KNES 330 Unit 4: Elbow, Forearm, Wrist, Hand

what holds the radius and ulna together?

interosseous membrane

what 3 joints are involved in the elbow, forearm, wrist & hand?

• humeroulnar

• humeroradial

• radioulnar

what is the traditional elbow joint?

humeroulnar

what ligament holds the radius on the ulna?

annular

flexor muscles of the arm

medial side

extensor muscles of the arm

lateral side

where is most of the arm’s vascular located?

medial side

what does the carrying angle of the elbow tell us?

the distal projection of the humerus

what is a normal carrying angle of the elbow?

5-15 degrees

cubital varus carrying angle of elbow

less than 5 degrees (closer to the body)

cubital valgus carrying angle of elbow

over 15 degrees

what are the male and female typical carrying angles of the elbow?

• males: 5-10 degrees

• women: 10-15 degrees

prevention of elbow, forearm, wrist & hand injuries

• Braces help prevent injuries typically for a secondary injury

• How to fall

  • FOOSH causes a mess for UE. Try to teach how to brace without putting the arm down.

• Decrease overuse by cross training. 

  • If we introduce other sports or cross train children, they have less injuries. 

  • Also helps them to decrease their chances at burnout. 

• Proper biomechanics

• Adequate recovery

• Adolescent and post-injury – number of throws/hits & types

  • There’s whole charts on this dependent on age, league, position, etc. We need these protocols so that kids don’t get overuse injuries. 

olecranon bursitis

• superficial, so injuries occur most often with direct blows

• symptoms: mild pain, pressure, swelling, being tender. tends to blow up and have little pain

• treatment: compress and ice it. If swelling doesn’t resolve, can drain it. If an athlete, we tend to pad area so it doesn’t keep happening

muscle strains and avulsions in arm

• tend to occur with resistive motion (FOOSH) or repeated micro tears due to overuse

• symptoms: pain during motion as well as tenderness and may have reduced strength

• treatment: depends on severity of strain, usually ice and rest

UCL sprain

• tend to rupture with valgus forces on the elbow, and with more repetition comes more microtears

• . Symptoms: can hear or feel a pop, pain, and tenderness on the medial elbow, possible tingling, and laxity at the joint line

• . Treatment: In depth, if grade 1 or 2, we hope conservative treatment will scar the area and stabilize it. Grade 3= 12-18 months of rehab after surgery. Throwing athletes can return to activity 22-26 weeks post-surgery, with full recovery at 18-24 months

Lateral epicondylitis

tennis elbow

medial epicondylitis

golfer’s elbow

lateral & medial epicondylitis

• where muscle groups insert and are inflamed due to overuse

• Symptoms: aching pain, possible tenderness, weakness in a muscle group, pain worsening as the muscle group is used, decreased ROM

• treatment: rest, NSAIDs, ice, and seeing if we can slightly change biomechanics

  • eventually, slight stretches, slow strengthening exercises, massage, and use a counterforce brace

elbow dislocations

• tends to occur due to a FOOSH

• we usually see a posterior dislocation, as well as a possible fracture with the dislocation

• symptoms: looks for deformity, pain, swelling and check neurovascular stat

• treatment: sling and ship to be reduced and imaged

  • usually will be in sling for at least 3 weeks

  • rehab will consist of a lot of hand things until we feel they are stabilized

  • stay away from stretching for those few weeks

elbow fracture

• FOOSH mechanism or direct hit

  • possible even incorrect reduction with elbow

• symptoms: swelling, muscle spasm, pain, possible deformity, reduced ROM, compromised neurovascular

• treatment: stabilize and ship

  • may need a sling or cast, or surgery

  • treatment will depend on cast vs. surgery

colles fx

radius & ulna fracture where they hyperextend (go dorsally)

smith fx

radius & ulna fracture and hyperflex (go volarly)

forearm fractures

• FOOSH or direct blows

• super common in youth due to the MOI, but rare to see as ulanr and radial fractures simultaneously

• symptoms: pop, pain, swelling, possible deformity, lack of ROM

• treatment: splint and ship, will need cast or surgery. 4-8 weeks and then therapy

volkmannn’s contracture

• associated with forearm fractures which causes muscle spams, swelling, and reduced brachial artery flow

• can be permanent or temporary, if we can fix blood flow, should be temporary but still can have muscle damage within hours

• symptoms: pain in forearm, passive extension of fingers, coldness in arm (no blood flow), and decreased ROM

• if caused by a cast or wrap, take it off

how many bones are in your hands?

• 8 carpals, 5 metacarpals, 2 sesamoids, 14 phalanges

• MCP, MP, DIP, PIP joints

thenar muscles

4 thumb muscles

hypothenar muscles

3 pinky muscles

anatomical snuffbox

ext pollicus brevis and adductor pollicus retinaculum hold down tendons at joint areas

what are the two neurovascular components on the hand?

• carpal tunnel

• tunnel of guyon

carpal tunnel

straight down wrist (dorsal side) and has median nerve

tunnel of guyon

is on ulnar side of hand with the ulnar nerve

wrist sprain

• most common wrist injury

• occurs with an abnormal, forced movement (falling on hypertext wrist or violent flexion)

• symptoms: pain, swelling, tenderness, difficulties with ROM

• treatment: can send for images to rule out a fracture

  • can splint if brace if bad enough

  • treatment for pain management (meds, modalities)

  • can prevent or treat with wrist tape

TFCC injury

• TFCC is injured when patient has a violent twist of the wrist, typically with a hyperextension

• symptoms: pain on ulnar side, possible clicking, lack of wrist extension, swelling

• treatment: if suspected, send for imaging

  • may need splint for about 4 weeks (rest), then start with strengthening and ROM exercises, bad case may need surgery

Triangular fibrocartilage complex (TFCC)

combination of ligaments and “meniscus” cartilage on ulnar side

stopped at nerve compression