SHOULDER INJURIESSHOULDER INJURIESAnatomy of the ShoulderAnatomy of the Shoulder

Ball-and-Socket joint, but much shallower Ball-and-Socket joint, but much shallower than the hip.than the hip.

Relies on muscular strength for stabilityRelies on muscular strength for stability

Involves several bones thus has movement Involves several bones thus has movement across a wide range of motion.across a wide range of motion.

Often referred to as the shoulder girdle.Often referred to as the shoulder girdle.

3 major components, bones, muscles, and 3 major components, bones, muscles, and joints.joints.

Lesson #1

ANATOMY OF THE SHOULDERANATOMY OF THE SHOULDER

1.1. Bones:Bones: 3 basic bones, humerus, clavicle, and 3 basic bones, humerus, clavicle, and scapula, which are all held together by ligaments.scapula, which are all held together by ligaments.

- Head of the humerus fits into the glenoid fossa - Head of the humerus fits into the glenoid fossa of the scapula.of the scapula.

- The bicipital groove (on top of humerus) is - The bicipital groove (on top of humerus) is where the bicep tendon moves up and down where the bicep tendon moves up and down during flexion and extension.during flexion and extension.

- Clavicle (collarbone) articulates at the top of the - Clavicle (collarbone) articulates at the top of the shoulder and at the sternum.shoulder and at the sternum.

- Scapula (shoulder blade) has two forward - Scapula (shoulder blade) has two forward projections located on the anterior aspect, projections located on the anterior aspect, acromion process and the coracoid process. acromion process and the coracoid process. Rotator cuff muscles attach to the scapula.Rotator cuff muscles attach to the scapula.

ANATOMY OF THE SHOULDERANATOMY OF THE SHOULDER

2.2. Muscles: Rotator cuff consists of 4 musclesMuscles: Rotator cuff consists of 4 muscles

- SITS (subscapularis, infraspinatus, teresminor, and the - SITS (subscapularis, infraspinatus, teresminor, and the supraspinatus. (pg. 102)supraspinatus. (pg. 102)

- Responsible for rotating the arm internally and - Responsible for rotating the arm internally and externally, and abducting the shoulder.externally, and abducting the shoulder.

- Deltoid muscles lies over head of humerus. Attaches to - Deltoid muscles lies over head of humerus. Attaches to acromion process and abducts, flexes and extends the acromion process and abducts, flexes and extends the shoulder.shoulder.

- Pectoralis muscles attach at the sternum and humerus.- Pectoralis muscles attach at the sternum and humerus.

- Bicep muscle flexes the elbow and attaches to humerus - Bicep muscle flexes the elbow and attaches to humerus and coracoid process. Bicep tendon runs through the and coracoid process. Bicep tendon runs through the bibipital groove. bibipital groove.

- Tricep muscle oppose the biceps. Attaches to the - Tricep muscle oppose the biceps. Attaches to the humerus and scapula.humerus and scapula.

ANATOMY OF THE SHOULDERANATOMY OF THE SHOULDER

3.3. Joints: Several joints involved, but the most Joints: Several joints involved, but the most commonly injured include the acromioclavicular commonly injured include the acromioclavicular and glenohumeral.and glenohumeral.

- - ACROMIOCLAVICULAR JOINTACROMIOCLAVICULAR JOINT: includes the : includes the acromion process of the scapula and distal end acromion process of the scapula and distal end of the clavicle. Held together by the of the clavicle. Held together by the acromioclavicular ligament.acromioclavicular ligament.

- - GLENOHUMERAL JOINT:GLENOHUMERAL JOINT: is the articulation of is the articulation of the head of the humerus and scapula. Very the head of the humerus and scapula. Very shallow, making it easy to injure.shallow, making it easy to injure.

- A capsular ligament surrounds the - A capsular ligament surrounds the glenohumeral joint giving it stability. Very easy glenohumeral joint giving it stability. Very easy to injure.to injure.

SHOULDER INJURIESSHOULDER INJURIESPreventing Shoulder InjuriesPreventing Shoulder Injuries

Shoulder injuries are often caused by:Shoulder injuries are often caused by:

- muscular weakness- muscular weakness

- postural problems- postural problems

- the sport itself- the sport itself

SHOULDER INJURIESSHOULDER INJURIESPreventing Shoulder InjuriesPreventing Shoulder Injuries

ADDRESSING MUSCULAR WEAKNESSADDRESSING MUSCULAR WEAKNESS- Out of Sight , Out of Mind: refers to weight training Out of Sight , Out of Mind: refers to weight training

that athletes do everyday. Often they only work the that athletes do everyday. Often they only work the muscles they can see in the mirror, or can flex muscles they can see in the mirror, or can flex easily because of their size and proportion. As a easily because of their size and proportion. As a result, the athlete can develop poor muscle result, the athlete can develop poor muscle symmetry leading to injury. (pg. 103)symmetry leading to injury. (pg. 103)

- Bench press and rounded shoulders.Bench press and rounded shoulders.- Leg Squats and weak hamstrings.Leg Squats and weak hamstrings.- Bicep curls and poor stability in the triceps.Bicep curls and poor stability in the triceps.- Anterior shoulder press and poor posterior strength.Anterior shoulder press and poor posterior strength.

TREATING SHOULDER INJURIESTREATING SHOULDER INJURIESLigament Injuries:Ligament Injuries:– Acromioclavicular Ligament SprainAcromioclavicular Ligament Sprain – Referred to as – Referred to as

a shoulder separation. a shoulder separation. Can be injured by impact to the top of the shoulder or by Can be injured by impact to the top of the shoulder or by falling on an outstretched arm.falling on an outstretched arm.Falling on the elbow forces the humerus up and into the Falling on the elbow forces the humerus up and into the acromioclavicular joint.acromioclavicular joint.Pain with movement, in a 3Pain with movement, in a 3rdrd degree sprain there will be a degree sprain there will be a large abnormal bump caused by excessive displacement of large abnormal bump caused by excessive displacement of the clavicle.the clavicle.Use the PRICE method to treat. Refer to a Doctor.Use the PRICE method to treat. Refer to a Doctor.Doctor will use surgery or a harness.Doctor will use surgery or a harness.

– Glenohumeral Ligament Sprain Glenohumeral Ligament Sprain Vulnerable to sprains when the joint is placed in abduction Vulnerable to sprains when the joint is placed in abduction and external rotation. Have pain and discomfort.and external rotation. Have pain and discomfort.Treat with PRICE.Treat with PRICE.

3rd Degree Shoulder Separation

TREATING SHOULDER INJURIESTREATING SHOULDER INJURIESMuscle and Tendon Injuries:Muscle and Tendon Injuries:– Rotator Cuff Strain – Rotator Cuff Strain – Always 1Always 1stst, 2, 2ndnd, or 3, or 3rdrd degree degree

strains.strains.Occur from excessive motion beyond the normal range. Occur from excessive motion beyond the normal range. Most often injury occurs to the supraspinatus.Most often injury occurs to the supraspinatus.Pain in motion and when the shoulder is not moving.Pain in motion and when the shoulder is not moving.Pain generally occurs during abduction, if unable to abduct Pain generally occurs during abduction, if unable to abduct it means a complete tear is suspected. Repetitive it means a complete tear is suspected. Repetitive movement.movement.A complete tear must be surgically repaired. PRICE.A complete tear must be surgically repaired. PRICE.

– Impingement Syndrome – Impingement Syndrome – Developed from repetitive Developed from repetitive overhead types of movement.overhead types of movement.

Tennis, throwers, ect. The supraspinatus and biceps Tennis, throwers, ect. The supraspinatus and biceps muscles run through a space beneath the acromion muscles run through a space beneath the acromion process, if the space narrows from swelling, the two process, if the space narrows from swelling, the two muscles become impinged.muscles become impinged.Treat with modified activity, strengthening.Treat with modified activity, strengthening.

TREATING SHOULDER INJURIESTREATING SHOULDER INJURIESMuscle and Tendon Injuries:Muscle and Tendon Injuries:– Bicipital Tendinitis Bicipital Tendinitis Repetitive movement causes an Repetitive movement causes an

irritation of the tendon in the bicipital groove.irritation of the tendon in the bicipital groove.AT will be able to palpate and feel crepitus.AT will be able to palpate and feel crepitus.

Pain is common. Immobilization is sometimes necessary, Pain is common. Immobilization is sometimes necessary, ultrasound or anti-inflammatory medications.ultrasound or anti-inflammatory medications.

– Biceps Tendon Rupture – Biceps Tendon Rupture – Two instances, a direct blow Two instances, a direct blow or severe contractional forces.or severe contractional forces.

When the tendon ruptures, the athlete will not be able to When the tendon ruptures, the athlete will not be able to flex the elbow.flex the elbow.

You will notice a change in the muscle as the tendon rolls You will notice a change in the muscle as the tendon rolls up the arm, looking like a golf ball under the skin.up the arm, looking like a golf ball under the skin.

Surgery is needed to repair.Surgery is needed to repair.

TREATING SHOULDER INJURIESTREATING SHOULDER INJURIESBone Injuries:Bone Injuries:– Clavicular Fractures Clavicular Fractures Most often fractured at it’s Most often fractured at it’s

weakest point, the distal third. Occurs from falls or direct weakest point, the distal third. Occurs from falls or direct blows.blows.

Arm must be restricted. Use PRICE. Takes generally 6 Arm must be restricted. Use PRICE. Takes generally 6 weeks to heal.weeks to heal.

– Humeral Fractures – Humeral Fractures – Shoulder musculature sometimes Shoulder musculature sometimes hides a fracture.hides a fracture.

Athlete will be unable to move the arm, report hearing a Athlete will be unable to move the arm, report hearing a pop.pop.

Palpate the circumference of the bone, if there is pain on all Palpate the circumference of the bone, if there is pain on all sides, it is fractured.sides, it is fractured.

Always placed in a splint, sometimes surgery. 6 weeks to Always placed in a splint, sometimes surgery. 6 weeks to heal.heal.

TREATING SHOULDER INJURIESTREATING SHOULDER INJURIES

Bone Injuries:Bone Injuries:– Epiphysis Injury Epiphysis Injury Growth plate in the shoulder is easily Growth plate in the shoulder is easily

injured with direct blows.injured with direct blows.Falling on the elbow can cause this. Falling on the elbow can cause this.

Pain, inability to use the arm, feeling a pop. Use PRICE, Pain, inability to use the arm, feeling a pop. Use PRICE, immobilize, sometimes surgery.immobilize, sometimes surgery.

– Avulsion Fracture – Avulsion Fracture – Occurs when the ligament or Occurs when the ligament or tendon pulls away a small portion of the bone.tendon pulls away a small portion of the bone.

Almost impossible for the AT to diagnose, send to a Almost impossible for the AT to diagnose, send to a physician. PRICE.physician. PRICE.

– Glenohumeral Dislocations & Subluxations – Glenohumeral Dislocations & Subluxations – Head Head of the humerus is out of it’s socket, then went back in.of the humerus is out of it’s socket, then went back in.

Excessive abduction and external rotation. Can cause Excessive abduction and external rotation. Can cause permanent damage to nerves and muscles. Pg. 107permanent damage to nerves and muscles. Pg. 107

ELBOW INJURIESELBOW INJURIES

ANATOMY OF THE ELBOWANATOMY OF THE ELBOW

- - The elbow is a hinge joint involving 3 major The elbow is a hinge joint involving 3 major bones: humerus, radius, and ulna.bones: humerus, radius, and ulna.

- Radius and ulna are bones between the wrist - Radius and ulna are bones between the wrist and elbowand elbow

- Distal end if the humerus becomes wider and - Distal end if the humerus becomes wider and forms the medial and lateral epicondyles.forms the medial and lateral epicondyles.

- Ulna is hooked to the end of the humerus and - Ulna is hooked to the end of the humerus and forms a tight joint.forms a tight joint.

- Radius is the bone on the thumb side.- Radius is the bone on the thumb side.

- Radius allows the forearm to rotate.- Radius allows the forearm to rotate.

Lesson 5

ELBOW INJURIESELBOW INJURIESANATOMY OF THE ELBOWANATOMY OF THE ELBOW11.. Ligaments: joint capsule surrounds the Ligaments: joint capsule surrounds the elbow.elbow.

Gives the elbow stability and protection. Gives the elbow stability and protection. Ulnar Ulnar Collateral, radial collateral, and annular Collateral, radial collateral, and annular ligament also give stability.ligament also give stability.

Ulnar CollateralUlnar Collateral – stabilizes the inside and – stabilizes the inside and medial aspect of the elbow.medial aspect of the elbow.Radial CollateralRadial Collateral – stabilizes the outside and – stabilizes the outside and lateral aspect.lateral aspect.These ligaments often referred to as the These ligaments often referred to as the

medial and lateral collateral ligaments.medial and lateral collateral ligaments.Annular ligamentAnnular ligament holds the radius and ulna holds the radius and ulna together near the elbow joint.together near the elbow joint.

ELBOW INJURIESELBOW INJURIES

ANATOMY OF THE ELBOWANATOMY OF THE ELBOW

22.. Muscles: As previously stated.Muscles: As previously stated.

Several nerves and blood vessels pass Several nerves and blood vessels pass through small grooves around the elbow en through small grooves around the elbow en route to the lower arm.route to the lower arm.

Any injury to the elbow must be assessed Any injury to the elbow must be assessed for for nerve and blood vessel damage.nerve and blood vessel damage.

Check for a pulse. Numb hands.Check for a pulse. Numb hands.

Funny Bone – actually a direct blow to the Funny Bone – actually a direct blow to the Olecranon process. Nerves are damaged.Olecranon process. Nerves are damaged.

PREVENTING ELBOW INJURIESPREVENTING ELBOW INJURIES

Not a frequently injured joint.Not a frequently injured joint.

Most injuries are caused by overuse and not Most injuries are caused by overuse and not direct blows. Breakdown of tissue causing direct blows. Breakdown of tissue causing inflammation and pain.( Bursitis “itis” injuries)inflammation and pain.( Bursitis “itis” injuries)

Work with coaches to detect training aspects:Work with coaches to detect training aspects:

1. Equipment problems (small grips on 1. Equipment problems (small grips on racquets)racquets)

2. Technique Problems (throwing and arm 2. Technique Problems (throwing and arm swings)swings)

3. Develop proper Conditioning programs.3. Develop proper Conditioning programs.

TREATING ELBOW INJURIESTREATING ELBOW INJURIES1.1. Ligament Injuries: Sprains are classified as 1Ligament Injuries: Sprains are classified as 1stst, ,

22ndnd, or 3, or 3rdrd. Any ligament can be sprained.. Any ligament can be sprained.A. Ulnar Collateral Ligament SprainA. Ulnar Collateral Ligament Sprain – More prone to – More prone to sprains because of the amount of stress placed on the sprains because of the amount of stress placed on the inner elbow during throwing and swinging.inner elbow during throwing and swinging.Repetitive trauma causes injury to occur.Repetitive trauma causes injury to occur.A direct blow may cause a sprain (wrestling)A direct blow may cause a sprain (wrestling)

B. Valgus StressB. Valgus Stress – medial part of the joint separates – medial part of the joint separates apart as the forearm moves laterally. Characterized by apart as the forearm moves laterally. Characterized by swelling and elbow pain. Joint laxity may also be present. swelling and elbow pain. Joint laxity may also be present. Treat a sprain using PRICE.Treat a sprain using PRICE.

C. Radial Collateral Ligament SprainC. Radial Collateral Ligament Sprain – very rare. – very rare. Same as the ulna collateral except pain is on the lateral Same as the ulna collateral except pain is on the lateral aspect.aspect.

Lesson 7

TREATING ELBOW INJURIESTREATING ELBOW INJURIES2.2. Muscle and Tendon Injuries: Strains are classified Muscle and Tendon Injuries: Strains are classified

as 1as 1stst, 2, 2ndnd, or 3, or 3rdrd. Caused by excessive force or . Caused by excessive force or overuse.overuse.

A. A. Elbow Flexor StrainElbow Flexor Strain: often caused by a loaded : often caused by a loaded movement that includes the elbow and the movement that includes the elbow and the shoulder. Two-joint muscles are prone to strains.shoulder. Two-joint muscles are prone to strains.

Will have small amounts of swelling and be Will have small amounts of swelling and be weaker.weaker.

B. B. Elbow Extensor StrainElbow Extensor Strain: caused by excessive : caused by excessive resistance to the triceps muscle such as trying to resistance to the triceps muscle such as trying to break a fall with an outstretched arm.break a fall with an outstretched arm.

More pain than flexor strains.More pain than flexor strains.

Treat with PRICE.Treat with PRICE.

TREATING ELBOW INJURIESTREATING ELBOW INJURIESCC. . Wrist Flexor StrainsWrist Flexor Strains: caused by excessive : caused by excessive resistance during wrist flexion movements and resistance during wrist flexion movements and overuse.overuse.Treat with PRICE and stretching.Treat with PRICE and stretching.

D. D. Wrist Extensor Strains:Wrist Extensor Strains: caused by excessive caused by excessive resistance during wrist extension movements and resistance during wrist extension movements and overuse.overuse.Treat with PRICE and stretching.Treat with PRICE and stretching.

TREATING ELBOW INJURIESTREATING ELBOW INJURIES

E. E. Medial and Lateral EpicondylitisMedial and Lateral Epicondylitis: Chronic : Chronic inflammation which occurs at the medial and inflammation which occurs at the medial and lateral epicondyles. Wrist extensors become lateral epicondyles. Wrist extensors become inflamed. Also called inflamed. Also called Tennis Elbow. Tennis Elbow.

Lateral epicondylitis is most common. Lateral epicondylitis is most common. Characterized by pain over the lateral epicondyle.Characterized by pain over the lateral epicondyle.Treat with PRICE.Treat with PRICE.

Medial epicondylitis is also called Little League Medial epicondylitis is also called Little League Elbow.Elbow.Little League Elbow is also suggested to be a Little League Elbow is also suggested to be a separation of the epiphysis at the medial aspect separation of the epiphysis at the medial aspect of the humerus. (ages 9-12)of the humerus. (ages 9-12)

TREATING ELBOW INJURIESTREATING ELBOW INJURIES

3.3. Bone Injuries:Bone Injuries: Fractures to the distal end of the Fractures to the distal end of the humerus are not common in athletics. Must be a humerus are not common in athletics. Must be a very powerful mechanism for injury to occur.very powerful mechanism for injury to occur.

If direct impact is the mechanism and there is If direct impact is the mechanism and there is pain located at the medial aspect of the elbow pain located at the medial aspect of the elbow two inches above the joint, suspect a fracture.two inches above the joint, suspect a fracture.

If an ATC suspects this it is an absolute If an ATC suspects this it is an absolute emergency because these fractures can emergency because these fractures can damage arteries and nerves.damage arteries and nerves.

TREATING ELBOW INJURIESTREATING ELBOW INJURIESEpiphyseal and Avulsion Fractures – more Epiphyseal and Avulsion Fractures – more common on the medial epicondyle or olecranon common on the medial epicondyle or olecranon aspect of the elbow. Epiphyseal injury must be aspect of the elbow. Epiphyseal injury must be suspected when an athlete presents swelling and suspected when an athlete presents swelling and loss of movement.loss of movement.

Ulna Dislocation – The elbow is one of the most Ulna Dislocation – The elbow is one of the most commonly dislocated joints in the body. Very commonly dislocated joints in the body. Very tight joint, therefore it takes a violent trauma to tight joint, therefore it takes a violent trauma to dislocate it. A violent hyperextension or severe dislocate it. A violent hyperextension or severe blow to the lateral aspect will dislodge the ulna blow to the lateral aspect will dislodge the ulna from the humerus. Sling immediately, then see a from the humerus. Sling immediately, then see a physician.physician.

TREATING ELBOW INJURIESTREATING ELBOW INJURIESOTHER COMMON INJURIES – ATHLETES will often fall on an OTHER COMMON INJURIES – ATHLETES will often fall on an outstretched arm or receive a blow that causes the elbow to outstretched arm or receive a blow that causes the elbow to be hyper-extended. This can result in one of three problems:be hyper-extended. This can result in one of three problems:

1.1. sprain the ligament at the anterior aspect of sprain the ligament at the anterior aspect of the the elbow,elbow,

2.2. strain the musculature at the anterior aspect of the strain the musculature at the anterior aspect of the elbow,elbow,

3.3. receive a painful bony compression if the olecranon receive a painful bony compression if the olecranon process impacts the humerus.process impacts the humerus.

Initially they are ALL treated with PRICE, then forInitially they are ALL treated with PRICE, then for

more severe you refer to a physician.more severe you refer to a physician.

Olecranon BursitisOlecranon Bursitis – when there is bruising on the olecranon – when there is bruising on the olecranon bursa causing it to become irritated and build up fluid at the bursa causing it to become irritated and build up fluid at the tip. If the fluid does not dissipate, it must be drained by a tip. If the fluid does not dissipate, it must be drained by a physician.physician.

WRIST AND HAND INJURIESWRIST AND HAND INJURIES

ANATOMY OF WRIST AND HANDANATOMY OF WRIST AND HAND- The wrist and hand contain many blood vessels, The wrist and hand contain many blood vessels,

bones, muscles, ligaments, and nerves all bones, muscles, ligaments, and nerves all necessary for total functioning of the hand.necessary for total functioning of the hand.

- If one part is injured, it will decrease an athletes If one part is injured, it will decrease an athletes functional ability.functional ability.

- It is the most active body part.It is the most active body part.

Lesson 8

WRIST AND HAND INJURIESWRIST AND HAND INJURIES

1.1. Bones and Joints Bones and Joints

- Wrist is the joint between the arm and the - Wrist is the joint between the arm and the hand. It is made up of 7 irregularly shaped hand. It is made up of 7 irregularly shaped carpal bones that articulate between the radius carpal bones that articulate between the radius and the ulna of the arm and the metacarpals of and the ulna of the arm and the metacarpals of the hand to allow movement.the hand to allow movement.

- Scaphoid bone is very important because it - Scaphoid bone is very important because it has a blood supply only on one end, and has a blood supply only on one end, and therefore has difficulty healing when fractured.therefore has difficulty healing when fractured.

- When the fingers are spread, the Scaphoid sits - When the fingers are spread, the Scaphoid sits at the depression in the wrist.at the depression in the wrist.

- Referred to as “Anatomical Snuff Box”- Referred to as “Anatomical Snuff Box”

WRIST AND HAND INJURIESWRIST AND HAND INJURIES

2.2. MusclesMuscles- Wrist and hand movements are controlled by many - Wrist and hand movements are controlled by many muscles.muscles.- Extensor group ( posterior aspect of the forearm)- Extensor group ( posterior aspect of the forearm)- Flexor group (anterior aspect of the forearm)- Flexor group (anterior aspect of the forearm)

3.3. LigamentsLigaments- Quite intricate because of the many bones that must be - Quite intricate because of the many bones that must be connected.connected.A.A. Ulna Collateral and Radial Collateral Ulna Collateral and Radial Collateral

- Also called medial and lateral collateral, stabilize - Also called medial and lateral collateral, stabilize the the wrist. wrist. B. Flexor Retinaculum (Transverse carpal Ligament)B. Flexor Retinaculum (Transverse carpal Ligament)

- stabilizes carpal bones, but also provides a - stabilizes carpal bones, but also provides a protective protective covering over flexor tendons and median covering over flexor tendons and median nerve that pass nerve that pass beneath it.beneath it.THUMB LigamentsTHUMB Ligaments

WRIST AND HAND INJURIESWRIST AND HAND INJURIES

Preventing Injuries: Commonly used protective Preventing Injuries: Commonly used protective equipment include braces, tape, gloves, and equipment include braces, tape, gloves, and padding.padding.

TREATING WRIST AND HAND INJURIESTREATING WRIST AND HAND INJURIES

With one hand, one can manipulate objects and perform With one hand, one can manipulate objects and perform feats of astounding complexity. The slightest injury can feats of astounding complexity. The slightest injury can effect this process.effect this process.

1.1. Ligament InjuriesLigament Injuries- Sprains are not serious and can be treated with PRICE.- Sprains are not serious and can be treated with PRICE.- Sprains are injured ligaments, pulling on them only - Sprains are injured ligaments, pulling on them only causes more injury.causes more injury.

A. A. Wrist SprainsWrist Sprains – occur from overuse, falls, and forceful – occur from overuse, falls, and forceful twisting motions. Which ligament is injured depends on twisting motions. Which ligament is injured depends on the stress. Injury occurs on the opposite side. Excessive the stress. Injury occurs on the opposite side. Excessive Ulnar deviation will cause an injury on the radial side do Ulnar deviation will cause an injury on the radial side do too stretching.too stretching.Pain will occur, decreased range of motion, swelling, and Pain will occur, decreased range of motion, swelling, and loss of grip strength. Use PRICE, and taping when back at loss of grip strength. Use PRICE, and taping when back at their sport.their sport.

Lesson 9

TREATING WRIST AND HAND INJURIESTREATING WRIST AND HAND INJURIES

B.B. Dislocation of the LunateDislocation of the Lunate – caused by falling on the hand – caused by falling on the hand with flexion or extension. Causes deformity, pain, with flexion or extension. Causes deformity, pain, swelling, and decreased ROM. Should be splinted.swelling, and decreased ROM. Should be splinted.

C.C. Ganglion CystGanglion Cyst – A pocket of fluid within the sheath. Use – A pocket of fluid within the sheath. Use ice.ice.

D.D. Gamekeeper’s ThumbGamekeeper’s Thumb – An injury to the medial collateral – An injury to the medial collateral ligament of the thumb. Term is used to describe the ligament of the thumb. Term is used to describe the farmer who injured his ligament when breaking the necks farmer who injured his ligament when breaking the necks of birds. Occurs when the thumb is forcefully abducted. of birds. Occurs when the thumb is forcefully abducted. (catching a basketball)(catching a basketball)Treatment involves splinting, ice, and generally an x-ray.Treatment involves splinting, ice, and generally an x-ray.

E.E. Finger Sprains and Finger Disclocations – Use ice, always Finger Sprains and Finger Disclocations – Use ice, always have the team physician relocate dislocated fingers so to have the team physician relocate dislocated fingers so to prevent further nerve and blood vessel damage.prevent further nerve and blood vessel damage.

TREATING WRIST AND HAND INJURIESTREATING WRIST AND HAND INJURIES

2.2. Muscle and Tendon InjuriesMuscle and Tendon Injuries- Repetitive stress and stretching will cause the muscles - Repetitive stress and stretching will cause the muscles to strain. Pain, swelling, weakness, and inability to move to strain. Pain, swelling, weakness, and inability to move are common signs and symptoms.are common signs and symptoms.- ATC should use a ROM test to determine which muscles - ATC should use a ROM test to determine which muscles are injured. Analysis of the Athlete’s movements can are injured. Analysis of the Athlete’s movements can determine if the injury is from repetitive stress.determine if the injury is from repetitive stress.- Use PRICE and conditioning exercises.- Use PRICE and conditioning exercises.

A. A. TendinitisTendinitis – inflammation of the tendon. Cause can – inflammation of the tendon. Cause can be overuse, stretching, or impact. ATCs goal is to be overuse, stretching, or impact. ATCs goal is to condition the athlete so this does not occur.condition the athlete so this does not occur.De Quervain’s TendinitisDe Quervain’s Tendinitis affects the abductor pollicis affects the abductor pollicis longus and extensor pollicis brevis of the thumb. Athlete longus and extensor pollicis brevis of the thumb. Athlete will have difficulty with abduction of the thumb.will have difficulty with abduction of the thumb.Treat with PRICE.Treat with PRICE.

TREATING WRIST AND HAND INJURIESTREATING WRIST AND HAND INJURIESB. B. Mallet FingerMallet Finger – is the result of the fingertip receiving an impact. – is the result of the fingertip receiving an impact.

The impact causes the extensor tendon to be torn from the The impact causes the extensor tendon to be torn from the bone. (pg. 123) Fingertip will be in flexion and the athlete can bone. (pg. 123) Fingertip will be in flexion and the athlete can not straighten it because the tendon is no longer attached. not straighten it because the tendon is no longer attached. Splint it and refer to a physician were it will be surgically Splint it and refer to a physician were it will be surgically repaired, or splinted for a period of time.repaired, or splinted for a period of time.

C. C. Jersey FingerJersey Finger – very similar to Mallet finger but it is the flexor – very similar to Mallet finger but it is the flexor tendon tears from the fingertip. Athlete will not be able to flex tendon tears from the fingertip. Athlete will not be able to flex the DIP joint. the DIP joint. Injury occurs when an athlete grabs an opponents jersey with a Injury occurs when an athlete grabs an opponents jersey with a fist and the finger is forced to extend tearing the tendon.fist and the finger is forced to extend tearing the tendon.Same treatment.Same treatment.

D.D. Boutonniere DeformityBoutonniere Deformity – occurs at the proximal – occurs at the proximal interphalangeal joint of the finger. (pg. 124) A hard impact over interphalangeal joint of the finger. (pg. 124) A hard impact over the PIP joint causes a tear in the joint capsule which leads to the the PIP joint causes a tear in the joint capsule which leads to the extensor tendons falling laterally. Same Treatment with PRICE extensor tendons falling laterally. Same Treatment with PRICE and physician.and physician.

TREATING WRIST AND HAND INJURIESTREATING WRIST AND HAND INJURIES

3.3. Bone Injuries Bone Injuries

- Any bone within the wrist and hand can fracture. - Any bone within the wrist and hand can fracture. Swelling, pain, and deformity are all signs and symptoms. Swelling, pain, and deformity are all signs and symptoms.

- Two complications are nonunion (fracture that does not - Two complications are nonunion (fracture that does not heal and remains two pieces of bone) and Avascular heal and remains two pieces of bone) and Avascular Necrosis (death due to lack of blood flow)Necrosis (death due to lack of blood flow)

- Scaphoid bone is the most common bone associated - Scaphoid bone is the most common bone associated with this.with this.

- All fractures should be cared for by a physician.- All fractures should be cared for by a physician.

FYI – FYI – Volar (refers to the palm side of the hand)Volar (refers to the palm side of the hand)

- Dorsal (refers to the back or posterior - Dorsal (refers to the back or posterior portion of the body)portion of the body)