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The Wrist Hand Forearm and Elbow PowerPoint Presentation

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Description : Check out this medical presentation on Orthopaedics, which is titled "The Wrist, Hand, Forearm & Elbow", to Understand the Anatomy of the Wrist, Hand, Forearm and Elbow.

Tags : Orthopaedics, Wrist, Hand, Forearm, Elbow, Anatomy

Published on : Aug 10, 2021 | Views : 2829 | Downloads : 6

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Slide 1-

The Wrist, Hand, Forearm & Elbow Chapter 19
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Bones: Humerus Radius Ulna Ligaments: Ulnar Collateral Ligament Connects the ulnar & humerus. Protects the elbow against valgus stress Annular Ligament Surrounds the radial head. Allows rotation of the radius. Radial Collateral Ligament Connects the humerus and radius. Protects the elbow against varus stress Anatomy of the Elbow
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Elbow Flexors: Biceps Brachii Brachialis Brachioradialis Elbow Flexors
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Elbow Extensors: Triceps Brachii Elbow Extensors
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Elbow Pronation (forearm) : Pronator Teres Pronator Quadratus Elbow Pronators
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Elbow Supinators (forearm): Biceps brachii Supinator muscles Elbow Supinators
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Injury Evaluation History Ask questions: How, where, when, who Observation What do you see? Swelling, bruising, deformity Palpation What do you feel? Instability, deformity, defects Special Tests What structures are damaged? How stable is the joint? Are they point tender?
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Injury Prevention Acute injuries usually occur from trauma or falling Wear protective padding to reduce the force of a blow Learning how to fall correctly Chronic injuries are very common in the elbow, forearm and wrist Limit # of repetitions throwing or hitting a tennis ball Make sure of proper mechanics Maintain appropriate strength and endurance levels Stretch to warm up & stretch to cool down Don’t overlook chronic injuries. REST if needed!
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Cause: Can be caused by a direct blow, falling on the tip of the elbow or excessive flexion/extension. This injury can be acute or chronic Signs & Symptoms: Excessive swelling that appears to be superficial, redness, warmth Care: Ice, rest, compression sleeve. On rare occasions, the elbow is drained. Pad when return to play. Athlete may take NSAIDs to reduce swelling. Ultrasound may be used if this is a chronic condition Olecranon Bursitis
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Olecranon Bursitis
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Cause: Hyperextension or excessive Valgus Force. This injury usually occurs during the cocking phase of the throwing motion Signs & Symptoms: Pain, Instability, numbness & tingling, Point tenderness over the UCL Care: Ice, compression sleeve, sling, rest. Follow up with a physician for evaluation, x-ray & MRI if necessary. Surgery is required to repair the injury. Recovery after surgery is approximately 9 months During rehabilitation throwing is restricted for the first 12 weeks. After 12 weeks, throwing is controlled by limiting & gradually progressing the number of throws per day Ulnar Collateral Ligament Sprain
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UCL Sprain Ulnar Collateral Ligament
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Stress on the UCL
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Ulnar Collateral Ligament Repair
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Ulnar Collateral Ligament Repair Using Palmaris Longus Tendon
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Cause: Typically happens as a result of a weak or torn UCL. It can become strained, chronically dislocated, or impinged Signs & Symptoms: Paresthesia or burning in fourth & fifth fingers, weakness in forearm Care: treat conservatively by rest & restricting aggravation motions. Surgery may be required. Do not compress the nerve with outside pressure Ulnar Nerve Injury
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Ulnar Nerve Injury
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Cause: repetitive wrist extension. Wrist extensor tendon become inflammed at the attachment. AKA Tennis Elbow Signs & Symptoms: Swelling, Pain with wrist extension, aching, weakness, point tenderness over lateral epicondyle Care: P.R.I.C.E, NSAIDs, Ice, Range of Motion exs, stretching, strengthening, Counterforce brace Lateral Epicondylitis
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Lateral Epicondylitis
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Cause: repetitive wrist flexion & elbow flexion. AKA as Little Leaguer’s elbow, Pitcher’s Elbow & Golfer’s Elbow Signs & Symptoms: Point tenderness, Swelling over medial epicondyle, Pain with wrist Flexion, Pain radiating down the arm, aching, weakness, point tenderness over medial epicondyle Care: Rest, NSAIDs, Ice, Range of Motion exs, stretching, strengthening, Counterforce brace. Return to play through throwing program if athlete is an overhead thrower, Severe cases may require splinting Medial Epicondylitis
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Medial Epicondylitis
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Cause: Fall on outstretched hand with elbow in hyperextension or a severe twist with elbow flexion Signs & Symptoms: bones can be displace anterior, posterior, or laterally, most noticeable deformity is displaced olecranon, widening of joint, loss or ROM, nerve injury, severe pain, swelling Care: Check pulses, immobilize injury, refer for emergency reduction, X-ray & splinting Elbow Dislocation
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Elbow Dislocation
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Cause: Fall on outstretched hand, fall on flexed elbow, direct blow or trauma to elbow Signs & Symptoms: May not see a visible deformity. Hemorrhage, swelling, muscle spasms Care: Ice, sling or splint, immediate referral to ER for x-ray & cast. Casting (immobilization) is typically limited to 3 weeks. After 3 wks., patient is moved to splint/brace that stabilizes but allows motion Elbow Fracture
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Elbow Fracture
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Elbow Fracture
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A fractured elbow is associated with rapid swelling that may cause a Volkmann’s contracture. Volkmann's contracture results from acute ischemia/necrosis of the muscle fibers of the flexor muscles in the forearm caused by obstruction of the brachial artery near the elbow. The obstruction may be caused by improper tourniquet use, improper casting, compartment syndrome, or profuse bleeding of fractured bones. The two most affected muscles are the flexor digitorum profundus & flexor pollicis longus. Volkmann’s Contracture
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Bracing
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Bones: Radius & Ulna Joints: Superior, Middle & Distal Radioulnar Joint Soft Tissue: Interosseous Membrane Anatomy of the Forearm
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Muscles (anterior): Biceps Brachii Brachialis Pronator Teres Brachioradialis Flexor Carpi Radialis Palmaris Longus Flexor Carpi Ulnaris Flexor Pollicis Longus Pronator Quadratus Muscles (posterior): Triceps Brachii Anconeous Flexor Carpi Ulnaris Extensor Carpi Ulnaris Extensor Digiti Minimi Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Digitiorum Abductor Pollicis Longus Extensor Pollicis Brevis Extensor Pollicis Longus Muscles of the Forearm
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Muscles Flexors Extensors
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Forearm Injury Evaluation History: how did it happen, where does it hurt, prior injury, loss of function, symptoms Observation: swelling, deformity, discoloration, skin defects, motion Palpation: tenderness, edema, deformity, skin temperature, bone fragments, continuity of bone
Slide 36-

Cause: repeated blows to the forearm or a blow with significant force. Typically occur on the ulnar side Signs & Symptoms: bruising, pain, swelling, hematoma, myositis ossificans may develop if the injury is severe Care: P.R.I.C.E., stretching, Range of motion exercises, Pad/Protect to return to play Contusion
Slide 37-

Cause: typically caused by a blow or falling on an outstretched hand Signs & Symptoms: Pain, swelling, deformity, ‘false joint’. There is a danger of soft tissue damage if the fractured bones move significantly Care: Splint & immediately refer for x-ray & physician consult. Ice. Typically casted for 6-8 weeks, surgery may be required if the deformity is significant. Take Tylenol for pain, NOT Ibuprofen. Ibuprofen can delay fracture healing by hindering the inflammatory response phase Forearm Fracture
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Forearm Fracture
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Cause: fall on outstretched hand forces the wrist into hyperextension. The most common forearm fracture. Distal Radius Fracture. Signs & Symptoms: visible deformity, pain, swelling, quick accumulation of blood. Median nerve damage is possible if the radius shifts forward enough Care: Splint & immediately refer for x-ray & physician consult. Ice. Typically casted for 4-8 weeks. Fracture deformity is usually reduced under anesthesia. Colles’ Fracture
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Bones of the Wrist 8 Carpal Bones Bones of the Hand 5 Metacarpals 14 Phalanx Bones Ligaments: Complex series of ligaments that bind the carpal bones to one another, to the ulna & radius, and to the proximal metacarpals Wrist: UCL & RCL Volar aspect of wrist is Transverse Carpal Ligament Each Joint in the fingers has MCL & LCL ligaments Anatomy of the Wrist and Hand
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Extrinsic muscles: originate outside of the hand Intrinsic Muscles: originate inside of the hand Motions of the Wrist Flexion Extension Radial Deviation Ulnar Deviation Motions of the Fingers Flexion Extension Abduction Adduction Motions of the Thumb Opposition Flexion Extension Abduction Adduction Muscles of the Hand
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Cause: Direct Axial force Trauma Contact Signs & Symptoms: Pain Point Tenderness Defect Rapid Swelling Care: Physician referral for x-ray & evaluation If the fracture is not displaced, they injury is casted If the fracture is displaced, surgical reduction may be necessary The most common metacarpal fracture is a 5th metacarpal fracture, aka Boxer’s Fracture Metacarpal Fracture
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Metacarpal Fracture
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Fracture of the 5th Metacarpal Boxer’s Fracture
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Mallet Finger Rupture of the Extensor Tendon at the Distal Interphalangeal Joint Bony Avulsion of that tendon Must be splinted in extension splint for 6-8 weeks, 24 hours a day
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Mallet Finger
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Boutonniere Deformity Rupture of the extensor tendon over the middle phalanx at the Proximal Interphalangeal Joint Caused by forcing the DIP into extension & the PIP into flexion Splint in extension for 6-8 weeks If not treated properly a boutonniere deformity will be permanent
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Boutonniere Deformity
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Cause: Rupture of the Flexor Digitorum Profundus from distal phalanx (DIP Joint) May occur with an avulsion Signs & Symptoms: Finger cannot be flexed Finger stuck in extension Pain & point tenderness over the distal phalanx Care: Surgery is required for flexion to be restored Surgery must be done within 7-10 days. Recovery is approx 12 weeks Jersey Finger
Slide 54-

Cause: forced axial load to the tip of the finger. Incredibly common in sports. Signs & Symptoms: severe point tenderness, lateral instability, swelling Care: x-ray to rule out fracture, ice, & splint, tape to return to play Jammed Finger
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Collateral Ligament Sprain “Jammed Finger”
Slide 56-

Cause: Ulnar Collateral Ligament Strain at MCP Joint Signs & Symptoms: Pain over UCL Weakness & pain with pinch Swelling over medial aspect of thumb Joint instability Care: X-ray to rule out fracture Splint or Cast 4-6 weeks Surgery can be required if not protected properly Gamekeeper’s Thumb
Slide 57-

Gamekeeper’s Thumb
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Cause: Blow to the tip of the finger Signs & Symptoms: Deformity, tearing of capsule resulting in hemorrhage, swelling Care: x-ray to rule out fracture, reduction of dislocation, splint for 3-4 weeks, tape to return to play Dislocated Finger
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Cause: Trauma such as being stepped on, hit, mashed between two objects, twisting, forced dislocation Signs & Symptoms: pain, swelling, point tenderness, deformity Care: Splint, refer for x-ray & physician evaluation Phalanx Fracture
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Phalanx Fracture
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Cause: Contusion or crushing injury to the first phalanx that causes blood to accumulate under the nail Signs & Symptoms: Extreme pain, blood under nail, more than 25% fracture needs to be ruled out Care: Drain within 12 to 24 hours, ice, elevate, clean once drilled, may have to be drilled twice, keep clean & covered. DO NOT DRILL THE NAIL IF A FRACTURE IS SUSPECTED!!! Subungual Hematoma
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Cause: a wrist sprain is caused by Hyperextension most often, but it can be caused by violent flexion or torsion Make sure the athlete gets an x-ray to rule out a fracture. Care: ice, splinting & analgesics, strengthening exercises, & taping to return to play Wrist Sprain
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Cause: repetitive wrist acceleration & deceleration Signs & Symptoms: Pain with use or pain with passive stretching. Point tender with swelling over the tendon Care: Ice massage, NSAIDs, rest, & splint injured tendon Wrist Tenosynovitis (Tendinitis)
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Cause: Carpal Tunnel is caused by inflammation of the flexor tendons that compress the median nerve Signs & Symptoms: Sensory & motor deficits Tingling & numbness Paresthesia of thumb, index & middle fingers. Weakness in thumb, index & middle fingers Aching in hand Care: Rest Wrist splint NSAIDS Injection of corticosteroid Surgery Carpal Tunnel Syndrome
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Carpal Tunnel Syndrome
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Caused by forceful hyperextension Not very common in sports Pain, swelling, deformity, difficulty with flexion May have numbness or paralysis due to pressure on the median nerve See physician immediately for x-ray and reduction. Cast for 4-8 weeks Dislocated Lunate
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Dislocated Lunate
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Scaphoid Fracture Scaphoid is found in the anatomical snuff box Typically caused by falling on outstretched hand Signs & symptoms include swelling & severe point tenderness, loss of grip strength, weakness with thumb movement Athlete should be x-rayed immediately, immobilized in a cast Rexray athlete every 2 weeks, & remain in splint if fx. Shows up. If a fracture is present, immobilization period is typically around 6 weeks The scaphoid doesn’t have good blood supply, which can result in a non-union Non-union fracture healing must be repaired with surgery When athlete returns to play once out of cast, they must be taped for 8-12 weeks
Slide 69-

Scaphoid Fracture
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Cause: A fall Contact while holding a sports implement such as the handle of a tennis racket, bat, golf club. Signs & Symptoms: Wrist pain & weakness Point tenderness Numbness & tingling (ulnar nerve) Care: Cast the wrist Doughnut pad over hook of hamate Hamate Fracture
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Hamate Fracture
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Cause: Damage to joint capsule, synovial sheath or a cyst Typically occurs after a trauma Usually found on dorsal side of wrist Signs & Symptoms: Pain Lump at the site of pain that is palpable Pain with wrist extension Care: Old: Pressure pad New: Combined treatment. Aspiration, Cauterization, pressure pad Only sure way to remove ganglion cyst is surgery Wrist Ganglion
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Wrist Ganglion