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Chapter 12

Chapter 12 . Elbow, Forearm, wrist, and hand. Educational Objectives. Understand Anatomy of the elbow, forearm, wrist, and hand Principles of rehab exercises Preventive/supportive techniques and protective devices Identify components of evaluation format Recognize the common injuries.

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Chapter 12

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  1. Chapter 12 Elbow, Forearm, wrist, and hand

  2. Educational Objectives Understand Anatomy of the elbow, forearm, wrist, and hand Principles of rehab exercises Preventive/supportive techniques and protective devices Identify components of evaluation format Recognize the common injuries

  3. Anatomy ELBOW Permits movements of flexion, extension, pronation, and supination. Delivers and receives accidental blows that can cause bruising, fracture, dislocation or nerve damage. Excessive stress are placed on elbow in throwing and racquet sports

  4. Anatomy Humerus- largest bone of the upper extremity. -two articulating condyles at distal end Ulna- remains stationary Radius-rotates on the ulna as the forearm, wrist, and hand pronate and supinate. The proximal end has a bony protuberance called the olecranon process. olecranon process articulates with the proximal radius.

  5. Ligaments, Tendons, Joints Very strong ligamentous and muscular support Attach at the condyles of the humerus Medial condyle articulates with the ulna for flexion and extension Lateral condyle articulates with the radius for pronation and supination

  6. Ligaments, Tendons, Joints -JOINTS Humeroulnar Humeroradial -LIGAMENTS Ulnar collateral Radial collateral Annular ligaments-adds elbow stability, attaches to the ulna and completely encircles the head of the radius. Helps keep the radius and ulna from separating. Medial collateral-attached to the humerus and the ulna Lateral collateral-attached to the humerus and the radius

  7. Muscles-control forearm and elbow’s movement Control elbow- Originate above the elbow on the humerus and the scapula. Biceps Triceps Brachialis Control forearm, wrist, and fingers -originate on the two epicondyles of the humerus. Flexor carpi radialis(flexion and pronation) Flexor carpi ulnaris(flexion and pronation) Flexor digitorumsublimis(flexion and pronation) Flexor pollicislongus(flextion and pronation) Extensor digitorumcommunis(extension and supination) Extensor carpi radials longusand brevis(extension and supination) Extensor carpi ulnaris(extension and supination) Extensor pollicislongus(extension and supination)

  8. Tests Elbow Test for collateral ligaments stability Valgus or abduction stress-(medial collateral) Varus or adduction stress-(lateral collateral) Epicondylitis tests-lateral Resisted wrist extension Resisted long finger extension Palmar flexion-pronation stretch Epicondylitis tests-medial Resisted wrist flexion Wrist extension-supination stretch

  9. Wrist test Bony integrity tests Anatomical snuffbox compression-fracture of scaphoid Murphy’s sign-dislocation of lunate

  10. Common injuries sprains: 1st, 2nd, and 3rd degrees Olecranon brusitis: inflammation to the olecranon bursa. (direct blow or overuse) Referral, after evaluated basic treatment. Carpal tunnel syndrome: pressure on the median nerve caused by constriction in the carpal tunnel. Treatment: wrist splints, rest, and medication. Medical re-evaluation is doesn’t get better. Scaphoid fracture: (navicular) fall extended wrist. Poor blood supply. Severe pain, medical treatment required. Dislocation/subluxation: force placed on a outstretched hand with elbow in extension. Always suspect a fracture. Medical referral. Epicondylitis: inflammation of the epicondyle and the tissues adjoining the humerus. Elbow joint medial (pitches elbow) and lateral (tennis elbow) Contusion Subungual hematoma: fingernail receives a contusion (bruise), accumulation of blood under the fingernail. Ice and medical referral if swelling is severe.

  11. Rehabilitation ROM Elbow: flexion, extension, supination, pronation Wrist: flexion, extension, radial deviation, ulnar deviation, supination, pronation Fingers: flexion, extension, abduction, adduction, opposition Resistance/strengthening exercises Elbow: arm flexion (bicep curls) arm extension (triceps extension) wrist, hand, fingers: hand squeeze, finger abduction, pinch grip, lateral/key pinch grip Return to competition guidelines Full ROM Strength, power, and endurance according to athlete and sport No pain in upper extremity during running, jumping, or cutting

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