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- 1. Chapter 24: The Forearm, Wrist, Hand and Finger
- 2. Anatomy of the Forearm
- 7. Assessment of the Forearm History What was the cause? What were the symptoms at the time of injury, did they occur later, were they localized or diffuse? Was there swelling and discoloration? What treatment was given and how does it feel now?
- 8. Observation Visually inspect for deformities, swelling and skin defects Range of motion Pain w/ motion Palpation Palpated at distant sites and at point of injury Can reveal tenderness, edema, fracture, deformity, changes in skin temperature, a false joint, bone fragments or lack of bone continuity
- 14. Elbow Dislocations • Posterior What’s Damaged? UCL Annular LCL Ant. Capsule Brachialis Flexor tendons
- 16. Chronic Injuries
- 17. Epicondylitis Medial “little league elbow” Wrist flex. On follow thru. Curve balls? Lateral “tennis elbow” Backhand
- 21. Olecranon Bursitis Etiology Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow Signs and Symptoms Pain, swelling, and point tenderness Swelling will appear almost spontaneously and w/out usual pain and heat
- 22. Recognition and Management of Injuries to the Forearm Forearm Contusion Etiology Ulnar side receives majority of blows due to arm blocks Can be acute or chronic Result of direct contact or blow Signs and Symptoms Pain, swelling and hematoma If repeated blows occur, heavy fibrosis and possibly bony callus could form w/in hematoma
- 23. Contusion (continued) Management Proper care in acute stage involves RICE for at least one hour and followed up w/ additional cryotherapy Protection is critical - full-length sponge rubber pad can be used to provide protective covering
- 24. Forearm Fractures Etiology Common in youth due to falls and direct blows Ulna and radius generally fracture individually Fracture in upper third may result in abduction deformity due pull of pronator teres Fracture in lower portion will remain relatively neutral Older athlete may experience greater soft tissue damage and greater chance of paralysis due to Volkman’s contracture Signs and Symptoms Audible pop or crack followed by moderate to severe pain, swelling, and disability Edema, ecchymosis w/ possible crepitus
- 25. Management Initially RICE followed by splinting until definitive care is available Long term casting followed by rehab plan
- 26. Colles’ Fracture Etiology Occurs in lower end of radius or ulna MOI is fall on outstretched hand, forcing radius and ulna into hyperextension Less common is the reverse Colles’ fracture
- 27. Colle’s Fracture Cont. Signs and Symptoms Anterior displacement of radius causing visible deformity (silver fork deformity) When no deformity is present, injury can be passed off as bad sprain Extensive bleeding and swelling Tendons may be torn/avulsed and there may be median nerve damage Management Cold compress, splint wrist and refer to physician X-ray and immobilization Severe sprains should be treated as fractures Without complications a Colles’ fracture will keep an athlete out for 1-2 months In children, injury may cause lower epiphyseal separation
- 28. Smith’s Fracture MOI – falling on back of hand forcing wrist into hyperflexion Radius displaces posteriorly Less common than colles’ fracture
- 30. Anatomy of the Wrist, Hand and Fingers
- 32. T H T C P T S L Never Lower Tilly’s Pants, Terrible Things Could Happen Some Lovers Try Positions That They Can’t Handle
- 37. •Blood and Nerve Supply Three major nerves Ulnar, median and radial Ulnar and radial arteries supply the hand Two arterial arches (superficial and deep palmar arches)
- 38. Activity- Anatomy Review WRIST AND HAND
- 39. Assessment of the Wrist, Hand and Fingers History Past history Mechanism of injury When does it hurt? Type of, quality of, duration of, pain? Sounds or feelings? How long were you disabled? Swelling? Previous treatments?
- 40. Assessment Cont. Observation Postural deviations Is the part held still, stiff or protected? Wrist or hand swollen or discolored? General attitude What movements can be performed fully and rhythmically? Thumb to finger touching Color of nailbeds
- 41. Recognition and Management of Injuries to the Wrist, Hand and Fingers Wrist Sprains Etiology Signs and Symptoms Most common wrist injury Arises from any abnormal, forced movement Falling on hyperextended wrist, violent flexion or torsion Multiple incidents may disrupt blood supply Pain, swelling and difficulty w/ movement Complications Can be complicated due to the complex Carpal fractures are often missed ligamentous structure
- 42. Tendinitis /Tenosynovitis Etiology Repetitive pulling movements of (commonly) flexor carpi radialis and ulnaris; repetitive pressure on palms (cycling) can cause irritation of flexor digitorum Primary cause is overuse of the wrist Signs and Symptoms Pain on active use or passive stretching Isometric resistance to involved tendon produces pain, weakness or both
- 43. Carpal Tunnel Syndrome Etiology Compression of median nerve due to inflammation of tendons and sheaths of carpal tunnel Result of repeated wrist flexion or direct trauma to anterior aspect of wrist Signs and Symptoms Sensory and motor deficits (tingling, numbness and paresthesia); weakness in thumb
- 45. Scaphoid Fracture Most fractured bone in the wrist -Fx of the bone most commonly from a fall on outstretched hand -Complications: 1. difficult to confirm with xray 2. poor blood supply = poor healing 3. high morbidity rate
- 47. Phalange Fracture "jammed" joint surface fx – axial load Direct blow Rotational force
- 49. Boxer’s Fracture (Donovan’s fx) -Fx of the 5th met. -Mech: axial compression mostly caused by punching
- 50. Finger Dislocations •IP Joint most common •Thumb dislocations are severe
- 51. UCL- Thumb Sprain Ulnar Collateral Ligament Mech - abduction and/or hyperextension 3rd Degree - Gamekeepers Thumb Commonly under dx. Severe laxity Chronic instability and dysfunction Early arthritis