the wrist where the strip of the hand and back to the point of the wrist where the strip started.  started. 

4.4.Repeat this pattern 3 or 4 times, making the next strip of Repeat this pattern 3 or 4 times, making the next strip of tape overlaps half of the previous strip.tape overlaps half of the previous strip.

This tape job can provide slightly more support than the basic circular, and also provides more of a limit on the wrists range of motion.  It works well for mild sprains and provides extra support.

Prophylactic Wrist Taping Prophylactic Wrist Taping (Figure 8 – Through the hand)(Figure 8 – Through the hand)

5.5.Apply 3 – 4 additional Apply 3 – 4 additional strips moving up and strips moving up and down the wrist toward the down the wrist toward the hand.  Each strip should hand.  Each strip should overlap about half of the overlap about half of the strip before it. strip before it.

6.6.The addition of a fan or The addition of a fan or checkrein may provide checkrein may provide additional support and additional support and limitation of movement.limitation of movement.

7.7.The tape should allow the The tape should allow the thumb and fingers to thumb and fingers to move freely, and only move freely, and only restrict movement of the restrict movement of the wrist.  wrist. 

Prophylactic Thumb Prophylactic Thumb TapingTaping

1. The athlete should fully extend and adduct the fingers while keeping the thumb in a relaxed, neutral position (as if holding a can). The taper should stand in front of the athlete’s thumb

2. Apply pre-wrap to the hand and wrist.3. Place an anchor strip around the base of the

wrist. Add another 2/3 strip anchor attaching from the wrist anchor to the back of the hand between the thumb and pointer finger to the palm side attaching to the wrist anchor.

4.4. Add a series of three “spica” strips. The first Add a series of three “spica” strips. The first spica is started on the radial side at the base of spica is started on the radial side at the base of the thumb and carried under the thumb, the thumb and carried under the thumb, completely encircling it, and then crossing to completely encircling it, and then crossing to the starting point. The strip should continue the starting point. The strip should continue around the wrist and finish at the starting point. around the wrist and finish at the starting point. Each of the following spica strips should overlap Each of the following spica strips should overlap the preceding strip by at least 2/3 inch and the preceding strip by at least 2/3 inch and move downward on the thumb.move downward on the thumb.

Prophylactic Thumb TapingProphylactic Thumb Taping

5. Apply C-strips; starting at base of thumb, apply tape from dorsal side of hand around the base of thumb to the palmer side to the hand. Each of the following strips should overlap the preceding strip by at least 2/3 and move upward on the thumb.

6. Secure the open ends of the “C” strips by the single strip of tape through the hand. Apply anchor strip around the wrist.

Prophylactic Thumb TapingProphylactic Thumb Taping

Questions?Questions?

Everyone PracticeEveryone Practice

**Remember to have partners sign-off your lab skill Remember to have partners sign-off your lab skill sheetssheets