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.
BONES TO KNOW: Humerus Ulna Radius Carpals Metacarpals Phelangies Fig 6.1 6-2
THE ELBOW JOINT STRUCTURE Actually 3 joints: Humeroulnar Hinge joint Humeroradial Gliding joint Radioulnar Pivot joint Fig 6.1 6-3
THE ELBOW JOINT STRUCTURE All 3 joints enveloped in a capsule, lined by synovial membrane. Strengthened by radial & ulnar collateral ligaments. 6-4
THE ELBOW JOINT STRUCTURE Distal humerus - trochlea & capitulum. Ulna - semilunar notch: Coronoid process Olecranon process Radial head Radial notch of ulna Fig 6.1 6-5
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
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 6.6 6-7
FUNDAMENTAL MOVEMENTS OF FOREARM Extension Pronation Supination 6-8
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 6.12 6-9
MOVEMENTS OF THE HAND AT THE WRIST Circumduction: fingertips describe a circle, hand describes a cone. Fig 6.16 6-10
MOVEMENTS OF THE CARPOMETACARPAL JOINT OF THE THUMB Fig 6.19 Abduction Hyperadduction Extension Flexion Hyperflexion Opposition 6-11
MOVEMENT OF THE METACARPOPHALANGEAL JOINTS OF THE FINGERS Fig 6.20 6-12
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
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
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
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
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
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
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