SM Study Guide Hand/Wrist/Elbow/Fingers

What are the motions of the hand/wrist/fingers?

supination and pronation

Flexion and extension

What 3 bones make up the elbow complex

humerus, ulna, radius

What joints do flexion and extension?

Humeroulna and humeradial

What joint does supination and pronation?

Radioulnar

What are the three ligaments of the elbow and what do they connect?

Ulnar (medial) collateral ligament: stabilizes the valgus force of the elbow

Annular ligament: extends from the ulna, forming a sling around the raidal head that allows free rotation and stability that

Radial (lateral) collateral ligament: stabilizes during varus force

Where is the RCL?

Extends from the lateral epicondyle and primarily attaches to the annular ligament (all the ligaments on the thumb side)

Where is the UCL?

Extends from the medial epicondyle to the proximal ulna

Elbow pain can be referred from the

Shoulder or neck

What are you observing in the elbow?

Clear deformity or swelling

if pt cannot flex or extend on one side more than the other = joint issues

elbow hyperextension, more common in females

What is a carrying angle?

A carrying angle that is too big or small could mean that the growth plate or bone is fractured

The acute angle formed by the median axis of the arm when in full extension and in a supinated posiotn

What is a normal angle?

5 to 15 degrees

Lateral and Medial Epicondylitis Tests:

Elbow flexed at 45 degrees while wrist extension is resisted. The lateral epicondyle pain will increase. When the wrist flexion is resisted, medial epicondyle pain is increased.

Functional Evaluation:

Muscles and joints are evaluated for pain and weakness through resistive, passive, and active extension, flexion, and forearm pronation and supination. ROM is mostly noted in active and passive supination and pronation.

Active ROM:

The athlete does the motion (muscles/structural)

Passive ROM:

The trained professional does the motion for the athlete (structure)

Resistive ROM:

The athlete does the motion while the trained professional resists the motion (muscles)

How do you prevent acute elbow injuries?

Acute: FOOSH or direct blow

Chronic: overuse typically caused by the throwing motion

Wear PPE to stop forces on elbow

learn how to fall correctly

limit throwing and hitting reps

use correct mechanics

use correct equipment

strength and endurance training

warming up and warming down

stretch

If chronic overuse, take time to heal

What does aspirate mean?

to draw out liquid from the injury and relieve pressure

What injury would be aspirated?

Olecranon bursitis

What are the three joints of the hand/wrist

proximal, distal, and middle radioulnar joints

What is the flexor retinaculum?

The roof of the carpal tunnel is made by the flexor retinaculum

Thick connective tissue ligament that bridges the space between the lateral and medial

Extrinsic muscles

muscles originating outside of the hand (forearm area)

Intrinsic muscles:

muscles originating inside of the hand (abduct, adduct, and create opposition of metacarpals in the thumb)

What are both the inrinisc and extrinsic muscles?

located on medial side to flex fingers and the wrist

located on the posterior/lateral side to extend fingers and wrist

What wrist injury should be aspirated?

wrist ganglion

What would pale nails indicate?

issue with blood circulation

What injury causes tenderness at the snuff box?

Scaphoid fracture

X-rays are reliable for scaphoid fractures

false

What are the three joints of the forearm?

proximal, distal, and middle

The flexors are on the...

anterior side

The extensors are on the...

posterior side

What is the difference between a Colles and a Smith fracture?

Colles: radius posterially displaced

Smith: hand anterioly displaced

When do you use a stirrup and when do you only splint the hand/wrist?

Stirrup for the elbow or if their is pain when the wrist is in supination or pronation

Only splint the hand or wrist when it is a sprain or strain

Colles fracture

MOI: radius posterioly displaced, FOOSH on extended wrist, dinner fork deformity

S&S: clear deformity, sometimes mistaken for a sprain, torn tendons and possible middle nerve damage

Tx: 6-8 weeks recovery, splint, PRICE, maybe sx

Smith fracture

MOI: FOOsH with flexed hand, displaced anterioly, less seen than Colles

Forearm Contusion:

MOI: can be acute or chronic, ulnar side hit more often, direct blow or contact

S&S: swelling, hematoma, pain, “Monkey Bump”, if hit many times could have myositis ossificans

Tx: PRICE mainly ice and compress, donut pad for added protection

Forearm shaft fractures

MOI: most seen in youth from direct blows or falling, fx to ulna or radius, only one is rare

S&S: p!, pop, echymosis w/ possible crepitus, edema, older athletes can have more damage to soft tissue structures

Tx: PRICE, immobilize, splint, refer to a doctor, recovery is 6-8 weeks, possible sx and reduction

Elbow Sprain

MOI: hyperextension, bends lower arm outward (valgus) injuring MCL

S&S: P!, can’t throw, point tenderness over MCL

Tx: apply cold immediately, pressure bandage for 24 hours, sling at 90 degree angle of flexion, active exercise, progressive throwing reps, if elbow is unstable “Tommy John” sx will fix joint capsule and MCL

Elbow Fracture

MOI: FOOSH, direct blow, falling on flexed elbow, children and young adults, most common, can break 1-many bones in the elbow

S&S: deformity, muscle spasm, hemorrhage, swelling

Tx: immediate care, ice, sling, rapid swelling may cause Volkmann’s contracture

Scaphoid Fracture

MOI: FOOSH, compresses scaphoid between the radius and second row of carpal bones

S&S: severe p! in snuff box, swelling, confused with wrist sprain

Tx: splint then X-ray before casting, sometimes can’t be seen on X-ray, immobile for 6 weeks, protect wrist with tape for 3 months, does not heal quickly

Hamate Fracture

MOI: contact with athlete holding something/falling

S&S: wrist is weak, p! in 5th digit b/c ulnar nerve compression, TTP

Tx: cast wrist and thumb, hook of hamate protected w/ donut pad

Wrist ganglion

MOI: synovial joint cyst appears after strain or repetitive hyperextension force

S&S: usually on posterior side of wrist, p! w/ lump, p! increases w/ movement, or pain-free

Tx: old method- hit with Bible to break down swelling then apply pressure pad. new method- aspiration, chemical cauterization w/ pressure from pad, can return 50% of the time, sx is most effective.

Dislocation of Phalange

MOI: blow to tip of finger, forces 1st and 2nd joint dorsally, tears supporting capsular tissue, causes hemmorhage, coud rupture flexor or extensor tendons or cause a chip fx, closed or open dislocation

S&S: relocate, X-ray to rule out fx, splint for 3 weeks in 30 degree angle of flexion, buddy tape, consider thumb and MCP more carefully

Phalanx Fracture

MOI: hit by ball, twisted, or crushed

S&S: swelling, p!, tenderness

Tx: splint in slight flexion around a gauze roll, avoid full extension, relaxes flexor tendons, fx of distal phalanx is less complicated, PRICE, immobilize

Forearm Splints/Strains

MOI: repeated static contractions for splints, severe static contraction for strains

S&S: achy/dull p!, between extensors (posterior), p! w/ contractions, weakness, point tenderness in interosseous membrane in between the radius and ulna

Tx: based off of symptoms, forearm strengthening, acute use chyrotherapy, chronic use thermotherapy, wraps protect and support

Metacarpalphalangial

Where the finger meets the hand

Interosseous

Inbetween the bones

Triceps

Elbow extension

Ulna is…

bigger at the elbow smaller at the wrist and radius is the opposite

The supinators and biceps

Do supination

Extensors do not pass where?

through the carpal tunnel

8 carpal bones

Start from thumb SLTPTTCH