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Elbow, Forearm, Wrist & Hand

Elbow, Forearm, Wrist & Hand. Dislocated Elbow. Def: Dislocation of the radius and/or ulna. Usually it is a posterior dislocation of both bones. MOI: A fall on the outstretched arm with the elbow hyperextended or a severe twist with the elbow flexed.

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Elbow, Forearm, Wrist & Hand

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  1. Elbow, Forearm, Wrist & Hand

  2. Dislocated Elbow • Def: Dislocation of the radius and/or ulna. Usually it is a posterior dislocation of both bones. • MOI: A fall on the outstretched arm with the elbow hyperextended or a severe twist with the elbow flexed.

  3. S/Sx: Severe pain and disability. Obvious deformity. Profuse hemorrhage and swelling. Complications include: injury to the median and radial nerves and to the major blood vessels and arteries. • Tx: Apply cold and pressure immediately, then a sling and refer to a doctor. Reducing an elbow dislocation should never be attempted by anyone other than a physician.

  4. Olecranon Bursitis • Def: inflammation of the olecranon bursae of the elbow • MOI: fall on or blow to the tip of the elbow • S/Sx: obvious localized swelling • Tx: ice, rest, NSAIDs and protective padding

  5. Epicondylitis • Medial epicondylitis: • Def: inflammation of the origins of the flexors at the medial epicondyle • MOI: repetitive forceful flexion of the wrist • Also known as pitcher’s elbow or little league elbow

  6. Lateral epicondylitis • Def: inflammation of the origin of the extensors at the lateral epicondyle • MOI: repetitive forceful extension of the wrist • Also known as tennis elbow

  7. S/Sx: pain over the attachment point and pain with either wrist flexion (medial epicondylitis) or wrist extension (lateral epicondylitis) • Tx: rest, NSAIDS, ultrasound • Brace or tape below the elbow joint • stretch

  8. Colles’ Fracture • Def: A fracture to the distal end of the ulna and/or radius. • MOI: A fall on the outstretched hand, forcing the radius and ulna backward and upward

  9. S/Sx: In most cases there is forward displacement of the radius that causes deformity of the wrist. Positive percussion and compression test. • Tx: Apply ice, splint the wrist and refer to a doctor. Athlete will be out 1-2 months.

  10. Mallet Finger • Def: An avulsion of the extensor tendon usually along with a piece of bone. • MOI: Common in sports, particularly baseball and basketball. Caused by a blow to the tip of the finger.

  11. S/Sx: Inability to extend the tip of the finger DIP joint (distal interphalangeal joint) • Tx: Ice, x-ray and splint the joint in extension

  12. Boutonniere Deformity • Def: A rupture of the extensor tendon of the middle phalanx. • MOI: A blow to the tip of the finger.

  13. S/Sx: The athlete complains of severe pain and the inability to extend the PIP (middle) joint. The PIP joint is fixed in flexion and the DIP (end) joint is fixed in extension. • Tx: Apply ice and splint finger with the middle joint in extension. Refer to a doctor.

  14. Jersey Finger • Def: Rupture of flexor digitorum profundus tendon off distal phalanx • MOI: most often occurs in the ring finger when the athlete tries to grab the jersy of an opponent

  15. S/Sx: DIP joint is fixed in extension, inability to actively flex DIP joint, can passively flex it, pain and point tenderness over distal phalanx. • Tx: Tendon needs to be surgically repaired or athlete will never be able to flex DIP joint. Rehab lasts approximately 12 weeks.

  16. Gamekeeper’s Thumb • Def: A sprain of the ulnar collateral ligament of the MCP joint of the thumb. • MOI: A forceful abduction of the thumb, occasionally combined with hyperextension of the thumb.

  17. S/Sx: Point tenderness over the ulnar aspect of the MCP joint. Pain with or inability to grip. Positive valgus stress test. • Tx: RICE, NSAIDs, splint the thumb close to the hand. In cases of severe disability refer to a doctor.

  18. Dislocated Finger • Def: A dislocation of any joint in the finger. Usually, the first of second joint is displaced dorsally. • MOI: A blow to the finger, usually directed from the palmar side upward.

  19. S/Sx: Obvious deformity. Inability to move injured joint. • Tx: Dislocations may be reduced without doctor referral. After reduction, ice and a splint should be applied. If a fracture or tendon rupture is suspected refer to a doctor. • Note: never reduce a dislocated thumb!

  20. Navicular fracture • Def: fracture of the navicular/scaphoid bone. Most commonly fractured carpal bone • MOI: fall on an outstretched hand

  21. S/Sx: often appears to be a wrist sprain. Increased pain with palpation in the anatomical snuff box. Swelling in anatomical snuff box. Pain when pressure is applied to long axis of thumb • Tx: ice, immobilize, refer to doctor. Cast for about 4 months

  22. Complications: • The scapoid has a poor blood supply • If not immobilized properly part of the bone will not heal • That part of the bone will die due to avascular necrosis • May result in arthritis

  23. Just Because It Looks Cool

  24. Open Dislocation of Thumb • Def: Dislocation of thumb which breaks the skin. • MOI: Direct blow to the thumb. • S/Sx: Pretty obvious • Tx: Reduce the dislocation using sterile gloves. Place sterile gauze over injury and send immediately to a doctor.

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