Sports Med Unit 3: Upper Extremity Notes

Elbow, Wrist, and Hand

• Hinge = elbow joint

• Pivot = wrist joint

Elbow Bones

• Radius near thumb, ulna on the outside

• Ulna hooks into the olecranon process 

• Olecranon process is part of the ulna

• Process = extensions

• Fassa = divot

• Radial head pivots around the capitulum

• Ulna pivots around trochlea

• Epicondyles = processes that come of the ends of humerus bones

  • Medial epicondyle and lateral epicondyle

• Annular ligament surrounds radial head and locks it into place

  • Allows rotation but wont allow for it to move away from its attachment

• Radial collateral ligament connections between radial head and humerus to maintain integrity from varus force

• Openderosis acts as attachment joint for part of the bicep tendon

Wrist Bones

• Radius is the most common place to fracture (greenstick in children)

• Styloid processes

  • Radial styloid process and ulnar styloid process

• Adults normally fracture distal ends of both radius and ulna

• Interosseous membrane between radius and ulna keeps the two bones from spreading apart

• Proximal row = 4 bones

• Distal row = 4 bones

• Naming carpals from lateral to medial (thumb to pinky):

  • Proxima row: Scaphoid, Lunate, Triquetrum, Pisiform

  • Dista row: Trapezium, Trapezoid, Capitate, Hamate

Hand Bones

• Thumb: metacarpal, proximal phalange, distal phalange

• Other fingers: metacarpal, proximal phalange, middle phalange, distal phalange

• Metacarpophalangeal joints (MCP joint) between metacarpal and phalange (condyloid)

  • First on in line with the thumb and move lateral to medial (thumb to pinky)

• Proximal interphalangeal joint (2-5) (hinge)

• Distal interphalangeal joint (2-5) (hinge)

• Thumb only has the metacarpophalangeal joint (saddle)

  • Medial side of joint: 

Muscles of the Elbow

• Flex the forearm : brachialis, biceps brachii, and brachioradialis

• Extend the elbow : triceps brachii and anconeus

  • Anconeus causes tendonitis and pain in the elbow

• Brachialis = flexes forearm

• Triceps brachii = extends and adducts forearm

• Biceps brachii = flexes are, flexes forearm, supinates hand

• Anconeus = extends forearm

• Brachioradialis = flexes forearm

Injuries in the Elbow

• Usually chronic injuries because of repetitive motion

• Activities with extension lead to majority of injuries

• FOOSH (falling on an outstretched hand) common mechanism of injury in the wrist, elbow, and shoulder

• Contusion = bruise always a result, direct blow to a part of the body (not always visible)

  • Movement helps (blood flow is good)

• Olecranon bursitis = inflammation in the bursa

• Ulnar nerve contusion (hitting your funny bone) = blow to the ulnar nerve

  • Runs through ulnar groove, goes down to pinky finger

• Dermatomes feel (nerve), myotomes moves (muscle)

• Epicondylitis = chronic strains in medial and lateral epicondyles

  • Problems in with the wrist flexors (originate on medial epicondyle)

  • Caused by overload or overuse

  • Symptoms = tenderness and pain with resisted wrist motion

• Golfer’s elbow or little leaguer's elbow = medial epicondylitis

  • Problems in with the wrist extensors (originate on lateral epicondyle)

  • Rehab focuses on mechanics, muscle control, or endurance

• Little leaguer's elbow = lengthening issue

  • Spend time stretching

• Tennis elbow = lateral epicondylitis

• Treatment = preventative measures, proper technique, appropriate equipment, and limited stress

• Elbow Sprains: common are UCL tears

  • Symptoms = “pop”, tenderness, swelling

  • Needs Tommy John’s surgery to make full recovery

• Talk about dislocations talking about distal bone

  • Divergent = spreading apart

• Divergent dislocations happen from FOOSH

• Fractures = result of direct trauma, or indirect stresses transmitted through upper extremity

• Open fractures need irrigation to sterilize

• Volkmann’s contracture = absence of blood flow (ischemia) to the forearm

  • Costacture = when a joint is bent and cannot be straightened

  • Mild, moderate, or severe

• Radial nerve = passes anteriorly to the lateral epicondyle and lies in a tunnel formed by several muscles and tendons

• Median nerve = crosses the anterior elbow and passes between the heads of the pronator teres muscle, just distal to the joint

• Game keepers thumb = tear or sprain in the UCL of the thumb

• Injuries to certain structures  from hyperextension of the elbow:

• UCL

• Bicep tendon

• Radial, Medial, and Ulnar nerve

• Anterior joint capsule

Injuries to Structures from a FOOSH:

• Scaphoid 🥲

• Annular ligament

• Median nerve

• Colles fracture

• Smith’s fracture

• Boxer’s fracture = 5th metacarpal

Shoulder

• Ball and socket joint

• Shoulder girdle = all joints that help shoulder move

  • Glenohumeral joint (ball and socket)

  • Acromioclavicular (AC) joint 

  • Sternoclavicular (SC)

• Scapula = not real joint

• SITS

  • Subscapularis, Infraspanatous, Trese Minor, and Supraspinatus muscles