This document provides an overview of anatomy and common injuries related to the wrist, hand, elbow, and shoulder. It begins with the bones and joints of the wrist and hand, including the carpal bones. It then discusses specific bones like the scaphoid and lunate, as well as common hand injuries. The document moves on to discuss the elbow, including ligaments, muscles, and common injuries such as epicondylitis. Finally, it covers the shoulder anatomy, including muscles like the rotator cuff, and common shoulder injuries such as strains, impingement, and fractures. Throughout, it emphasizes prevention of injuries through proper training, equipment fitting, and rehabilitation.
2. Anatomy of the Wrist and Hand
Looks a lot like the foot
Has similar bone
structures:
– Phalanges
– Metatarsals
– Carpals
There are 26 bones
There are many ligaments
that hold the structure of
the hand together
4. The Scaphoid Bone
Find your anatomical
snuff box
Only blood supply at
one end of the bone
It has difficulty
healing if the blood
supply is interrupted
5. Joints of the wrist and hand
There are three phalanges in each finger
and two in the thumb
Distal, middle and proximal
Joints:
– Distal Interphalangeal jnt (DIP)
– Proximal Iinterphalangeal jnt (PIP)
– Metacarpal Phalangeal jnt (MCP)
– Carpometacarpal jnt (CMP)
6. Muscles of the hand and forearm
There are two major
groups of muscles at
the wrist and forearm
Flexors: on the dorsal
side of the hand
Extensors: on the
ventral side of the
hand
7. The Thumb
Testing the ulnar
collateral ligament of
the thumb
The collateral
ligaments of the
thumb provide the
majority of its
stability
11. Wrist Sprains
Occur from twisting
and overuse
Injured structure
depends upon the
stress placed on the
wrist
Ulnar Deviation is
movement towards
the ulnar
13. The Lunate
Dislocation of the
lunate bone occurs
more often than any
other carpal
dislocation
Presents as deformity,
pain, swelling, and
decreased range of
motion
14. Ganglion Cyst
A pocket of fluid
within the sheath
Should be referred to
a physician
Sometimes is
removed surgically
15. Gamekeepers/Skiers Thumb
Thumb is forced into
abduction forcefully
Pain over the joint,
swelling may be
present
An x-ray may be
necessary to rule out a
fracture
17. Finger Dislocations
Don’t JUST
“pop” it !!!!!
There could be underlying
hidden issues going on at
the joint
There could be a tendon
rupture or a fracture!!!
20. Muscle and Tendon Injuries
Repetitive stress and
stretching can cause
injuries to these structures
Some of these include
– Carpal tunnel
– deQuervian’s tendinitis
– Mallet Finger
– Jersey finger
– Boutonniere deformity
26. Boutonniere deformity
Deformity arises when there is a rupture of the
central slip of the extensor mechanism.
This is an uncommon sporting injury usually due to
an end-on injury to the finger with sudden bending
at the P.I.P. joint
Often in football or basketball
30. Ligaments
There is thick joint
capsule surrounding
the elbow.
Relies on the
ligaments for stability
– Ulnar collateral
– Radial collateral
– Annular
33. Preventing Injuries to the Elbow
Not a frequently injured joint
Many of the injuries are caused by overuse
Most injuries occur in racket sports such as
tennis, or overhead throwing sports such
as baseball and softball.
Many times injuries are brought about by
poor training
34. Preventing Injuries to the Elbow
Athletes train the “beach muscles”
Overwork the Biceps to get “ pipes” or
“guns”
What about the Triceps???
What about the wrist flexors and
extensors??
35. What about equipment?
Tennis players can cause themselves
injuries if the grip is too small on the
racket.
Throwers should have a strong tricep and
lots of flexibility in the elbow to prevent
injuries.
36. Sprains
Ulnar collateral
More common in
throwers
The stress of overhead
activity strains the medial
aspect of the elbow.
Wrestling?
Pain and swelling treat as
any other ligament sprain
Radial Collateral
These are rare
Treat the same as a
ulnar collateral sprain.
38. Epicondylitis
Lateral Epicondylitis
aka: Tennis Elbow
Poor mechanics and
overuse
Presents as pain and
swelling at the lateral
epicondyle
Treat with PRICES
Medial Epicondylitis
aka: Little League Elbow
Repetitive Throwing
Little league elbow may
have an avulsion fracture at
the epiphysis
39. Fractures
Elbow fractures are rare in athletics.
Often results from a forceful blow to the
area or landing on hard surface.
42. Elbow Dislocation
One of the most commonly dislocated
joints in the body
Doesn’t take a lot of force to dislocate the
joint
MUST BE SEEN by MD immediately
44. Olecranon Bursitis
PRICES
Use a compression wrap or sleeve to
alleviate swelling
May have to be drained by MD
Not always painful
45. Shoulder Anatomy
A separation occurs here
at the acromio-clavicular
joint
A dislocation occurs here at the gleno-humeral joint
46. Bony Anatomy
Three bones:
– Humerus
– Bicipital groove
– Clavicle
– S shape
– Scapula
– Corocoid process
– Acromion process (a/c joint)
Many ligaments
Not a very stable joint
47. JOINTS
There are many joints
at the shoulder
Most commonly
injured joints are
Acromio-clavicular
Gleno-humeral
– Each held together by
many ligaments
49. Muscles of the shoulder
The Rotator Cuff
– SITS muscles
• Supraspinatus
• Infraspiantus
• Teres minor
• Subscapularis
Deltoid
– Lays over the head of the
humerus
Pectoralis
– Originate at sternum attach
to the anterior portion of
the humerus
50. Muscles
Biceps- two heads
Originates at the Coracoid
process and the Humerus
Distal attachment is a the
radial head
Runs through the bicipital
groove
ACTION: elbow flexion
and forearm supination
Triceps
Originates at the posterior
humeral head and scapula
Distal attachment is distal
humerus at the elbow
ACTION: Elbow
extension and shoulder
extension
54. Rotator Cuff Strain
Characterized like any other strain
– 1st, 2nd, and 3rd degree
Common in throwing athletes
Occurs from excessive motion beyond the
normal range
55. Impingement Syndrome
Overdoing it with overhead motions
Supraspinatus and Bicep run together
beneath the acromion process
Space narrows because of swelling, poor
posture, muscle imbalance
Not enough room for everything in the
joint pain occurs with motion sometimes
there is numbness along with the pain
59. Fractures
There is a tremendous amount of stress at
the shoulder
Given its role in contact and collision
sports fractures are common in athletics
– Clavicular
– Humeral
– Scapular