Hand & wrist

Hand & wrist

HAND & WRIST Intro to Sports Medicine I Bony Anatomy Radius Ulna Metacarpals 5 (hand) Phalanges 14 Carpals 8

(fingers) (wrist) Thumb-1 Scaphoid Index-2 Trapezium Middle-3 Trapezoid Ring-4 Capitate Pinky-5 Hamate

Pisiform Triquetrum Lunate Joints Radiocarpal (wrist and hand) Distal radioulnar Ulnocarpal Intercarpal Carpometacarpal Metacarpal Metacarpophalangeal

Interphalangeal Proximal Distal Ligaments Radial Collateral Ulnar Collateral Palmar radiocarpal Dorsal radiocarpal Motions of the Wrist Flexion

Extension Radial Deviation Ulnar Deviation Supination Pronation Anatomy of Elbow/Forearm ELBOW & FOREARM Intro to Sports Medicine I

Bony Anatomy Humerus Radius Ulna Joints Elbow Humeroulnar Humeroradial Proximal radioulnar Wrist

Radiocarpal Distal radioulnar Ligaments Ulnar collateral Radial collateral Annular Motions of the Elbow & Forearm Elbow Flexion Extension

Pronation Supination Forearm Flexion Extension Radial Deviation Ulnar Deviation Muscles Elbow Flexors Biceps brachii Brachialis

Pronators Pronator Teres Quadratus Elbow Extensors Triceps brachii Anconeus Supinators Supinator Biceps brachii

Anatomy of Elbow/Forearm Carpal Tunnel 8 flexor tendons Median nerve INJURIES Hand and Finger Injuries Majority of injuries to hand and finger in

sport are acute. Contusions Fractures Dislocations Sprains/Strains Tendon avulsions Hand Injuries Hand Fractures Fractures can occur to any of the bones.

Metacarpals can be fractured by a crushing mechanism. Most common fractures occur to 5th metacarpal (Boxers Fracture), 1st metacarpal (Bennetts Fracture), and distal phalanges. Hand Fractures Bennetts fracture is an

injury unique to the thumb (1st metacarpal). Involves 1st metacarpal fracture into joint space of metacarpophalangeal joint. Boxers fracture Mechanism includes blows with a clenched

fist. Fracture involves 4th Hand Fractures Signs and symptoms History of trauma. Deformity may be present/Significant inflammation. Associated pain and dysfunction of hand. Broken skin (in compound fractures).

First Aid Apply ICE. Apply splint and sling & swathe bandage. Leave fingernails exposed. An isolated phalangeal fracture can be buddy-taped to an adjacent finger. Sprains/Strains and Dislocations of the Hand

Any joint in the hand can be involved. Most common are: Gamekeepers thumb (thumb sprain). Mallet finger (distal extensor tendon rupture). Jersey finger (distal flexor tendon rupture). Boutonnire deformity (exstenor slip rupture). Gamekeepers Thumb

Gamekeepers thumb involves sprain of the ulnar collateral ligament of the thumb. Mechanism of injury is a valgus force to the MP joint of the thumb. Thumb is unstable. Gamekeepers Thumb

Signs and symptoms History of an appropriate injury mechanism. Pain and swelling over the area of the ulnar collateral ligament (MP joint). Snapping or popping at the time of injury. Inability to move the thumb or grip. First Aid Apply ICE. Apply splint or tape to support. Refer athlete to a physician if significant

instability. Mallet Finger Injury involves distal phalanx and torn exstensor tendon. Mechanism is a blow to the fingertip while extending it from a flexed position. Injury often occurs in baseball or basketball.

Mallet Finger Signs and symptoms Flexion deformity is the MOST important sign. Inability to extend fingertip. Recent trauma to fingertip. Point tenderness on dorsal side of the base of distal phalanx. First Aid Immediate application of ICE.

Immediate application of splint with the DIP joint extended. Do not let the distal phalanx fall back into flexed position. Jersey Finger Involves the tearing away of a finger flexor tendon. Mechanism of injury involves catching the finger in an opponents

clothing. The flexor digitorum profundus is torn from its attachment to the distal phalanx. Jersey Finger Signs and symptoms Inability to flex distal phalanx. Snapping/tearing sensation. Point tenderness over the distal phalanx. First Aid

Apply ICE. Splint the finger in extension. Refer the athlete to a physician this injury will need advanced medical attention. Boutonnire Deformity Injury involves tearing of the central band of the extensor digitorum tendon. Allows the PIP to pop through the opening, like a

button through a buttonhole. Mechanism is a blow while the finger is flexed during active extension. Boutonnire Deformity Signs and symptoms History of violent flexion injury to finger. Deformity is characterized by hyperextension of MP & DIP with flexion of PIP. Significant weakness in finger extension at the PIP joint.

Joint becomes painful, swollen, then stiff. If uncorrected, deformity will develop. First Aid Apply ICE Splint with proximal in extension Refer athlete to a physician for evaluation of more serious injury to joint. Wrist and Forearm Injuries Majority of injuries to wrist and forearm in sport are acute. Contusions Fractures

Sprains/Strains Several chronic injuries can also be a part of sport participation. Carpal tunnel syndrome Tendonitis Wrist ganglion Wrist Fractures Fractures of carpal bones common in sports. Most common wrist fractures involve

scaphoid bone and tend to occur at the waist, the narrowest portion of the bone. Deformity is typically not present. Wrist Fractures Signs and symptoms History of wrist trauma with popping or snapping sensation. Scaphoid Fracture: Pain with movement, wrist feels

locked, and a positive snuffbox test. First Aid Apply ICE. Apply a splint that immobilizes wrist. Support with sling-and-swathe bandage, leaving fingertips exposed to monitor blood flow beyond the splint. Refer to physician. Colles Fracture Signs and symptoms

History of significant trauma. Feeling the bone snap or hearing a popping sound. Deformity; severe swelling that may affect hand and fingers; severe pain; and significant loss of wrist, hand, or finger motion. Loss of sensation in either hand or fingers may occur. First Aid Immediately apply ICE. Do not use ice if you suspect the vascular or nerve supply is affected. Apply a splint that immobilizes wrist. Support with sling-and-swathe bandage, leaving fingertips

exposed to monitor blood flow beyond the splint. Wrist Sprains & Dislocations The same mechanisms that cause fractures can also cause sprains or dislocations in the region. Injury affects radiocarpal (wrist) joints, intercarpal joints and ligaments. Lunate is the most commonly dislocated

MOI is hyperextension Wrist Sprains & Dislocations Signs and symptoms History of injury combined with snapping/popping sensation. Painful movement; movement may be impossible. Numbness and/or pain radiating into hands or fingers. First Aid Apply ICE.

Splint with sling & swathe bandage. Allow for monitoring of circulation Refer athlete to a physician if dislocation. Injuries to the Upper Arm Majority of injuries are contusions and fractures. Contusions Muscle tissue is compressed between skin and bone. Repeated episodes can result in myositis ossificans traumatica Fractures

Such injuries are common in contact sports. Significance of damage is directly proportional to the force involved. Triceps Injuries Triceps injuries are infrequent in sports. Mechanism is a direct blow or fall on outstretched hand. Either mechanism can result in partial or complete rupture of muscle or tendon. Injury may occur in a wide variety of sports: Competitive weight lifting.

Power lifting. Body building. Alpine skiing. Volleyball. Triceps Injuries Signs and symptoms History of sudden popping in posterior humerus or elbow region. Pain in elbow region or just proximal in the area of triceps tendon. Visible defect within muscle or tendon near

olecranon process. Discoloration and swelling. First Aid Immediate application of ice & compression. Placement of arm in a sling with elbow flexed to 90, if pain is tolerated. Referral to a physician. Fractures of the Upper Arm Although rare, such fractures may be associated with activities that involve collisions between

participants or in high-speed falls. Signs and symptoms Severe pain in upper arm. Deformity and loss of function and unwillingness to use arm. Muscle spasm. Athlete reports an audible snap or pop at the time of injury. Sensory loss in forearm, if radial nerve is affected. Fractures of the Upper Arm

First Aid Immediate application of ice and compression. Properly constructed splint. Discontinuing ice if symptoms indicate radial nerve involvement or circulatory deficit is developing. Monitor pulse and sensation changes. Sling & swathe bandage. Treatment for shock and transport

Elbow Injuries Sprains and Dislocations Ulnar & radial collateral ligaments protect elbow from valgus and varus forces. Annular ligament protects from rotational. Injury mechanism includes falling backward with elbow locked in extension. Sprains also result from both valgus and varus forces that occur as the arm is trapped in a vulnerable position like overhead pitching (ulnar). Elbow Dislocations

Elbow dislocations constitute extreme sprains. Mechanism for this injury includes falling either on a flexed or fully extended arm. The deformity is usually obvious. Elbow Dislocation Signs and symptoms Gross elbow deformity in dislocations.

Loss of function and severe pain. Mild swelling & localized pain in minor sprains. Difficulty in gripping or making a fist. Possible neurological symptoms. First Aid Application of ice & compression. Application of splint & sling-and-swathe bandage. Monitoring distal pulse. Treatment for shock. Summon EMS. Elbow Fractures

Signs and symptoms Recent history of elbow trauma. Deformity in cases of displaced fractures. Significant pain and dysfunction. Immediate swelling. First Aid Immediate application of ice, but avoid compressing the joint. Application of splint (avoid moving elbow bones) and support of the arm in a sling. Treatment for shock. Arrange for transport to medical facility.

If forearm feels cold and clammy, and the athlete reports numbness in the hand, the forearms blood supply is Epicondylitis of the Elbow Medial epicondyle is the attachment site of the forearm flexors and ulnar collateral ligament. Lateral epicondyle is the attachment site of forearm extensors and radial collateral

ligaments. Epicondylitis of the Elbow Sports that require gripping combined with wrist movements place great stress on the epicondylar region. Little League baseball pitching (Little league elbow) and golf (Golfers elbow) associated with injury to the flexors and medial humeral epicondyle. Backhand motion in tennis (Tennis elbow) is associated with injury to the extensor carpi radialis

brevis muscle and the lateral humeral epicondyle. Epicondylitis of the Elbow Possible causes include: Excessive number of strokes or pitches. Incorrect technique. Racket handle thats too small or change in racket materials. Grip thats too tight. Muscle imbalance in shoulder and core.

Epicondylitis of the Elbow Signs and symptoms Pain and swelling in the region of one or both epicondyles. Pain that worsens with activity. Radiating pain into forearm muscles. Epicondylar pain associated with resisted wrist movements. First aid is not practical, but if symptoms worsen: Apply ice and compression. Rest. Fix potential causes. Refer to physician if pain persists.

Contusions of the Elbow Blows to the elbow are common; the majority result in temporary symptoms. Exception involves the olecranon bursa. Repeated irritation of the bursa can result in inflammation (bursitis). Contusions of the Elbow Signs and symptoms Swelling around the olecranon process.

Pain and stiffness, especially when elbow is flexed. Elevated skin temperature over olecranon process, skin may be taut, and joint may show signs of internal hemorrhage. First Aid Apply ice and compression. Pad to protect. In cases of recurrent bursitis, refer to a physician.

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