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1、 2007 McGraw-Hill Higher Education. All rights reserved.The Elbow, Forearm, Wrist and HandPE 236Juan Cuevas, ATC 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Hi
2、gher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Prevention of Elbow, Forearm and Wrist InjuriesVulnerable to a variety of acute and chronic injuriesProtective gear is always recommended to reduce severity of injuryChronic injury reductionLimit repetitions
3、(baseball, tennis)Utilize proper mechanicsUse equipment that is appropriate for skill levelMaintain appropriate levels of strength, flexibility, and endurance for activity 2007 McGraw-Hill Higher Education. All rights reserved.Recognition and Management of Injuries to the ElbowOlecranon BursitisCaus
4、e of InjurySuperficial location makes it extremely susceptible to injury (acute or chronic) -direct blowSigns of InjuryPain, swelling, and point tendernessSwelling will appear almost spontaneously and w/out usual pain and heat 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill
5、Higher Education. All rights reserved.ContusionCause of InjuryVulnerable area due to lack of paddingResult of direct blow or repetitive blowsSigns of InjurySwelling (rapidly after irritation of bursa or synovial membrane)CareTreat w/ RICE immediately for at least 24 hoursIf severe, refer for X-ray t
6、o determine presence of fracture 2007 McGraw-Hill Higher Education. All rights reserved.Elbow SprainsCause of InjuryElbow hyperextension or a valgus force (often seen in the cocking phase of throwingSigns of InjuryPain along medial aspect of elbowInability to grasp objectsPoint tenderness over the M
7、CLCareConservative treatment begins w/ RICE elbow fixed at 90 degrees in a sling for at least 24 hoursCoach should be concerned with gradually regaining elbow full ROMAthlete should modify activityGradual progression involving an increase in number of throws while range and strength return 2007 McGr
8、aw-Hill Higher Education. All rights reserved.Ligament InjuriesUlnar Collateral Ligament tearOveruse injuryBaseball pitchersSigns and SymptomsMedial elbow painPop sensationMedial elbow swelling TreatmentSURGERY “Tommy JohnElbow ligament reconstruction 2007 McGraw-Hill Higher Education. All rights re
9、served.Lateral Epicondylitis (Tennis Elbow)Cause of InjuryRepetitive microtrauma to insertion of extensor muscles of lateral epicondyleSigns of Injury Aching pain in region of lateral epicondyle after activityPain worsens and weakness in wrist and hand developElbow has decreased ROM; pain w/ resisti
10、ve wrist extension 2007 McGraw-Hill Higher Education. All rights reserved.Lateral Epicondylitis (continued)CareRICE, NSAIDs and analgesicsROM exercises and PRE, deep friction massage, hand grasping while in supination, avoidance of pronation motionsMobilization and stretching in pain free rangesUse
11、of a counter force or neoprene sleeveProper mechanics and equipment instruction is critically important 2007 McGraw-Hill Higher Education. All rights reserved.Medial Epicondylitis (Little League Elbow)Cause of Injury Repeated forceful flexion of wrist and extreme valgus torque of elbowSigns of Injur
12、yPain produced w/ forceful flexion or extensionPoint tenderness and mild swellingPassive movement of wrist seldom elicits pain, but active movement doesCareSling, rest, cryotherapy or heat through ultrasoundAnalgesic and NSAIDsCurvilinear brace below elbow to reduce elbow stressingSevere cases may r
13、equire splinting and complete rest for 7-10 days 2007 McGraw-Hill Higher Education. All rights reserved.Ulnar Nerve InjuriesCause of InjuryPronounced cubital valgus may cause deep friction problemUlnar nerve dislocationSigns of Injury Generally respond with paresthesia (numbness) in 4th and 5th fing
14、ersCareConservative management avoid aggravating conditionSurgery may be necessary if stress on nerve can not be avoided 2007 McGraw-Hill Higher Education. All rights reserved.Dislocation of the ElbowCause of Injury High incidence in sports caused by fall on outstretched hand w/ elbow extended or se
15、vere twist while flexedSigns of InjurySwelling, severe pain, disabilityMay be displaced backwards, forward, or laterallyComplications w/ median and radial nerves and blood vesselsCareImmobilize and refer to physician for reductionFollowing reduction, elbow should remain splinted in flexion for 3 wee
16、ks 2007 McGraw-Hill Higher Education. All rights reserved.Elbow Dislocation 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Fractures of the ElbowCause of Injury Fall on flexed elbow or from a direct blowFracture can occur in any one or
17、more of the bonesFall on outstretched hand often fractures humerus above condyles or between condylesSigns of Injury May or may not result in visual deformityHemorrhaging, swelling, muscle spasmCareIce and sling for support refer to physician 2007 McGraw-Hill Higher Education. All rights reserved. 2
18、007 McGraw-Hill Higher Education. All rights reserved.Anatomy of the Forearm 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Recognition and Management of Injuries to the Forearm Co
19、ntusionCause of Injury Ulnar side receives majority of blows due to arm blocksCan be acute or chronic Result of direct contact or blowSigns of Injury Pain, swelling and hematomaIf repeated blows occur, heavy fibrosis and possibly bony callus could form w/in hematoma 2007 McGraw-Hill Higher Education
20、. All rights reserved.Contusion (continued)CareProper care in acute stage involves RICE for at least one hour and followed up w/ additional cryotherapyProtection is critical - full-length sponge rubber pad can be used to provide protective covering 2007 McGraw-Hill Higher Education. All rights reser
21、ved.Forearm FracturesCause of Injury Common in youth - due to falls and direct blowsFracturing ulna or radius singularly is rarer than simultaneous fractures to bothSigns of InjuryAudible pop or crack followed by moderate to severe pain, swelling, and disabilityEdema, ecchymosis w/ possible crepitus
22、Older athlete may experience extensive damage to soft tissue structures 2007 McGraw-Hill Higher Education. All rights reserved.CareRICE, splint, immobilize and refer to physician Athlete is usually incapacitated for 8 weeks 2007 McGraw-Hill Higher Education. All rights reserved.Colles FractureCause
23、of Injury Occurs in lower end of radius MOI is fall on outstretched hand, forcing radius and ulna into hyperextension 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Signs of Injury
24、 Forward displacement of radius causing visible deformity (silver fork deformity)When no deformity is present, injury may be passed off as bad sprainExtensive bleeding and swellingTendons may be torn/avulsed and there may be median nerve damageCareCold compress, splint wrist and refer to physicianX-
25、ray and immobilizationWithout complications a Colles fracture will keep an athlete out for 1-2 months 2007 McGraw-Hill Higher Education. All rights reserved.Anatomy of the Wrist, Hand and Fingers 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights re
26、served. 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Recognition and Management of Injuries to the Wrist, Hand and FingersWrist SprainsCause of Injury Most common wrist injuryArises from any abnormal, forced movementFalling on hyperex
27、tended wrist, violent flexion or torsionSigns of Injury Pain, swelling and difficulty w/ movement 2007 McGraw-Hill Higher Education. All rights reserved.CareRefer to physician for X-ray if severeRICE, splint and analgesicsHave athlete begin strengthening soon after injuryTape for support can benefit
28、 healing and prevent further injury 2007 McGraw-Hill Higher Education. All rights reserved.Scaphoid / Navicular FractureCause of InjuryCaused by force on outstretched hand, compressing scaphoid between radius and second row of carpal bonesSigns of Injury Swelling, severe pain in anatomical snuff box
29、CareMust be splinted and referred for X-ray prior to castingMay be missed on initial X-rayImmobilization lasts 6 weeks and is followed by strengthening and protective tapeWrist requires protection against impact loading for 3 additional monthsOften fails to heal due to poor blood supply 2007 McGraw-
30、Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Metacarpal FractureCause of InjuryDirect axial force or compressive forceFractures of the 5th metacarpal are associated w/ boxing or martial arts (boxers fracture)Signs of InjuryPain and swelling; poss
31、ible angular or rotational deformityPalpable defect is possibleCareRICE, refer to physician for reduction and immobilizationDeformity is reduced, followed by splinting - 4 weeks 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights reserved.Recognition
32、 and Management of Finger Injuries Mallet Finger Cause of Injury Caused by a blow that contacts tip of finger avulsing extensor tendon from insertionSigns of InjuryPain at DIP; X-ray shows avulsed bone on dorsal proximal distal phalanxUnable to extend distal end of finger (carrying at 30 degree angl
33、e)Point tenderness at sight of injuryCareRICE and splinting (in extension) for 6-8 weeks 2007 McGraw-Hill Higher Education. All rights reserved.Boutonniere DeformityCause of InjuryRupture of extensor tendon dorsal to the middle phalanxForces DIP joint into extension and PIP into flexionSigns of Inju
34、rySevere pain, obvious deformity and inability to extend DIP jointSwelling, point tendernessCareCold application, followed by splinting of PIPSplinting must be continued for 5-8 weeksAthlete is encouraged to flex distal phalanx 2007 McGraw-Hill Higher Education. All rights reserved.Gamekeepers Thumb
35、Cause of Injury Sprain of UCL of MCP joint of the thumbMechanism is forceful abduction of proximal phalanx occasionally combined w/ hyperextensionSigns of Injury Pain over UCL in addition to weak and painful pinchTenderness and swelling over medial aspect of thumbCareImmediate follow-up must occurIf
36、 instability exists, athlete should be referred to orthopedistIf stable, X-ray should be performed to rule out fractureThumb splint should be applied for protection for 3 weeks or until pain free 2007 McGraw-Hill Higher Education. All rights reserved. 2007 McGraw-Hill Higher Education. All rights re
37、served.Dislocation of PhalangesCause of Injury Blow to the tip of the finger (directed upward from palmar side Forces 1st or 2nd joint dorsallyResults in tearing of supporting capsular tissue and hemorrhagingPossible rupture of flexor or extensor tendon(s) and/or chip fractures may also occurCareRed
38、uction should be performed by physicianX-ray to rule out fracturesSplint for 3 weeks in 30 degrees of flexionInadequate immobilization may lead to instability or excessive scar tissue accumulationBuddy-tape for support upon return 2007 McGraw-Hill Higher Education. All rights reserved.CareSpecial co
39、nsideration must be given for thumb dislocations and MCP dislocationsMCP joint of thumb dislocation occurs with thumb forced into hyperextensionAny MCP dislocation will require immediate care by a physician 2007 McGraw-Hill Higher Education. All rights reserved.hTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0B3F
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