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Elbow---Wrist---Hand

Elbow---Wrist---Hand. Chapter 20. The elbow. The Elbow. Humerus Lateral condyle Medial condyle Capitulum Ulna Olecranon Process Radius Radial Head Hinge joint. Bony Anatomy. Articulations at the Elbow. (1) Humeroradial (2) Humeroulnar (3)Proximal Radioulnar.

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Elbow---Wrist---Hand

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  1. Elbow---Wrist---Hand Chapter 20

  2. The elbow

  3. The Elbow • Humerus • Lateral condyle • Medial condyle • Capitulum • Ulna • Olecranon Process • Radius • Radial Head • Hinge joint

  4. Bony Anatomy

  5. Articulations at the Elbow (1) Humeroradial (2) Humeroulnar (3)Proximal Radioulnar

  6. Muscles of the Elbow • Brachialis • Biceps brachii • Brachioradialis

  7. Muscles of the Elbow • Triceps brachii • Anconeus

  8. Muscles of the Elbow

  9. Ligaments of the Elbow Annular Ligament Radial Collateral Ligament Ulnar Collateral Ligament

  10. Ligaments of the Elbow Radial Collateral Ligament Ulnar Collateral Ligament

  11. Ulnar (Medial) Collateral Ligament

  12. Radial (Lateral) Collateral Ligament

  13. Elbow Anatomy • Ulnar Nerve • Olecranon Bursa

  14. Common injuries to the elbow

  15. Olecranon Bursitis • Direct blow to olecranon process results in contusion that produces acute hemorrhagic bursitis • Treat with ice compresses, rest, and anti-inflammatory meds • Occasionally requires aspiration of bursa fluid

  16. Ulnar Nerve Contusion • Ulnar nerve passes behind medial epicondyle runs subcutaneously in groove and pass through cubital tunnel • Lack of bony protection makes nerve vulnerable • Direct blow may cause immediate pain & burning, shooting down to 4th & 5th phalanges

  17. Epicondylitis • Overuse condition caused by repeated overload of the musculotendinous units attaching to one of the epicondyles • Also due to: faulty techniques/mechanics, weak muscle groups, inappropriate equipment • Lateral • Tennis elbow • Medial • Golfer’s elbow • Thrower’s elbow • Pitcher’s elbow

  18. Lateral Epicondylitis

  19. Medial Epicondylitis

  20. Epicondylitis—Signs & Symptoms • Local tenderness over involved epicondyle • Pain on use of involved muscles • Swelling • Resisted wrist motion often reproduces pain

  21. Epicondylitis—Treatment • Preventative measures: • Proper technique • Use of appropriate equipment • Limited stress • Proper/adequate warm-up • Stretch to maintain flexibility • RICE • Modify activities that aggravate condition • Decrease amount, frequency, or intensity of activity

  22. Sprains of the Elbow • Result from: • Hyperextension • Valgus/varus force • Signs/Symptoms • “click” or “pop” • Sharp pain at time of injury • Point tenderness • Localized swelling • Paint with attempt to reproduce MOI • Extension may be limited • Treatment • Special tests • Progressive rehab • Bracing • Depends on degree of injury

  23. Elbow Dislocations • Second most frequently dislocated major joint • Posterior displacement of ulna and radius in relationship to humerus most common • Result of FOOSH with elbow in extension • Collateral ligament will be severely stretched or ruptured

  24. Elbow Dislocation Signs & Symptoms Treatment Prompt reduction important Rehab based on injury • Obvious deformity • Loss of elbow function • PAIN • Check for: • Circulation • Nerve function • Properly immobilized • Refer immediately

  25. Fractures of the Elbow and Forearm • Result of: • Direct trauma • Indirect stresses transmitted through UE (FOOSH) • Excessive forces associate with throwing and swinging activities • Most frequent in children and skeletally immature athletes

  26. Volkmann’s Contracture • Occurs in absence of blood flow (ischemia) to forearm • Caused by increased pressure due to: • Swelling • Trauma • fracture • Blood vessels compress, decreasing blood flow to arm • ® injury to muscles, causing it to shorten • Pulls on joint at end of muscle just as it would if it were normally contracted

  27. Volkmann’s Contracture • Wrist remains flexed and cannot be straightened • Causes fingers to form fist and flex the wrist • Muscles involved are on palm side of forearm • Three levels of severity: • Mild—two/three fingers only; no or limited loss of sensation • Moderate—all fingers flexed; thumb stuck in palm; wrist stuck in flexion; usually loss of some sensation • Severe—all muscles in forearm involved; completely disabling

  28. Volkmann’s ContractureSigns & Symptoms • Severe pain with passive movement • Forearm tensely swollen and shiny • Pain when forearm squeezed • Pain not improve with rest • Continue to get worse over time • If condition not corrected: • Decreased sensation • Weakness • Paleness of skin

  29. Injury to the Ulnar Nerve • Passes through cubital tunnel in the posterior aspect of medial epicondyle • Vulnerable to compression forces and tension stresses due to: • Repetitive movement in cubital tunnel • Relative lack of bony protection • Repetitive throwing and/or swinging can irritate, compress or entrap the nerve • aka cubital tunnel syndrome

  30. Injury to the Ulnar Nerve

  31. Injury to the Radial Nerve • Passes anteriorly to the lateral epicondyle and lies in a tunnel formed by several muscles and tendons • Repetitive pronation/supination can cause entrapment • aka radial tunnel syndrome • Differentiate from lateral epicondylitis

  32. Injury to the Radial Nerve • Pain over lateral aspect of elbow • Tenderness present over anterior radial head • Symptoms reproduced by: • Resisting supination with elbow at 90 • Resisting extension of middle finger with elbow extended • Failed treatment of lateral epicondylitis may be radial nerve

  33. Injury to the Median Nerve • Crosses anterior elbow and passes between the heads of the pronator teres muscle just distal to the joint • Entrapment caused by: • Hypertrophy of the pronator teres • Activities that involve repetitive pronation • aka pronator teres syndrome

  34. Injury to the Median Nerve • Pain radiating down the anterior forearm • Numbness & tingling in thumb, index, and middle fingers • Increases pain with resistive pronation

  35. Wrist & hand

  36. The Wrist and Hand • Radius • Ulna • 8 Carpal bones • 5 Metacarpal bones • 14 Phalanges

  37. Radius

  38. Carpals • Scaphoid • Lunate • Triquetrum • Pisform • Trapezium • Trapezoid • Capitate • Hamate

  39. Wrist Articulations

  40. Sesamoid Bone in Pollux

  41. Wrist Range of Motion

  42. Muscles of Hand and Wrist • Wrist Flexors • Flexor carpi radialis • Flexor carpi ulnaris • Palmaris longus • Wrist Extensors • Extensor carpi radialis • Extensor carpi ulnaris • Supinator • Pronator teres • Thumb • Flexor pollicis longus/brevis • Extensor pollicis longus/brevis • Adductor pollicis • Abductor pollicis longus/brevis • Opponens pollicis • Fingers • Flexor digitorum profundus • Flexor digitorum superficialis • Extensor digitorum

  43. Pronator & Supinator

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