SM Study Guide Hand/Wrist/Elbow/Fingers

supination and pronation

Flexion and extension

humerus, ulna, radius

Humeroulna and humeradial

Radioulnar

Ulnar (medial) collateral ligament: stabilizes the valgus force of the elbow

Annular ligament: extends from the ulna, forming a sling around the raidal head that allows free rotation and stability that

Radial (lateral) collateral ligament: stabilizes during varus force

Extends from the lateral epicondyle and primarily attaches to the annular ligament (all the ligaments on the thumb side)

Extends from the medial epicondyle to the proximal ulna

Shoulder or neck

Clear deformity or swelling

if pt cannot flex or extend on one side more than the other = joint issues

elbow hyperextension, more common in females

A carrying angle that is too big or small could mean that the growth plate or bone is fractured

The acute angle formed by the median axis of the arm when in full extension and in a supinated posiotn

5 to 15 degrees

Elbow flexed at 45 degrees while wrist extension is resisted. The lateral epicondyle pain will increase. When the wrist flexion is resisted, medial epicondyle pain is increased.

Muscles and joints are evaluated for pain and weakness through resistive, passive, and active extension, flexion, and forearm pronation and supination. ROM is mostly noted in active and passive supination and pronation.

The athlete does the motion (muscles/structural)

The trained professional does the motion for the athlete (structure)

The athlete does the motion while the trained professional resists the motion (muscles)

Acute: FOOSH or direct blow

Chronic: overuse typically caused by the throwing motion

Wear PPE to stop forces on elbow

learn how to fall correctly

limit throwing and hitting reps

use correct mechanics

use correct equipment

strength and endurance training

warming up and warming down

stretch

If chronic overuse, take time to heal

to draw out liquid from the injury and relieve pressure

Olecranon bursitis

proximal, distal, and middle radioulnar joints

The roof of the carpal tunnel is made by the flexor retinaculum

Thick connective tissue ligament that bridges the space between the lateral and medial

muscles originating outside of the hand (forearm area)

muscles originating inside of the hand (abduct, adduct, and create opposition of metacarpals in the thumb)

located on medial side to flex fingers and the wrist

located on the posterior/lateral side to extend fingers and wrist

wrist ganglion

issue with blood circulation

Scaphoid fracture

false

proximal, distal, and middle

anterior side

posterior side

Colles: radius posterially displaced

Smith: hand anterioly displaced

Stirrup for the elbow or if their is pain when the wrist is in supination or pronation

Only splint the hand or wrist when it is a sprain or strain

MOI: radius posterioly displaced, FOOSH on extended wrist, dinner fork deformity

S&S: clear deformity, sometimes mistaken for a sprain, torn tendons and possible middle nerve damage

Tx: 6-8 weeks recovery, splint, PRICE, maybe sx

MOI: FOOsH with flexed hand, displaced anterioly, less seen than Colles

MOI: can be acute or chronic, ulnar side hit more often, direct blow or contact

S&S: swelling, hematoma, pain, “Monkey Bump”, if hit many times could have myositis ossificans

Tx: PRICE mainly ice and compress, donut pad for added protection

MOI: most seen in youth from direct blows or falling, fx to ulna or radius, only one is rare

S&S: p!, pop, echymosis w/ possible crepitus, edema, older athletes can have more damage to soft tissue structures

Tx: PRICE, immobilize, splint, refer to a doctor, recovery is 6-8 weeks, possible sx and reduction

MOI: hyperextension, bends lower arm outward (valgus) injuring MCL

S&S: P!, can’t throw, point tenderness over MCL

Tx: apply cold immediately, pressure bandage for 24 hours, sling at 90 degree angle of flexion, active exercise, progressive throwing reps, if elbow is unstable “Tommy John” sx will fix joint capsule and MCL

MOI: FOOSH, direct blow, falling on flexed elbow, children and young adults, most common, can break 1-many bones in the elbow

S&S: deformity, muscle spasm, hemorrhage, swelling

Tx: immediate care, ice, sling, rapid swelling may cause Volkmann’s contracture

MOI: FOOSH, compresses scaphoid between the radius and second row of carpal bones

S&S: severe p! in snuff box, swelling, confused with wrist sprain

Tx: splint then X-ray before casting, sometimes can’t be seen on X-ray, immobile for 6 weeks, protect wrist with tape for 3 months, does not heal quickly

MOI: contact with athlete holding something/falling

S&S: wrist is weak, p! in 5th digit b/c ulnar nerve compression, TTP

Tx: cast wrist and thumb, hook of hamate protected w/ donut pad

MOI: synovial joint cyst appears after strain or repetitive hyperextension force

S&S: usually on posterior side of wrist, p! w/ lump, p! increases w/ movement, or pain-free

Tx: old method- hit with Bible to break down swelling then apply pressure pad. new method- aspiration, chemical cauterization w/ pressure from pad, can return 50% of the time, sx is most effective.

MOI: blow to tip of finger, forces 1st and 2nd joint dorsally, tears supporting capsular tissue, causes hemmorhage, coud rupture flexor or extensor tendons or cause a chip fx, closed or open dislocation

S&S: relocate, X-ray to rule out fx, splint for 3 weeks in 30 degree angle of flexion, buddy tape, consider thumb and MCP more carefully

MOI: hit by ball, twisted, or crushed

S&S: swelling, p!, tenderness

Tx: splint in slight flexion around a gauze roll, avoid full extension, relaxes flexor tendons, fx of distal phalanx is less complicated, PRICE, immobilize

MOI: repeated static contractions for splints, severe static contraction for strains

S&S: achy/dull p!, between extensors (posterior), p! w/ contractions, weakness, point tenderness in interosseous membrane in between the radius and ulna

Tx: based off of symptoms, forearm strengthening, acute use chyrotherapy, chronic use thermotherapy, wraps protect and support

Where the finger meets the hand

Inbetween the bones

Elbow extension

bigger at the elbow smaller at the wrist and radius is the opposite

Do supination

through the carpal tunnel

Start from thumb SLTPTTCH