Wrist, Hand, Elbow & Shoulder

Chapters 12, 11 & 10

Anatomy of the Wrist and Hand

Looks a lot like the foot Has similar bone

structures:– Phalanges

– Metatarsals

– Carpals

There are 26 bones There are many ligaments

that hold the structure of the hand together

Carpal Bones

Proximal:A=Scaphoid B=Lunate C=Triquetral D=Pisiform

Distal:E=Trapezium F=Trapezoid G=Capitate H=Hamate

The Scaphoid Bone

Find your anatomical snuff box

Only blood supply at one end of the bone

It has difficulty healing if the blood supply is interrupted

Joints of the wrist and hand

There are three phalanges in each finger and two in the thumb

Distal, middle and proximal Joints:

– Distal Interphalangeal jnt (DIP)– Proximal Iinterphalangeal jnt (PIP)– Metacarpal Phalangeal jnt (MCP)– Carpometacarpal jnt (CMP)

Muscles of the hand and forearm

There are two major groups of muscles at the wrist and forearm

Flexors: on the dorsal side of the hand

Extensors: on the ventral side of the hand

The Thumb

Testing the ulnar collateral ligament of the thumb

The collateral ligaments of the thumb provide the majority of its stability

Preventing injuries to the hand

Boxing

Batting

Field hockey/ girls lacrosse

Cycling

More Gloves

Receiver/ Running back gloves Lineman Gloves

Splints

Wrist Sprains

Occur from twisting and overuse

Injured structure depends upon the stress placed on the wrist

Ulnar Deviation is movement towards the ulnar

Radial deviation is movement towards the radius

The Lunate

Dislocation of the lunate bone occurs more often than any other carpal dislocation

Presents as deformity, pain, swelling, and decreased range of motion

Ganglion Cyst

A pocket of fluid within the sheath

Should be referred to a physician

Sometimes is removed surgically

Gamekeepers/Skiers Thumb

Thumb is forced into abduction forcefully

Pain over the joint, swelling may be present

An x-ray may be necessary to rule out a fracture

A “Jammed” Finger

A sprain of the collateral ligaments in the finger

Finger Dislocations

Don’t JUST

“pop” it !!!!!

There could be underlying hidden issues going on at the joint

There could be a tendon rupture or a fracture!!!

Fractures

Boxer’s fracture is most common in athletes for many reasons

Fractures

Other fractures require the same care and treatment

Muscle and Tendon Injuries

Repetitive stress and stretching can cause injuries to these structures

Some of these include– Carpal tunnel

– deQuervian’s tendinitis

– Mallet Finger

– Jersey finger

– Boutonniere deformity

Carpal tunnel

Carpal tunnel

Most common as an overuse injury– Tennis– Field hockey

Watch for acute carpal tunnel due to poor position in slings and casts

deQuervian’s tendinitis

Abductor pollicis longus & Extensor Pollicis brevis tendons

Prolonged or repetitive radial deviation (shot putters)

Swelling, crepitus and pain with abduction

Mallet Finger

An avulsion fracture of the distal phalanx.

Cannot extend the distal phalanx

Jersey finger

Avulsion fracture of flexor tendon

Unable to flex the DIP

Boutonniere deformity

Deformity arises when there is a rupture of the central slip of the extensor mechanism.

This is an uncommon sporting injury usually due to an end-on injury to the finger with sudden bending at the P.I.P. joint

Often in football or basketball

Boutonniere deformity

Elbow

This is a very bony jointCommon to have contusions all around the

elbow.Use PRICES

Elbow

Ligaments

There is thick joint capsule surrounding the elbow.

Relies on the ligaments for stability– Ulnar collateral

– Radial collateral

– Annular

Muscles

Biceps- elbow flexionTriceps- elbow

extensionWrist flexors- medial

epicondyle of humerusWrist extensors- lateral

epicondyle of humerus

What it really looks like

Preventing Injuries to the Elbow

Not a frequently injured jointMany of the injuries are caused by overuseMost injuries occur in racket sports such as

tennis, or overhead throwing sports such as baseball and softball.

Many times injuries are brought about by poor training

Preventing Injuries to the Elbow

Athletes train the “beach muscles”Overwork the Biceps to get “ pipes” or

“guns”What about the Triceps???What about the wrist flexors and

extensors??

What about equipment?

Tennis players can cause themselves injuries if the grip is too small on the racket.

Throwers should have a strong tricep and lots of flexibility in the elbow to prevent injuries.

Sprains

Ulnar collateral More common in

throwers The stress of overhead

activity strains the medial aspect of the elbow.

Wrestling? Pain and swelling treat as

any other ligament sprain

Radial CollateralThese are rareTreat the same as a

ulnar collateral sprain.

Vascularity and Nerves

There are numerous blood vessels and three major nerves that pass though t he elbow

Epicondylitis

Lateral Epicondylitis aka: Tennis ElbowPoor mechanics and

overusePresents as pain and

swelling at the lateral epicondyle

Treat with PRICES

Medial Epicondylitisaka: Little League Elbow

Repetitive ThrowingLittle league elbow may have an avulsion fracture at the epiphysis

Fractures

Elbow fractures are rare in athletics.Often results from a forceful blow to the

area or landing on hard surface.

Elbow Dislocation

Elbow Dislocation

Elbow Dislocation

One of the most commonly dislocated joints in the body

Doesn’t take a lot of force to dislocate the joint

MUST BE SEEN by MD immediately

Olecranon Bursitis

Olecranon Bursitis

PRICESUse a compression wrap or sleeve to

alleviate swellingMay have to be drained by MDNot always painful

Shoulder Anatomy

A separation occurs here at the acromio-clavicular joint

A dislocation occurs here at the gleno-humeral joint

Bony Anatomy

Three bones:– Humerus

– Bicipital groove

– Clavicle

– S shape

– Scapula

– Corocoid process

– Acromion process (a/c joint)

Many ligamentsNot a very stable joint

JOINTS

There are many joints at the shoulder

Most commonly injured joints are

Acromio-clavicularGleno-humeral

– Each held together by many ligaments

JOINTS

Muscles of the shoulder

The Rotator Cuff– SITS muscles

• Supraspinatus• Infraspiantus• Teres minor• Subscapularis

Deltoid– Lays over the head of the

humerus Pectoralis

– Originate at sternum attach to the anterior portion of the humerus

Muscles

Biceps- two heads Originates at the

Coracoid process and the Humerus

Distal attachment is a the radial head

Runs through the bicipital groove

ACTION: elbow flexion and forearm supination

Triceps Originates at the posterior

humeral head and scapula Distal attachment is distal

humerus at the elbow ACTION: Elbow

extension and shoulder extension

Brachial Plexus

Brachial Plexus

Brachial Plexus

Rotator Cuff Strain

Characterized like any other strain– 1st, 2nd, and 3rd degree

Common in throwing athletesOccurs from excessive motion beyond the

normal range

Impingement Syndrome

Overdoing it with overhead motionsSupraspinatus and Bicep run together

beneath the acromion processSpace narrows because of swelling, poor

posture, muscle imbalanceNot enough room for everything in the

joint pain occurs with motion sometimes there is numbness along with the pain

Bicipital Tendonitis

Pain with overhead motionsPalpate crepitusInflammation of the tendon in the groove

Tendon rupture

Tendon rupture

Fractures

There is a tremendous amount of stress at the shoulder

Given its role in contact and collision sports fractures are common in athletics– Clavicular– Humeral – Scapular

Fractures

What does this mean?

SubluxationDislocationSeparation

Protection

Fitting Correctly