Elbow joints and wrist joints are most common joints in upper extremity effected by sports related injury. This injuries can be prevented and treated with different orthosis.

1. Orthotic management of Elbow joint, Wrist Joint
and hand in Sports injuries
Poly Ghosh
Lecturer (P & O)
NILD, Kolkata

2. Introduction
• The term “sports injury” refers to
the kinds of injuries that most
commonly occur during sports or
exercise, but they are not limited to
athletes. Factory workers get tennis
elbow, painters get shoulder
injuries, and gardeners develop
tendinitis, even though they may
not participate in sports.

3. • Anatomical factors
• Individual difference factors
• Age related causes
• Training related causes
• Equipment selection factors
• Impact and contact causes
• Poor techniques
Causes of sports Injury

4. External factors
• Movements factors- types & Velocity of
Movements
• Fatigue response
• Equipments
• Playing surface
• Improper technique
• Poor conditioning
• Lack of warm up
• Increased frequency
• Flexibility
• Stress
Internal factors
• Ligamentt laxity
• Soft tissue tightness/contractures
• Instability/malalignment of joints/
• Lack of co-ordination/ Range of
Motion
• Deficient Balance/ Equilibrium
PREDISPOSING FACTORS

5. Soft tissue injuries
• Muscular
• Tendon
• Ligamentous
• Synovial
• Bursal
Bony injuries
• Fractures
• Sublaxations
• Dislocations
Skin injuries
• Blisters
• Contusion
• Laceration
• Avulsion
•
Types of injury

6. Elbow injuries
• Boxing, martial arts,
snowboarding,
skateboarding, tennis,
ice hockey, hockey,
handball, volleyball and
similar sports.

8. Cartilage injury & Loose bodies
• There is acute or gradual onset of
exercise-induced pain around the
elbow with recurrent locking or
pseudo-locking or extension and
flexion lag
• Can occur by repetitive stress or direct
impact, causing mechanical blocking
and synovitis.

9. Distal biceps tendon rupture
• Pain and weakness is provoked by
resisting elbow flexion. There is
often significant swelling, bruising
and/or haemarthrosis
• An acute injury, where the tendon
usually ruptures close to the distal
insertion at the radius during an
excessive elbow extension or flexion
manoeuvre.
• Complete tear- surgical fixations
• Partial tear- immobilization

10. Golfer’s elbow
• Over-use type injury of unknown
aetiology, often affecting the wrist flexor
muscle origins at the medial epicondyle in
racket sports players, javelin throwers and
cricket bowlers. Despite the name, such
injury to golfers is rare.
• Gradual onset of exercise induced pain
around the medial epicondyle of the elbow
that is aggravated by hyper-extension.
• Tenderness on palpation over the medial
humerus epicondyle and pain and
weakness is caused by resisted elbow
hyper-extension.

11. Lateral epicondylitis (tennis elbow)
• Over-use type injury of unknown aetiology,
affecting the wrist extensor muscle origin at
the lateral epicondyle in racket sports
players, javelin throwers and cricket
bowlers.
• Reducing pain, controlling inflammation,
promoting healing, regulating force loads,
and improving muscular strength and
flexibility of structures directly and
indirectly involved

12. Splinting

13. Olecranon bursitis
• Gradual or acute onset of localised
swelling and inflammatory signs over the
olecranon
• Can occur after direct trauma and
bleeding, from repetitive stress causing
synovial fluid to fill the bursa, ‘student’s
elbow’ or pus in the bursa from infected
superficial skin wounds.

14. Orthotic management

15. Pronator teres syndrome
• compression neuropathy of the median
nerve at the elbow.
• lack of sensation in the distribution of
the palmar cutaneous branch of the
median nerve
• weakness can develop in the flexor
pollicis longus and flexor digitorum
profundus of the index finger and the
pronator quadratus.
• Pain around the anterior proximal arm
with paraesthesia of the radial three and
a half fingers

16. • Using a resting or night splint
during the inflammatory period
of 1 to 2 weeks to reduce
tension and compression on the
aggravated nerve and tendinous
tissue.
• Splinting for pronator teres
syndrome requires a long arm
splint holding the elbow flexed
to 90" with the forearm and
wrist in neutral

17. Radial tunnel syndrome
• Radial tunnel syndrome refers to a rare
compressive neuropathy of the posterior
interosseous nerve (PIN) as it passes through
the radial tunnel resulting in pain without
motor or sensory dysfunction

18. Triceps tendon rupture
• Results from overloading on the extended elbow,
or an abrupt eccentric contraction of the muscle.
• Acute onset of pain and bleeding around the
triceps, tendor insection at the olecranon of the
elbow, and loss of extension power.
• Tenderness on palpation over the olecranon and
pain and weakness on resisted elbow extension.
• Partial tears can be treated with two to four
weeks’ immobilisation, followed by progressive
rehabilitation over three months.
• A complete rupture requires surgical re-fixation.

19. Little league elbow
• This is a growth plate injury to the elbow
caused by repetitive throwing in youths. It is
most common in pitchers, but any young
athlete who throws repeatedly can get it. The
pain is in the inner part of the elbow.
• Correlated to chronic forces of valgus overload
produced during the early and late cocking
phases of throwing. This valgus force places
tension on the medial structures and
compression of the lateral structures (radial
head, capitellum).

20. Symptoms & Splinting
• Medial/ lateral sided elbow
pain
• Decreased throwing speed or
distance
• Point tenderness
• Effusion
• Flexion contracture (noted up
to 15 degrees)
• Widening and/or fragmentation
of apophysis on radiographs

21. Elbow Sprain
• Intra-articular or extra-articular injuries to the elbow without
fracture are not uncommon and are peculiarly resistant to
treatment. There may be a primary or secondary injury to the
upper radioulnar articulation by sudden overpronation or
oversupination, followed by pain over the articulation and limited
rotation. Overlooking radial-head dislocation is a common
orthopedic pitfall.

22. Sublaxations
• POSTERIOR-MEDIAL RADIAL HEAD SUBLUXATION-Pulled/ nursemaid
elbow
• MEDIAL OLECRANON SUBLUXATION
• LATERAL OLECRANON SUBLUXATION
• ANTERIOR OLECRANON SUBLUXATION
• SUPERIOR ULNA SUBLUXATION

23. • The radial head at the elbow transmits the force of a fall on the hand to the
shoulder; thus explaining why the radial head is a common site of fracture in the
elbow area. Subtle impaction fractures of the distal humerus and radial head are
not uncommon and often can only be witnessed on x-ray film after a week or two.
Acute signs are local swelling, tenderness about the radial head, and severe pain
increased on pronation or supination. Severe displacement is not typical.
Fractures and dislocations

24. Wrist & Hand injuries

25. Baseball mallet finger
• End joint is flexed, cannot
actively straighten – due to
extensor tendon injury or small
fracture.
• Mechanism of injury:
• Sudden and forcibly flexion of
the DIP joint with resistance
force along the long axis of the
finger.
• This may lead to terminal
tendon tear or soft tissue mallet
finger or terminal tendon
avulsion with bony fragments
or bony mallet finger.

26. Classification of mallet finger
TYPE-1
• Closed injury with or without small dorsal
avulsion fracture.
TYPE-2
• Open injury (laceration)
TYPE-3
• Open injury (deep soft tissue abrasion involving
loss of skin and tendon substance.
TYPE-4
• Mallet fracture
•4A= distal phalanx physis injury
•4B=fracture fragments involving 20% to 50% of articular
surface
•4C= fracture fragments involving more than 50% of articular
surface

27. Splinting
• It is most common initial treatment
method for both soft tissue or bony
mallet finger.
• hold the finger tips straight in
extension until it heal.

28. Skier's thumb
An injury to the ulnar collateral ligament (UCL) of the
thumb metacarpophalangeal joint (MCPJ) due to
hyperabduction of thumb, which has a serious risk of
disabling chronic instability if not treated adequately. The
lesion most often occurs in skiers when the ski pole
forces the thumb to deviate radially.

29. Symptoms & Splinting
• Pain at the base of the thumb in the web space
between thumb and index finger
• Swelling of your thumb
• Inability to grasp or weakness of grasp
between your thumb and index finger
• Tenderness to the touch along the index finger
side of your thumb
• Blue or black discoloration of the skin over the
thumb
• Thumb pain that worsens with movement in
any or all directions
• Pain in the wrist (which may be referred pain
from your thumb)

30. Bowlers thumb
• Bowler’s thumb is an overuse injury
/compression neuropathy resulting
from compression or repeated friction
on the inside of the thumb which
causes pressure on the ulnar nerve.
• Numbness and tingling at the end of
the thumb.
• A neuroma can develop, causing
permanent symptoms.
• Pain in the inner thumb and the web
between the thumb and index finger.
• Tender nodule may be felt in the
thumb.

31. Carpal tunnel syndrome
• Carpal tunnel syndrome is pressure
on the median nerve -- the nerve in
the wrist that supplies feeling and
movement to parts of the hand
• It can lead to numbness, tingling,
weakness, or muscle damage in the
hand and fingers.

32. Splinting for Carpal tunnel syndrome
Dorsal carpal tunnel splint
Volar carpal tunnel splint
CTS carpal lock splint

33. Dequervain syndrome (DQ)
• Stenosing tenosynovitis which affects the
tendon sheaths of the 1st dorsal compartment
of the wrist.
• It is characterized by degeneration and
fibrosis of the tendon sheath
• More common in women and in dominant
hand.
• First dorsal compartment of hand- APL & EPB

34. Signs & symptoms
• Pain
• Tenderness along the radial
styloid
• The Finkelstein test is positive
Differential diagnosis
•Intersection syndrome
•Radial styloid fracture
• Scaphoid fracture
•Basilar arthritis of the thumb
and
• Radial neuritis

35. Splinting
Long thumb spica
Short thump spica

36. Dislocation of finger joint
• Intense localised pain and deformation
(bayonet position, where distal phalanx is
retracted over the dislocated joint by flexor
tendons) of a meta-carpo-phalangeal
(MCP), proximal inter-phalangeal joint
(PIP) or distal inter-phalangeal (DIP) joint
after direct trauma from a hard ball or a fall
on a stretched-out finger.
• One or more joints may dislocate and the
joint capsule ruptures, causing bleeding and
other soft tissue injuries.
• Splinting-
• Buddy tapping
• Gutter splint

37. Handlebar palsy
• Paraesthesia of the ulnar one and a half
fingers and weakness and atrophy of the
intrinsic hand muscles. It is common in
cyclists and racket sport players.
• Numbness
• Tingling
• Weakness
• Clumsiness
• Cramping
• Pain
• Possible motor limitation
Prevention : padded handlebars, handlebar
grips ( see image) or padded cycling gloves.

38. Hypothenar syndrome
• Hypothenar hammer syndrome is a condition of the hand in
which the blood flow to the fingers is reduced. It occurs
when workers repeatedly use the palm of the hand
(especially the hypothenar eminence) as a hammer to grind,
push, and twist hard objects. These activities can damage
certain blood vessels of the hand especially the ulnar artery.
This artery goes through the hypothenar area of the palm and
supplies blood to the fingers. Damage to the ulnar artery
results in a reduction of blood flow to the fingers.
Sometimes a single significant episode can cause hypothenar
hammer syndrome.
• Pain and a sensation of cold in the fingers. Often sleep is
disturbed by pain. It is common in martial arts and lacrosse.
• Caused by spasm, thrombosis or aneurysm in the ulna artery
in guyon’s canal.
• Ulceration of a distal finger tip and swelling around the base
of the palm.

39. Jersey/Rugby finger
• The traumatic rapture of the FDP tendon from its point of
attachment at the base of the distal phalanx.
• Mechanism of injury typically forced extension of the flexed
finger.
• On examination the affected digits remain in slight extension
compare to noninvolved digits and no active flexion of DIPJ.

40. Leddy
and
Packer
classification
(1977)
Type-I: FDP tendon retracted to
palm. Leads to disruption of the
vascular supply
Type-II: FDP retracts to level of PIP
joint
Type-III:PIP joint flexion is limited
irrespective of Large avulsion
fracture limits retraction to the
level of the DIP joint

41. Splinting
• Mainly recommended for surgery.
• Splinting is recommended for type-ii & iii for acute patients to
restricts the motion and maintain the finger DIP in neutral
position and allow maximum time for healing.

42. Scaphoid fracture
• Scaphoid fractures are the most common carpal
bone fracture, often occurring after a fall onto an
outstretched hand.
• Mechanism of injury is axial load across a hyper-
dorsiflexed, pronated and ulnarly-deviated wrist
• Variable level of pain over wrist
• Worsened wrist pain with circumduction
• Pain with resisted pronation
• Anatomic snuffbox tenderness dorsally
• Scaphoid tubercle tenderness volarly
• The prognosis varies depending on whether there
is vascular disruption leading to avascular
necrosis.

43. • Management:- cast immobilization
• A stabilising cast, brace or strapping
• should be applied over six to twelve weeks
depending
• on clinical findings and healing

44. Scapholunate ligament tears
• The scapholunate ligament usually tears when there
is a lot of stress put on the wrist. A common cause is
a fall onto the hand. Typically, the ligament is
injured when the wrist is bent backward or into an
unusual position. Sometimes, the ligament stretches
out over time. This can be due to repeated strains or
loosening with age. Long-standing inflammation
can also cause gradual breakdown of the ligament
• Pain when bending the wrist backward
• Limited range of motion
• Bruising
• Pain and swelling that has developed over several
days, usually on the back side of the wrist
• Popping or grinding
• Weakness in the wrist

45. Oarsman’s/ Squeaker’s wrist
• Painful inflammation of the forearm
• Caused by friction occurring at site where four
muscles of the forearm cross over each other.
• Common complain amongst rowers.
• Swelling over the distal forearm
• Pronation is typically found more uncomfortable
than supination
• A temporary splint for protection and comfort at
night may also be beneficial (a neutral position
with a splint)

46. Stress fracture of the radial epiphysis
• A distal radial epiphysis injury is an injury to
the growth plate at the wrist end of the radius
bone in the forearm. It mostly affects young
athletes and is most often caused by overuse.
• As a result, the blood supply to the area is
compromised.

47. Tenosynovitis of the extensor carpi ulnaris
• Acute or gradual onset of exercise-induced
pain and swelling over the ulnar aspect of the
wrist. Tenosynovitis can affect any tendon in
any location.
• These symptoms are caused by tenosynovitis
and/or subluxation of the extensor carpi
ulnaris tendon. It is common in tennis players,
golf players, weightlifters and jockeys.
• Localised tenderness on palpation and on the
ulnar aspect of the dorsal part of the wrist.

48. Wartenberg’s syndrome
• entrapment of a superficial branch of
the radial nerve between the brachi
radialis tendons. with only sensory
manifestations and no motor
deficits.
• In this condition, the patient reports
pain over the distal radial forearm
associated with paresthesia over the
dorsal radial hand.
• It is common in racket sports; wrist
sweat bands have been suspected of
causing this injury.
• As external compression is a
common underlying etiology,

49. Bennett and reverse-bennett fractures
• An intraarticular fracture that separates the palmar
ulnar aspect of the first metacarpal base from the
remaining first metacarpal. The injury is typically
caused by axial loading on a partially flexed
metacarpal and may be associated with other
carpal bone fractures or ligament injuries.
• A reverse Bennett fracture-dislocation is a
fracture-dislocation of the base of the
5th metacarpal bone. It is pathologically and
radiographically analogous to the Bennett fracture
of the thumb

50. Prevention of sports injury
• Proper biomechanical technique during
activity
• Wear proper protective orthotics/
equipments during sports activity

51. Materials for for protective orthotics/splinting
• Hard/rigid materials for immobilization or when not participating in sports
• Soft spilnts during practice and play
• Wraps and tapes
• Rigid thermoplastics materials – LTTP & HTTP, elastomers
• Open cell and closed cell foam pads and splints – Plastazote, alipast, EVA Foam,
• Pneumatics devices – Mainly for trauma to immobilize injured extremities