Elbow, wrist, hand ntp f12


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Elbow, wrist, hand ntp f12

  1. 1. Chapter 24: The Forearm, Wrist, Hand and Finger
  2. 2. Anatomy of the Forearm
  3. 3. Assessment of the Forearm History     What was the cause? What were the symptoms at the time of injury, did they occur later, were they localized or diffuse? Was there swelling and discoloration? What treatment was given and how does it feel now?
  4. 4. Observation    Visually inspect for deformities, swelling and skin defects Range of motion Pain w/ motion Palpation   Palpated at distant sites and at point of injury Can reveal tenderness, edema, fracture, deformity, changes in skin temperature, a false joint, bone fragments or lack of bone continuity
  5. 5. Valgus carrying angle
  6. 6. Gunstock deformity
  7. 7. Normal carrying angle a b
  8. 8. Normal elbow alignment a b
  9. 9. Dislocations http://www.youtube.com/watch? v=RaLQYJOFl6k
  10. 10. Elbow Dislocations • Posterior What’s Damaged? UCL Annular LCL Ant. Capsule Brachialis Flexor tendons
  11. 11. Elbow Dislocations
  12. 12. Chronic Injuries
  13. 13. Epicondylitis Medial “little league elbow” Wrist flex. On follow thru. Curve balls? Lateral “tennis elbow” Backhand
  14. 14. Epicondylitis Cause: Overuse!!!
  15. 15. Epicondylitis Youth? Avulsed epicondylar growth plates
  16. 16. Olecranon Bursitis  Etiology  Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow  Signs and Symptoms   Pain, swelling, and point tenderness Swelling will appear almost spontaneously and w/out usual pain and heat
  17. 17. Recognition and Management of Injuries to the Forearm Forearm Contusion  Etiology     Ulnar side receives majority of blows due to arm blocks Can be acute or chronic Result of direct contact or blow Signs and Symptoms   Pain, swelling and hematoma If repeated blows occur, heavy fibrosis and possibly bony callus could form w/in hematoma
  18. 18. Contusion (continued)  Management   Proper care in acute stage involves RICE for at least one hour and followed up w/ additional cryotherapy Protection is critical - full-length sponge rubber pad can be used to provide protective covering
  19. 19. Forearm Fractures Etiology  Common in youth due to falls and direct blows  Ulna and radius generally fracture individually  Fracture in upper third may result in abduction deformity due pull of pronator teres  Fracture in lower portion will remain relatively neutral  Older athlete may experience greater soft tissue damage and greater chance of paralysis due to Volkman’s contracture Signs and Symptoms  Audible pop or crack followed by moderate to severe pain, swelling, and disability  Edema, ecchymosis w/ possible crepitus
  20. 20. Management Initially RICE followed by splinting until definitive care is available  Long term casting followed by rehab plan 
  21. 21. Colles’ Fracture  Etiology    Occurs in lower end of radius or ulna MOI is fall on outstretched hand, forcing radius and ulna into hyperextension Less common is the reverse Colles’ fracture
  22. 22. Colle’s Fracture Cont. Signs and Symptoms  Anterior displacement of radius causing visible deformity (silver fork deformity)  When no deformity is present, injury can be passed off as bad sprain  Extensive bleeding and swelling  Tendons may be torn/avulsed and there may be median nerve damage Management  Cold compress, splint wrist and refer to physician  X-ray and immobilization  Severe sprains should be treated as fractures  Without complications a Colles’ fracture will keep an athlete out for 1-2 months  In children, injury may cause lower epiphyseal separation
  23. 23. Smith’s Fracture MOI – falling on back of hand forcing wrist into hyperflexion Radius displaces posteriorly Less common than colles’ fracture
  24. 24. Anatomy of the Wrist, Hand and Fingers
  25. 25. T H T C P T S L Never Lower Tilly’s Pants, Terrible Things Could Happen Some Lovers Try Positions That They Can’t Handle
  26. 26. •Blood and Nerve Supply Three major nerves  Ulnar, median and radial Ulnar and radial arteries supply the hand  Two arterial arches (superficial and deep palmar arches)
  27. 27. Activity- Anatomy Review WRIST AND HAND
  28. 28. Assessment of the Wrist, Hand and Fingers History         Past history Mechanism of injury When does it hurt? Type of, quality of, duration of, pain? Sounds or feelings? How long were you disabled? Swelling? Previous treatments?
  29. 29. Assessment Cont. Observation        Postural deviations Is the part held still, stiff or protected? Wrist or hand swollen or discolored? General attitude What movements can be performed fully and rhythmically? Thumb to finger touching Color of nailbeds
  30. 30. Recognition and Management of Injuries to the Wrist, Hand and Fingers Wrist Sprains  Etiology      Signs and Symptoms   Most common wrist injury Arises from any abnormal, forced movement Falling on hyperextended wrist, violent flexion or torsion Multiple incidents may disrupt blood supply Pain, swelling and difficulty w/ movement Complications   Can be complicated due to the complex Carpal fractures are often missed ligamentous structure
  31. 31. Tendinitis /Tenosynovitis  Etiology    Repetitive pulling movements of (commonly) flexor carpi radialis and ulnaris; repetitive pressure on palms (cycling) can cause irritation of flexor digitorum Primary cause is overuse of the wrist Signs and Symptoms   Pain on active use or passive stretching Isometric resistance to involved tendon produces pain, weakness or both
  32. 32. Carpal Tunnel Syndrome  Etiology    Compression of median nerve due to inflammation of tendons and sheaths of carpal tunnel Result of repeated wrist flexion or direct trauma to anterior aspect of wrist Signs and Symptoms  Sensory and motor deficits (tingling, numbness and paresthesia); weakness in thumb
  33. 33.  Scaphoid Fracture  Most fractured bone in the wrist  -Fx of the bone most commonly from a fall on outstretched hand  -Complications:  1. difficult to confirm with xray  2. poor blood supply = poor healing  3. high morbidity rate
  34. 34.  Scaphoid Fracture
  35. 35. Phalange Fracture  "jammed"   joint surface fx – axial load Direct blow Rotational force
  36. 36.  Boxer’s Fracture (Donovan’s fx)  -Fx of the 5th met.  -Mech: axial compression mostly caused by punching
  37. 37. Finger Dislocations •IP Joint most common •Thumb dislocations are severe
  38. 38. UCL- Thumb Sprain Ulnar Collateral Ligament    Mech - abduction and/or hyperextension 3rd Degree - Gamekeepers Thumb     Commonly under dx. Severe laxity Chronic instability and dysfunction Early arthritis