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Chapter 12

Chapter 12. Injuries to the Arm, Wrist and Hand. 1. Elbow. Bones Humerus Ulna Radus Ligaments Ulnar Collateral Annular Ligament Interossius Membrane Joints Humeroulnar, Humeroradial Radialulnar. 2. Elbow Movements flexion/extension, pronation/supination Wrist Movements

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Chapter 12

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  1. Chapter 12 Injuries to the Arm, Wrist and Hand 1

  2. Elbow • Bones • Humerus • Ulna • Radus • Ligaments • Ulnar Collateral • Annular Ligament • Interossius Membrane • Joints • Humeroulnar, • Humeroradial • Radialulnar 2

  3. Elbow Movements • flexion/extension, pronation/supination • Wrist Movements • flexion/extension, radial & ulnar deviation 3

  4. Soft Tissue Injuries Contusions and fractures • common in contact sports • muscle tissue compressed between skin and bone • Repeated episodes can result in myositis ossificans traumatica. • chronic inflammation of the muscle and underlying periosteum resulting in development of bony mass within the muscle • develops over weeks or months and is often ignored during the early stages 4

  5. Signs/symptoms: severe pain in upper arm deformity & loss of function muscle spasm audible snap or pop sensory loss in forearm First Aid: application of ice & compression splint & sling/swathe monitor distal pulse treat for shock summon EMS Fractures of the Humerus

  6. Elbow Dislocation Mechanism for this injury includes falling either on a flexed or fully extended arm -- deformity is usually obvious 8

  7. Elbow sprains and dislocations • three joints of the elbow • ulnar & radial collateral ligaments -- valgus/varus • injury mechanism includes falling backwards with elbow in extension • valgus/varus forces can result in sprains • dislocations constitute extreme sprains

  8. Signs/symptoms: in minor sprains -- mild swelling & localized pain difficulty in gripping or making a fist in dislocations -- gross deformity loss of function & severe pain possible neurological symptoms First Aid: application of ice & compression splint & sling/swathe monitor distal pulse treat for shock summon EMS Elbow Sprains 9

  9. Elbow Fractures • generally involve the distal humerus • danger to neurovascular structures • injury mechanism similar to sprains and dislocations • fractures of the olecranon associated with direct blows • if radial artery is compressed -- Volkmann’s contracture may result 10

  10. Epicondylitis Epicondylitis of the elbow • lateral epicondyle • attachment of the extensors • Medial epicondyle • Attachment of the flexors • gripping combined with wrist movements 12

  11. Elbow Injuries • Golf associated with medial epicondyle • Tennis elbow -- involves the lateral epicondyle • excessive number of strokes • incorrect technique • racket handle too small • change in racket materials • grip too tight • muscle imbalance 13

  12. Signs/symptoms: pain in the region of an epicondyle with swelling becomes worse with activity radiating pain into forearm muscles epicondylar pain associated with resisted wrist movements First Aid: ice, compression, rest medical referral if pain persists Elbow Injuries

  13. Osteochondritis Dissecans throwing mechanism can result in impingement between radial head and capitulum high velocity elbow extension - joint compression on the lateral side joint cartilage becomes inflamed & may fracture axial loading may also result in damage Signs/symptoms: painful participation swelling 12-24 hrs. after “locking” of joint osteoarthritis in advanced cases First Aid: ice and compression medical referral 14

  14. Contusions of the elbow • blows to the elbow are common • majority result in temporary symptoms • exception involves the olecranon bursa • repeated irritation of the bursa can result in inflammation (bursitis) • Signs/symptoms: • swelling in the region of the olecranon process • pain/stiffness with movement • elevated skin temperature • First Aid: • ice and compression • in cases of bursitis -- medical referral 15

  15. Wrist and Forearm Injuries 16

  16. Anatomy of the wrist • complex due to small size and large number of tendons that serve the wrist, thumb and fingers • Tendons are held in place by retinaculum • Retinaculum is small ligaments • Major nerves and vessels pass through this region as well. They are: • ulnar and radial arteries and veins • ulnar, median, radial nerves 17

  17. Colles’ Fracture • rare in sports • Colles’ Fracture is most serious. • Signs/symptoms: • history of significant trauma • snap or popping sound • deformity, swelling into hand/fingers • severe pain and loss of sensation may occur 18

  18. Wrist Fractures • Navicular • navicular fracture most common • generally occur at the “waist” 19

  19. Navicular Fractures • Signs/symptoms: • history of wrist trauma with popping or snapping • pain with movement/wrist feels locked, positive “snuffbox” test • First Aid: • I.C.E. application • splint with sling & swathe, leave fingertips exposed (to observe circulation • medical referral

  20. Wrist and Forearm Injuries A simple test for assessment of the integrity of the carpal navicular bone -- pressing lightly in the “anatomic snuffbox” 20

  21. 21

  22. Wrist Sprains and Dislocations Mechanism is typically hyperextension, similar mechanism to fractures Signs/symptoms: history combined with snapping/popping sensation painful movement movement may be impossible numbness and/or radiating pain First Aid: application of I.C.E. splint with sling & swathe expose fingertips refer to a physician

  23. Nerve injuries in the wrist • median is most commonly injured -- carpal tunnel • carpal tunnel related to inflammation of flexor tendons • carpal tunnel related to sports requiring extensive gripping • ulnar nerve injuries -- produce numbness in the hypothenar eminence 23

  24. Signs/symptoms: sensory loss to a portion of the hand/fingers pain/tenderness in the wrist, associated tendonitis and symptoms increase with wrist flexion Care for carpal tunnel syndrome consist of treating the inflammation and rest. Carpal Tunnel

  25. Ganglion Cyst • Results from a herniation of the synovium surrounding a tendon herniated area becomes filled with fluid • variable in appearance -- some soft, other hard and painful Ganglions 25

  26. Signs/symptoms: visible swelling in advanced cases, painful, hardened nodule First Aid: some spontaneously regress leave alone if possible can be surgically removed Ganglion Cysts

  27. Hand Injuries 26 19 bones in the hand and wrist

  28. Hand fractures • Bennett fracture • mechanism includes blows with a clenched fist • Metacarpals can be fractured by a crushing mechanism • Phalangeal fractures common in sports • Signs/symptoms: • history of trauma • associated dysfunction • deformity • broken skin (compound) • significant inflammation 27

  29. Sprains & dislocations of the hand • any joint in the hand can be involved • most common forms are: • gamekeeper’s thumb • mallet finger • boutonniere deformity 28

  30. Gamekeeper’s thumb • involves sprain of the ulnar collateral lig. • mechanism of injury is a valgus force • thumb is unstable • Signs/symptoms: • history of an appropriate mechanism • pain over the area of the ulnar collateral ligament • snapping or popping at the time of injury • swelling of the MP joint • inability to move the thumb • inability to grip tightly using the thumb Anatomy of a gamekeeper’s thumb 29

  31. Mallet (baseball) Finger • involves distal phalanx, name comes from the deformity • mechanism -- blow to the fingertip while extending, can’t extend fingertip • Signs/symptoms: • deformity MOST important • recent trauma to fingertip • point tender DIP 30

  32. Boutonniere deformity • extensor tendon involved as it crosses the PIP • mechanism is blow while the finger is flexed during active extension • Signs/symptoms: • violent flexion injury associated with feeling of tearing/popping • significant weakness in finger extension • PIP painful and swollen • if uncorrected, deformity will develop • characterized by hyperextension of MP & DIP with flexion of PIP 32

  33. Anatomy of the Finger Tendons 31

  34. Splinting for fractures of the forearm, wrist and/or hand

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