Athletic Injury Management Chapter 19

3 Bones of the Elbow complex
humerus radius and ulna
3 Joints of the Elbow Complex
jumeroulnar joint, the humeroradial joint and the radioulnar joint
Unlnar collateral ligament
the most important for stability to valgus force of the elbow and extends from the medial epicondle to the proximal ulna
annular ligament
extends from the ulna forming a sling around the radial head and thus allowing free rotation of the radius while providing stability and preventing radial head luxation
radial collateral ligament
provides stability to a varus force, extends from the lateral epicondyle and attaches primarily to the annular ligament
muscles of the elbow
biceps brachii and the brachialis and the brachioradialis muscles all of which are flexors of the elbow.
Elbow Flexion
muscles biceps brachii, brachialis, brachioradialis
Elbow extension
triceps brachii, anconeus
Observation of elbow injury
deformities and swelling. Increased or decreased carrying angle may indicate injury, carrying angle to great or too little may indicate growth plate fracture, a decrease in normal flexion and inability to extend fully or beyond a normal extension on one side more than the other
lateral and medial epicondylitis tests
the elbow is flexed to 45 degrees and wrist extension is resisted which increases pain at the lateral epicondyle when wrist flexion is resisted pain increases at the medial epicondyle
functional evaluation
the joint and muscles are evaluated for pain sites and weakness through passive active and resistive motions consisting of elbow flexion and extension and forearm pronation and supination
Olecranon Bursitis Cause
most frequently injured bursa in the elbow. Direct blow or falling
Olecranon Bursistis symptoms
inflamed, painful, swelling and tenderness
Olecranon Bursitis care
Ice and compression for 20 mins if acute. If chronic you need a program of protective therapy
Elbow sprain cause
hyperextension or a force that bends or twists the lower arm outward valgus force causing injury to the collateral ligament
Elbow sprain symptoms
point tenderness at the medial collateral ligament
Elbow sprain care
cold and pressure bandage for at least 24 hrs with sling support fixed at 90 degrees flexion
Lateral Epicondylitis cause
“tennis elbow” repetitive extension of the wrist inflamtion to the insertion of the extensor muscle of the lateral epicondyle
Tennis Elbow symptoms
achining pain in the lateral epicondyle region during and after activity. Weakness in hand and wrist, tenderness and pain on resisted extension of the wrist and full extension of the elbow
Tennis Elbow care
PRICE, NSAIDS analgesics. ROM exercises, stretching and mobilization. Counterforce brace or neoprene elbow sleeve for 1-2 months
Medial Epicondylitis cause
repeated forceful flexion of the wrist. Pitching, golf etc
Medial Epicondylitis symptoms
pain around the epicondyle of the humerus during forceful wrist flexion that may radiate down the arm, point tenderness and mild swelling
Medial Epicondylitis Care
rest, cryotherapy, heat through ultrasound, analgelsics, NSAIDS, counterforce brace below elbow bend
Elbow Osteochrondritis Dissecans Cause
blood supply can lead to fragmentation and separation of the articular cartilage and bone creating loose bodies within the bone
Elbow Osteo. Diss. Symptoms
sudeen pain and locking of elbow joint rom returns slowly and pain and crepitus may occur
Ulnar Nerve Injury Cause
nerve becomes dislocated and impinged by a ligament during flexion activies
Ulnar Nerve Injury Sypmtoms
lack of sensation or PARESTHESIA in 4th and 5th fingers
Ulnar Nerve injury care
surgery, no direct pressure
Dislocation of Elbow Cause
fall on the outstretched hand with elbow hyperextended or by a sever twist while elbow is flexed
Dislocation of Elbow sypmtom
bones may be displaced, deformity of the olecranon process. Bleeding, swelling. Check pulse immediatley
Dislocation of Elbow care
immobilizing splint reduction with physician ASAP 3 weeks splint, may have neurovascular problems
Fracture of Elbow Cause
fall on the outstretched hand of flexed elbow or by direct blow to the elbow
Fracture of Elbow Symptoms
usually a hemorrhage swelling nad muscle spasm
Fracture of Elbow care
ice and sling medical attention
2 bones in forearm
Ulna radius
Ulna
long straight and larger at its upper end than its lower end
Radius
extension of the hand is thicker at it’s lower end than it’s upper end
Three articulations of forearm
superior, middle and distal radioulnar joints
Muscles of forearm
flexors and pronators positioned anteriorly and attached to the medial epicondyle and of extensors and supinators which lie posteriory and are attached to the lateral epicondyle. Deep and superficial muscles at the wrist
Contusion cause
repeated blows to the forearm
Contusion symptoms
pain, swelling, and hematoma
Contusion care
PRICE for 20 mins every 1 1/2 waking hours followed the next day by cold and exercise
Forearm Splints and other strains cause
repeated static contraction. Like shin splints
Forearm Splints sypmtoms
dull ache in the extensor muscles crossing the back of the forearm. Muscle weakness
Forearm splints care
Concentrate on increasing strength through resistance exercises. rest cold heat and supportive wraps
Forearm shaft fracture cause
blow or a fall on the outstretched hand
Forearm shaft fracture symptoms
pain swelling deformity and non union
Forearm shaft fracture care
cold pack, sling, splint 8 weeks
Colles Fracture cause
involves lower distal end of radius. Fall on outstretched hand with an extended wrist forcing the forearm backward and upward into hyperextension
Colles Fracture syptoms
visable deformity to wrist bleeding, swelling the fingers and forearms as well
Colles fracture care
ice, splint wrist, sling, doctor 1 to 2 mos immobilization
Wrist bones
formed by the distal aspect of the radius and the ulna with a proximal row of four carpal bones and a distal row of four carpal bones that articulate with 5 metacarpals.
Fingers have 3 phalanges thumb has two
🙂
wrist ligaments
ulnar collateral ligament also medial and lateral collateral ligaments
volar plate
thickened joint capsule on the palmar surface of hand
muscles of wrist and hands
extrinsic (outside of the hand) intrinsic (inside of the hand)
Wrist Sprain cause
abnormal forced movement of the wrist. Falling on the hyperextended wrist is the most common cause or violent flexion/torsion
Wrist Sprain Symptoms
pain swelling and difficulty moving wrist
Wrist Sprain Care
xray PRICE, splinting, angelelsics, strengthening exercises
Carpal Tunnel Syndrome cause
inflammation of the tendons and synovial sheaths within the wrist which leads to compression of the median nerves also direct trauma
Carpal Tunnel Symptoms
tingling, numbness, paaresthesia in the arc over thumb. Weakness in thumb movement
Carpal Tunnel Care
rest, immobilization, NSAIDS, injections and surgical decompression
Scaphoid Fracture cause
most frequently fractured carpal bone. Fall on outstretched hand
Scaphoid Fracture symptoms
swelling and tenderness
Scaphoid Fracture care
cold, splint, doctor cast 6 weeks
Hamate Fracture cause
fall, sports with sticks or handles
Hamate Fracture symptoms
wrist pain and weakness and point tenderness. Tingling, numbness and weakness in little and ring fingers
Hammate fracture care
cast
Wrist ganglion cause
repeated forced hyperextension of the wrist, and contains a clear mucinous fluid appears on back of wrist
Wrist ganglion symptoms
lump pain
Wrist ganglion care
aspiration and chemical cauterization surgical removal is best option
Fifth metacarpal fracture (boxers fracture) cause
boxing martial arts, direct axial force caused by punching something
5th Metacarpal fracture symptoms
tenderness and defect in the shaft of the 5th metacapal swelling
5th Metacarpal Fracture care
reduction and immobilzation for 3-4 weeks
Mallet Finger Cause
blow from a thrown ball on tip of finger
Mallet finger symptoms
pain at joint, avulsion can’t extend finger tenderness
Mallet finger care
PRICE splinted in extension for 6 to 8 weeks
Boutonniere Deformity Cause
rupture of the extensor tendon over the middle phalanx
Butonniere Deformity Symptoms
severe pain and inability to extend the DIP joint. Deformity and swelling
Butonniere Care
cold application splint in extension
Jersey Finger Cause
rupture of the flexor digitorum profundus tendon from it’s insertion on the distal phalanx
Jersey finger symptoms
can’t flex DIP joint finger is in extended position pain and tenderness
Jersey finger care
surgery, 12 weeks of rehab
Gamekeeper’s thumb cause
sprain of the ulnar collateral ligament of the MCP joint of the thumb by direct blow or exerting torque on the joint
Gamekeepers thumb symptoms
pain over the ulnar collateral ligament tenderness and swelling
Gamekeeper’s thumb care
x ray splinting over 3 weeks or until pain free
Collateral Ligament Sprain cause
axial force to the tip of the finger
Collateral Ligament sprain symptom
tenderness joint instability
Collateral ligament sprain care
ice packs splinting
Dislocation of Phlanges cause
blwo to the tip of the finger
Dislocation of phlanges symptoms
deformity,
Dislocation of phlanges care
reduction performed by doctor. splinting for 3 weeks in 30 degrees of flexionl buddy tape to adjacent finger xray
Phalanx Fracture cause
fingers hit, stepped on twisted
Phalanx fracture symptoms
pain and swelling
Phalanx fracture care
splinted in flexion