CHAPTER 6: THE UPPER EXTREMITY: THE ELBOW, FOREARM, WRIST, AND HAND

Transcription

1 CHAPTER 6: THE UPPER EXTREMITY: THE ELBOW, FOREARM, WRIST, AND HAND KINESIOLOGY Scientific Basis of Human Motion, 12 th edition Hamilton, Weimar & Luttgens Presentation Created by TK Koesterer, Ph.D., ATC Humboldt State University Revised by Hamilton & Weimar McGraw-Hill/Irwin Copyright 2012 by The McGraw-Hill Companies, Inc. All rights reserved.

2 BONES TO KNOW: Humerus Ulna Radius Carpals Metacarpals Phelangies Fig

3 THE ELBOW JOINT STRUCTURE Actually 3 joints: Humeroulnar Hinge joint Humeroradial Gliding joint Radioulnar Pivot joint Fig

4 THE ELBOW JOINT STRUCTURE All 3 joints enveloped in a capsule, lined by synovial membrane. Strengthened by radial & ulnar collateral ligaments. 6-4

5 THE ELBOW JOINT STRUCTURE Distal humerus - trochlea & capitulum. Ulna - semilunar notch: Coronoid process Olecranon process Radial head Radial notch of ulna Fig

6 THE RADIOULNAR JOINTS STRUCTURE Distal: Pivot joint Radius articulates with head of ulna. Strengthened by: Volar radioulnar ligament Dorsal radioulnar ligament Fig 6.1 The radiolunar joints-- movements 6-6

7 MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF FOREARM Flexion Biceps brachii, brachioradialis, brachialis Brachialis active in all conditions. Biceps brachii most active with supination, least with pronation. supination pronation Fig

8 FUNDAMENTAL MOVEMENTS OF FOREARM Extension Pronation Supination 6-8

9 THE WRIST AND HAND Great mobility due to generous supply of joints: Radiocarpal (wrist) joint. Articulation between two rows of carpal bones. Carpometacarpal joints. Scaphoid Trapezoid Trapezium Lunate Triquetral Hamate Capitate Fig

10 MOVEMENTS OF THE HAND AT THE WRIST Circumduction: fingertips describe a circle, hand describes a cone. Fig

11 MOVEMENTS OF THE CARPOMETACARPAL JOINT OF THE THUMB Fig 6.19 Abduction Hyperadduction Extension Flexion Hyperflexion Opposition 6-11

12 MOVEMENT OF THE METACARPOPHALANGEAL JOINTS OF THE FINGERS Fig

13 MUSCULAR ANALYSIS OF THE FUNDAMENTAL MOVEMENTS OF THE WRIST, THUMB, AND HAND Wrist Flexion Extension & Hyperextension Radial deviation (Abduction) Ulnar Deviation (adduction) Fingers Flexion Extension Abduction Adduction Opposition 6-13

14 COMMON INJURIES OF THE FOREARM, ELBOW, WRIST, AND FINGERS: FRACTURES OF THE FOREARM Result of direct blow or falling on outstretched hand. Usually both ulna & radius fracture. In the young usually a greenstick type. Immobilization of the elbow is important to reduce movement at fracture site. 6-14

15 ELBOW DISLOCATION AND FRACTURE Results from falling on outstretched hand with elbow extended or hyperextended. Most common is backward displacement of ulna & radius in relation to humerus. Dislocation is frequently accompanied by fracture. Most common is to medial epicondyle. Very serious - likely to involve blood vessels & nerves. 6-15

16 SPRAINED OR STRAINED WRIST From falling on palm of hand with wrist hyperextended. Usually a sprain of ligaments. May be a strain to tendons. May be pain, weakness, limited ROM. 6-16

17 CARPAL TUNNEL SYNDROME This is an overuse, repetitive stress injury. Long hours working with small hand tools and keyboards. Nerve & blood vessel compression as they pass through carpal arch & transverse carpal ligament. Indicators are pain, numbing of fingers. 6-17

18 AVULSION FRACTURE External force applied to tendon pulls off a piece of bone. Often from rapid pronation/supination or high energy flexion of fingers. Probability for occurrence greatest during growth and maturation. 6-18

19 EPICONDYLITIS Lateral epicondylitis tennis elbow Medial epicondylitis Little League elbow Both are repetitive stress injuries. Micro-traumas or tears in muscle & soft tissue at proximal attachments. Indication is pain on activity. Rest, ice, anti-inflammatory drugs, bracing often used as treatment. 6-19