wrist, hand, elbow & shoulder chapters 12, 11 & 10
TRANSCRIPT
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Wrist, Hand, Elbow & Shoulder
Chapters 12, 11 & 10
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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
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Carpal Bones
Proximal:A=Scaphoid B=Lunate C=Triquetral D=Pisiform
Distal:E=Trapezium F=Trapezoid G=Capitate H=Hamate
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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
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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)
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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
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The Thumb
Testing the ulnar collateral ligament of the thumb
The collateral ligaments of the thumb provide the majority of its stability
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Preventing injuries to the hand
Boxing
Batting
Field hockey/ girls lacrosse
Cycling
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More Gloves
Receiver/ Running back gloves Lineman Gloves
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Splints
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Wrist Sprains
Occur from twisting and overuse
Injured structure depends upon the stress placed on the wrist
Ulnar Deviation is movement towards the ulnar
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Radial deviation is movement towards the radius
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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
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Ganglion Cyst
A pocket of fluid within the sheath
Should be referred to a physician
Sometimes is removed surgically
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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
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A “Jammed” Finger
A sprain of the collateral ligaments in the finger
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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!!!
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Fractures
Boxer’s fracture is most common in athletes for many reasons
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Fractures
Other fractures require the same care and treatment
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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
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Carpal tunnel
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Carpal tunnel
Most common as an overuse injury– Tennis– Field hockey
Watch for acute carpal tunnel due to poor position in slings and casts
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deQuervian’s tendinitis
Abductor pollicis longus & Extensor Pollicis brevis tendons
Prolonged or repetitive radial deviation (shot putters)
Swelling, crepitus and pain with abduction
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Mallet Finger
An avulsion fracture of the distal phalanx.
Cannot extend the distal phalanx
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Jersey finger
Avulsion fracture of flexor tendon
Unable to flex the DIP
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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
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Boutonniere deformity
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Elbow
This is a very bony jointCommon to have contusions all around the
elbow.Use PRICES
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Elbow
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Ligaments
There is thick joint capsule surrounding the elbow.
Relies on the ligaments for stability– Ulnar collateral
– Radial collateral
– Annular
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Muscles
Biceps- elbow flexionTriceps- elbow
extensionWrist flexors- medial
epicondyle of humerusWrist extensors- lateral
epicondyle of humerus
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What it really looks like
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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
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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??
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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.
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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.
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Vascularity and Nerves
There are numerous blood vessels and three major nerves that pass though t he elbow
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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
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Fractures
Elbow fractures are rare in athletics.Often results from a forceful blow to the
area or landing on hard surface.
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Elbow Dislocation
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Elbow Dislocation
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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
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Olecranon Bursitis
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Olecranon Bursitis
PRICESUse a compression wrap or sleeve to
alleviate swellingMay have to be drained by MDNot always painful
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Shoulder Anatomy
A separation occurs here at the acromio-clavicular joint
A dislocation occurs here at the gleno-humeral joint
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Bony Anatomy
Three bones:– Humerus
– Bicipital groove
– Clavicle
– S shape
– Scapula
– Corocoid process
– Acromion process (a/c joint)
Many ligamentsNot a very stable joint
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JOINTS
There are many joints at the shoulder
Most commonly injured joints are
Acromio-clavicularGleno-humeral
– Each held together by many ligaments
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JOINTS
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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
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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
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Brachial Plexus
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Brachial Plexus
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Brachial Plexus
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Rotator Cuff Strain
Characterized like any other strain– 1st, 2nd, and 3rd degree
Common in throwing athletesOccurs from excessive motion beyond the
normal range
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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
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Bicipital Tendonitis
Pain with overhead motionsPalpate crepitusInflammation of the tendon in the groove
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Tendon rupture
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Tendon rupture
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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
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Fractures
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What does this mean?
SubluxationDislocationSeparation
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Protection
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Fitting Correctly