Elbow/Wrist/Hand Labeling. Sports med 2

Transcription

1 Elbow/Wrist/Hand Labeling Sports med 2

2 Phalanges Distal Middle Head Body Base Distal Proximal Proximal Metacarpals Carpals Head Body Base Hamate Pisiform Triquetral Lunate 1 st Metacarpal Trapezoid Trapezium Capitate Scaphoid

3 Olecranon Fossa Lateral Epicondyle Medial Epicondyle Capitulum Trochlea Trochlea Olecranon Olecranon Head of Radius Neck of Radius Ulna Radius Interosseous Membrane Anterior Posterior

4 Ulnar Collateral Ligament Transverse Carpal Ligament Radial Collateral Ligament

5 Annular Ligament Biceps Brachii Tendon Radius Humerus Triceps Brachii Tendon Ulnar Collateral Ligament Olecranon Bursa Ulna Humerus Lateral Epicondyle Lateral Collateral Ligament Olecranon Annular Ligament Biceps Brachii Tendon Radius Ulna

6 Biceps Brachii Brachialis Brachioradialis Pronator Teres Supinator Flexor Carpi Radialis Palmaris Longus Flexor Carpi Ulnaris Pronator Quadratus

7 Flexor Digitorum Superificalis

8 Elbow Sports med 2

9 Movements Carrying angle Females degrees, Males 5 degrees Flexion 145 degrees Extension Pronation 80degrees Supination 85 degrees

10 Articulations Consists of 3 separate joints Humeroulnar Humeroradial Proximal radioulnar

11 Ligaments and Bursae Ulnar collateral ligament Prevents valgus forces Radial collateral ligament Prevents varus forces (uncommon) Annular ligament Stabilizes head and neck of radius (strong) Olecranon bursa Between olecranon process and skin

12 Musculature Biceps Brachii, Brachialis, brachioradialis Elbow flexion Triceps brachii, anconeus Elbow extension Pronator teres and quadratus, supinator Pronation and supination

13 Nerve/Blood Supply Median Nerve Radial Nerve Ulnar Nerve Funny bone Radial Artery Ulnar Artery

14 Assessment History Land on tip of bent elbow? (most common MOI) Overuse from throwing? Over extension? Location and duration of pain? Positions that increase or decrease pain? Previous elbow injuries? Locking or crepitation w/movement?

15 Assessment Observations Deformities, swelling Carrying angle Normal 5-15 degrees Too little or too great could = fx Decreased flexion or hyperextension 45 degree angle, posterior observation of epicondyles and olecranon process to make isosceles triangle

16 Bony Palpations Medial epicondyle Lateral epicondyle Olecranon process Radial head Radius ulna Assessment

17 Soft tissue palpations Anterior Biceps brachii Brachialis Brachioradialis Pronater teres Posterior Triceps Brachii supinator Medial Ulnar collateral ligament Lateral Radial collateral ligament Annular ligament Assessment

18 Strains MOI FOOSHA = hyperextension S/S AROM or RROM= pain Point tender TX RICE possibly a sling Cryotherapy, US, rehab X-ray if severe Special Test: MMTs

19 Elbow MMTs Flexion Extension Pronation Supination Write in the muscle for each action

20 MOI S/S TX Elbow Dislocation FOOSHA, or severe twist with flexion Ulna and radius are pushed posterior (most common) Severe pain, swelling and disability Deformity Probable radial head fx Ice, sling, check circulation Refer for x-ray and reduction

21 MOI S/S TX Elbow Fractures FOOSHA, or direct blow Possible visible deformity Hemorrhage, muscle spasm, and swelling Stabilize, monitor distal pulse Refer for x-ray, splint 6-8 weeks

22 Ulnar Collateral Lig. (UCL) sprain MOI Valgus force from repetitive trauma Tennis, golfing, throwing S/S TX Pn. On medial aspect of elbow Parasthesia, and laxity Rest, NSAIDs, strengthening, correct form Special Test: Valgus Test

23 Procedure Evaluator grasps athletes wrist and lateral elbow applying a valgus force at 0 and 30 degrees. Positive Test Pn at the medial aspect of elbow, laxity Ulnar (medial) collateral ligament sprain Valgus Test

24 Procedure Evaluator grasps athletes wrist and medial elbow applying a varus force at 0 and 30 degrees. Positive test Lateral elbow pn, and laxity Radial (lateral) collateral ligament sprain Varus Test

25 Volkmann s Contracture MOI Complication of serious elbow injury Muscle spasm, swelling, or bone pressure on the brachial artery S/S Pn. In the forearm that is worse when fingers are passively extended Decreased or absent brachial and radial pulses TX Removal of constricting casts, wraps or braces, elevation Can become permanent

26 Ulnar Nerve Injuries MOI Pronounced valgus at the elbow friction problem Dislocation or pinched by a ligament during flexion activities S/S Paresthesia to fourth and fifth fingers TX Conservative, avoid activities that aggravate nerve Possible surgery to move nerve anteriorly Special Test: Tinels Sign

27 Procedure Patient is seated, elbow in flexion Evaluator grasps wrist and taps the ulnar notch with finger Positive Test Athlete complains of tingling sensation along forearm, hand and fingers Indicates ulnar nerve compromise ch?v=oj9weejea3o Tinel s sign

28 Epicondylitis MOI Lateral (tennis elbow) Tennis, baseball, swimming, golfing Repeated forearm flexion and extension Medial (pitchers or golfers elbow) Repetitive wrist flexion, valgus stress on elbow S/S Aching pn. During and after activity decreased ROM hand weakness TX RICE, NSAIDS, US ROM, PRE, Deep friction massage Elbow sleeve or band just below the bend of the elbow Special Test: Epicondylitis tests

29 Procedure Wrist extension is resisted, increases pn at lateral epicondyle Wrist flexion is resisted, increases pn at medial epicondyle 3 rd phalanx extension/flexion is resisted Positive Test Pn at either epicondyle Epicondylitis Tests

30 Olecranon Bursitis MOI S/S TX Direct blow Pain, severe swelling, point tenderness Acute= ice, compression Chronic = compression, modalities, aspiration Padding for play

31 Wrist/Hand Sports med 2

32 Articulations Radiocarpal Flexion, extension, abduction, and circumduction Carpal Gliding joints Stabilized by anterior, posterior, and connecting ligaments Metacarpal Flexion, extension, abduction, adduction, circumduction Phalangeal Hinge joints Proximal interphalangeal (PIP), Distal interphalangeal (DIP)

33 Ligaments Wrist Ulnar Collateral ligament Ulna to pisiform Radial collateral ligament Radius to scaphoid Transverse carpal ligament Roof of the carpal tunnel Phalanges Collateral ligaments

34 Flexors Palmar surface Muscles Flexor digitorum superficialis, flexor digitorum profundus Extensors Dorsal surface Extensor digitorum longus, Intrinsics Abduction and adduction

35 MMTs Flexion Extension Ulnar deviation Radial Deviation Finger Abduction Finger Adduction

36 Blood/Nerve Supply Nerves Ulnar, radial Median Arteries Enters palm through carpal tunnel Radial ulnar

37 Allens Test Procedure Athlete squeezes hand into a fist and fully opens hand 3-4 times With athlete holding the last fist the evaluator puts pressure over radial and ulnar artery Athlete opens hand (appears white), evaluator releases 1 artery and the hand should become red Positive Test Not turning red instantly = radial or ulnar artery compromise

38 Assessment History MOI Location and type of pain? Increases or decreases pain? History of trauma or overuse? Any therapy given in the past?

39 Assessment Observations Hand usage like writing, unbuttoning shirt Open and close hand Fully? Rythmically? Touch thumb to each fingertip Flat knuckle Color of fingernails Pale= poor circulation

40 Assessment Bony Palpations Scaphoid (anatomical snuffbox) Lunate Hamate (hook) Metacarpals Phalanges (proximal, middle, and distal)

41 Assessment Soft Palpations Triangular fibrocartilage (TFCC) Collateral ligaments of phalanges Flexor and extensor muscles

42 Tenosynovitis MOI Repetitive use and overuse of tendons and their sheaths S/S Pn with use, pn w/passive stretching Tenderness, swelling over tendon TX Ice massage, NSAIDS, rest ROM, contrast baths, US, PRE Special Test: Finkelsteins

43 Finkelsteins Test Procedure Athlete is sitting, forms a fist around the thumb. Examiner grasps the athlete's forearm and fist and ulnarly deviates Positive Test Pn. = Possible tenosynovitis Pn. At carpal tunnel = carpal tunnel syndrome

44 Carpal Tunnel Syndrome MOI Inflammation in the carpal tunnel, compresses median nerve Repeated flexion, or direct blow S/S Tingling, numbness, weakness TX Rest, immobilization, NSAIDS Possible surgery Special Test: Phalens

45 Procedure Have athlete flex both wrists as far as possible and press together for 1 minute Positive Test Pn. At the carpal tunnel = carpal tunnel syndrome Phalens Test

46 Wrist Sprains (most common) MOI Falling on hyperextended wrist Violent flexion or torsion S/S TX Pn, swelling, decreased AROM RICE, splinting, analgesics Tape, strengthening Special Test: Glide

47 Procedure Grasp the athletes wrist with one hand and their carpals with the other Move anterior/posterior and radial/ulnar directions Can also do on each phalange/metacarpal joint Positive Test Pn./laxity = sprain Glide Test

48 Gamekeepers Thumb MOI (skiiers, tacklers) Sprain of UCL ligament of MCP joint of thumb Forceful abduction with hyperextension S/S Pn, weak pinch, Tenderness and swelling TX Refer Splint 3 weeks Special Test: Valgus/Varus

49 Procedure Examiner maintains stabilization of the proximal bone between the thumb and forefinger and grasps the distal bone Examiner provides a valgus/varus force Positive Test Pn./laxity = collateral ligament tear/sprain Valgus/Varus

50 Triangular Fibrocartilage Complex Injury (TFCC) MOI S/S TX Forced hyperextension Pn along the ulnar side of wrist Extension = pn, difficulty Swelling later on refer

51 Wrist Ganglion MOI S/S TX appears slowly, contains clear mucinous fluid Repeated hyperextension Bump on dorsal wrist Occasional pn, increases w/wrist extension Cystic structure is soft, rubbery, or hard Aspiration and chemical cauterization, pressure pad Surgical removal

52 Scaphoid Fx (most common) MOI FOOSHA, compresses scaphoid between radius and carpals S/S Point tenderness in snuff box Pn. With thumb compression and radial deviation TX Splint and refer for x-ray Untreated leads to necrosis

53 Hamate (hook) Fx MOI S/S TX Direct blow from racket, bat, sports stick, club Wrist pn and weakness Point tender Refer for x-ray Doughnut pad

54 Colles Fx MOI Fx to distal end of radius or ulna FOOSHA, or hyperextension S/S Visible deformity Swelling and pn TX Ice and splint refer

55 Boxers (5 th metacarpal) Fx MOI Direct axial force (punching) Getting stepped on S/S TX Pn and swelling RICE, analgesics, refer Splint 4 weeks, early ROM Special Test: Compression

56 Procedure Athlete has finger extended Examiner holds the distal phalanx and applies compression along the axis of the bone of the finger being tested Can also be done on metacarpal in fist position Positive Test Pn at injury site = possible fx Compression Test

57 Mallet Finger MOI S/S TX Direct blow to extended finger Pn at DIP unable to extend finger RICE Splinted 24 hr/day, 6-8 weeks

58 Boutonniere Deformity MOI Trauma forcing the DIP into extension and PIP into flexion S/S Pn and inability to extend the DIP Swelling, obvious deformity TX Ice Splint PIP in extension5-8 weeks Flex distal phalanx

59 Jersey Finger MOI Most often in the ring finger Grabs a jersey, ruptures flexor tendon S/S DIP joint cant be flexed Finger stuck in extension TX No surgery = never flex DIP again Surgery = 12 weeks of rehab

60 Phalanx Fractures MOI S/S TX Stepped on, torsion, hit by a ball Pn and swelling TTP at fx site Splint in slight flexion Refer for xray Special Test: Tap/Percussion

61 Procedure Tap/Percussion Test Athlete extends affected finger Evaluator applies a firm tap to the end of the finger Positive Test Pn. At injury site = possible fx

62 Subungual Hematoma MOI Contusion/crushing S/S Slow or immediate bleeding into the nail bed Extreme pn Bluish/purple nail bed TX Ice, elevation Drill a small hole in nail bed

63 Elbow/wrist/hand Rehab Sports med 2

64 Phase 1 Elbow General Body conditioning ROM Joint Mobilizations Inferior, anterior and posterior glides Humeroulnar traction Passive stretching Low force and long duration Flexion and extension Strengthening Low resistance, high reps Flexion, extension, pronation, supination, grip, and shoulder

65 Phase 1 Wrist/Hand General Body Conditioning ROM Traction, joint mobilizations Stretching PROM Extension, flexion Strength Towel/flex bar twists Wrist roll Flexion and extension (no or decreased weight) Ulnar/radial deviation (no or decreased weight) Pronation/supination (no or decreased weight) Grip Web, stress ball, machine, rubberbands Neuromuscular control Coin pickup Tying shoes/knots Buttoning buttons

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67 Phase 2 Elbow General body conditioning Proprioception Strengthening PNF, Isokinetic PRE Tubing, weights, or manual resistance ROM Joint mobilizations Stretches

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69 Phase 2 Wrist/Hand General Body Conditioning ROM Traction, joint mobilizations Stretching AROM Extension, flexion Strength Towel/flex bar twists (thicker bar) Wrist roll (more weight) Flexion and extension (dumbbells/bands) Ulnar/radial deviation (dumbbells/bands) Pronation/supination (dumbbells/bands) Grip Web, stress ball, machine, rubberbands Neuromuscular control Coin pickup Handwriting Buttoning buttons

70 Phase 3 Elbow General Body Conditioning Functional Progressions Swimming Throwing Pushups Sitting pushup Weight shifting on ball

71 Phase 3 Wrist/Hand General Body Conditioning Sports specific activities Full grip strength is goal

72 Buddy Tape: Watch and practice

73 Finger Splint: Watch and Practice

74 Enter your SOAP note information from your partners Elbow/Wrist/ Hand injury into our injury tracking software program Sportsware (SWOL) 1. From ipad homescreen, choose SWOL login Password: Sportsmedicine 2. Click quick injury 3. Group: eagle high school 4. Sport: skiing, m 5. Click M 6. Name: choose Sports Medicine 2 7. Click select, Click notes and enter YOUR name 8. Click SOAP, and fill in the information from your partners injury SOAP note 9. Click Save