The Elbow, Forearm, Wrist, and Hand

Chapter 19

BonesArticulationsLigaments and CapsuleSynovium and BursaMusculatureNerve SupplyBlood SupplyFunctional Anatomy

Elbow Anatomy

Preventing/Assessing ElbowInjuries

History Observation Palpation (bony and soft tissue) Special Tests

Tinel sign Test for capsular injury Valgus and Varus tests Medial and Lateral Epicondylitis Test Pinch Grip test Pinch Grip Test Pronator Test syndrome test

Functional Evaluation

Recognition and Management of Injuries

Contusion Etiology Signs and Symptoms Management

Olecranon Bursitis Etiology Signs and Symptoms Management

Strains Etiology Signs and Symptoms Management

Elbow Sprains Etiology Signs and Symptoms Management

Lateral Epicondylitis Etiology Signs and Symptoms Management

Medial Epicondylitis Etiology Signs and Symptoms Management

Recognition and Management of Injuries (contd.)

Elbow Osteochondritis Dissecans Etiology Signs and Symptoms Management

Little League Elbow Etiology Signs and Symptoms Management

Cubital Tunnel Syndrome Etiology Signs and Symptoms Management

Elbow Dislocation Etiology Signs and Symptoms Management

Fracture of the Elbow Etiology Signs and Symptoms Management

Volkmann’s Contracture Etiology Signs and Symptoms Management

Rehabilitation Principles for the Elbow

Phase I - immobilization (maintain wrist and hand strength) - 6 weeks

Phase II - Increase ROM (after cast removal) Therapy: Ice (5 to 15 minutes) Exercise: PREs in all directions

General Body Conditioning Joint mobilization Flexibility Strengthening Functional Progression Return to Activity Protective Taping and Bracing

Forearm Anatomy

Radius and Ulna: Elbow Joints: radioulnar joint (superior, middle,

and distal) Bone: proximal radial head, olecranon

process, radial shaft, ulnar shaft, distal radius, radial styloid process, ulnar head, ulnar styloid

Musculature: Forearm, flexors, pronators, extensors, and supinators

Nerve/Blood Supply: median and radial nerve and brachial, radial, and ulnar artery

Forearm Assessment

HistoryObservationPalpationSpecial Tests

Recognition and Management of Forearm

InjuriesContusion

Etiology Signs and Symptoms Management

Forearm Splints Etiology Signs and Symptoms Management

Colles’ fracture Etiology Signs and Symptoms Management

Forearm Splints Etiology Signs and Symptoms Management

Wrist, Hand, and Finger Anatomy

Bones: carpals and metacarpals Joints: radiocarpal, carpal, metacarpal, and

phalangeal jointsLigaments: “many at each joint in the hand”Musculature: “many intrinsic and extrinsic

muscles”Blood and Nerve Supply: ulnar, median,

radial nerve and radial and ulnar superficial and deep palmar arch arteries

Assessment of Wrist, Hand, and Finger Injuries

History Observation Palpation Special Tests: Finklestein’s test, Tinel’s

Sign, Phalen’s test, valgus and varus stress test, Glide test, Lunotriquetral Ballotment test

Circulatory and Neurological Evaluation Allen test

Functional Evaluation

Recognition and Management of Wrist, Hand, and Finger Injuries

Wrist Sprain Etiology Signs and Symptoms Management

Triangular Fibrocartilage Complex Injury Etiology Signs and Symptoms Management

Carpal tunnel syndrome Etiology Signs and Symptoms Management

Tenosynovitis Etiology Signs and Symptoms Management

Tendinitis Etiology Signs and Symptoms Management

Nerve Compression, Entrapment, Palsy Etiology Signs and Symptoms Management

Recognition and Management of Wrist, Hand, and Finger Injuries

De Quervain’s Disease Etiology Signs and Symptoms Management

Dislocation of the Lunate Bone Etiology Signs and Symptoms Management

Scaphoid Fracture Etiology Signs and Symptoms Management

Hamate Fracture Etiology Signs and Symptoms Management

Wrist Ganglion Etiology Signs and Symptoms Management

Recognition and Management of Wrist, Hand, and Finger Injuries

Contusion to hand and fingers Etiology Signs and Symptoms Management

Bowler’s Thumb Etiology Signs and Symptoms Management

Jersey finger Etiology Signs and Symptoms Management

Trigger finger or thumb Etiology Signs and Symptoms Management

Mallet finger Etiology Signs and Symptoms Management

Boutonniere deformity Etiology Signs and Symptoms Management

Recognition and Management of Wrist, Hand, and Finger Injuries

Dupuytren’s Contracture Etiology Signs and Symptoms Management

Sprains, Dislocations, and Fractures Etiology Signs and Symptoms Management

Gamekeeper’s Thumb Etiology Signs and Symptoms Management

Sprains PIP and DIP joint Etiology Signs and Symptoms Management

Swan neck deformity Etiology Signs and Symptoms Management

PIP Dorsal dislocation Etiology Signs and Symptoms Management

Recognition and Management of Wrist, Hand, and Finger Injuries

MCP dislocation Etiology Signs and Symptoms Management

Metacarpal fracture Etiology Signs and Symptoms Management

Bennett’s Fracture Etiology Signs and Symptoms Management

Distal/Middle/Proximal phalangeal fracture Etiology Signs and Symptoms Management

Fingernail deformity Etiology Signs and Symptoms Management

Rehabilitation Principles for the Forearm, Wrist, Hand, and

Fingers

General Body ConditioningJoint MobilizationFlexibilityStrengthNeuromuscular ControlReturn to Activity