09-03 Elbow/Forearm/Wrist/Hand

Question 1

Olecranon Bursitis

Answer 1

• Cause: Superficial location extremely susceptible to injury [direct blow - banging elbow]
• Signs of injury: Pain, swelling, joint tenderness; appears spontaneously without usual pain and heat
• Care: Acute conditions - ice; Chronic cases require protective therapy; if swelling doesn’t resolve, aspiration may be necesary
• Can be padded in order to return to competition

Question 2

Contusion

Answer 2

• Cause: Vulnerable area due to lack of padding; Direct blow or repetitive blows
• Signs of injury: Swelling
• Care: RICE for at least 24 hours; If severe, refer for X-ray

Question 3

Elbow Sprain (collateral ligaments, usually MCL)

Answer 3

• Cause: Elbow hyperextension or valgus force [often seen in cock-up phase of throwing]
• Signs of Injury: Pain @ medial aspect of elbow; Inability to grasp objects [affects integrity of flexors]; Point tenderness over the MCL
• Care: RICE, elbow flexed at 90˚ in sling for 24 hours; Gradually regain elbow full ROM; Athlete should modify activity

Question 4

Lateral Epicondylitis (Tennis Elbow)

Answer 4

• Common Extensor Tendon: ECRB, ECU, EDC, EDM
• Lesser: Supinator, Anconeus
• Cause: Repetitive microtrauma to insertion of extensor muscles of lateral epicondyle; trauma from constant eccentric contraction [control again weight resistance]
• Signs of Injury: Aching pain after activity; Pain worsens and weakness in wrist and hand develop; Elbow has decreased ROM - pain with resistive wrist extension
• Care: RICE, NSAID’s and analgesics; ROM exercises and PRE, deep friction massage, hand grasping while in supination; avoidance of pronation motions; Mobilization and stretching; Use of counterforce or neoprene sleeve; Proper mechanics and equipment instruction
• LE Check: 2nd digit doesn’t hurt, check ECRL [base of 2nd digit]; 3rd digit does hurt, check ECRB [base of 3rd digit]

Question 5

Medial Epicondylitis (Golfer’s Elbow)

Answer 5

• Common Flexor Tendon: FCR, FCU, PL, FDS
• Not so much finger flexors as pronator teres
• Cause: Repeated forceful wrist flexion and extreme valgus torque of elbow
• Signs of injury: Pain with forceful flexion/extension; Point tenderness and mild swelling; Passive movement of wrist seldom elicits pain, but active movement does
• Care: Sling, rest, cryotherapy, heat through US; Analgesic, NSAIDs, Curvilinear brace below elbow to reduce elbow stressing
• Severe cases may require splinting and complete rest for 7-10 days

Question 6

Pushed Elbow

Answer 6

• FOOSH, Scaphoid fx

- Radius approximates into capitulum, radial nerve above annular ligament

Question 7

Pulled elbow

Answer 7

• Radius slips under annular ligament

Question 8

Ulnar nerve injury

Answer 8

• Common sites of nerve impingement: Ulnar Notch, Tunnel of Guyon [Handlebar palsy]
• Cause: Pronounced cubital valgus = deep friction problem; Ulnar nerve dislocation; traction injury; irregularities with tunnel; subluxation of ulnar nerve due to lax impingement, or progressive compression of ligament on nerve
• Signs of injury: Paresthesia in 4th and 5th fingers
• Care: Avoid aggravating condition; Surgery may be necessary
• Affects Hypothenar; Adductor Pollicis, Opponens Digiti Minimi, Lumbricals, Palmar Interossei, Dorsi Interossei

Question 9

Dislocation of elbow

Answer 9

• Cause: FOOSH with elbow extended or severe twist while flexed
• Signs: Swelling, severe pain, disability; Displaced backwards, forward, laterally; Complications with median, radial nerves and blood vessels; Rupture and tearing of stabilizing ligaments
• Care: Treat immobilization; Elbow should remain splinted in flexion for 3 weeks

Question 10

Wrist Fractures

Answer 10

• Colles’ Fx: Posterior displacement
• Smith’s Fx: Anterior displacement
• Lower end of radius/ulna
• MOI: FOOSH
• Signs of injury: Visible deformity [silver fork]; extensive bleeding/swelling; tendons may be torn/avulsed, maybe median nerve damage

Question 11

Wrist sprains

Answer 11

• Most common wrist injury; caused form any abnormal, forced movement
• Signs of Injury: Pain, swelling, difficulty with movement
• Care: RICE, splint, analgesics

Question 12

Carpal Tunnel Syndrome

Answer 12

• Cause: Compression of median nerve due to inflammation of tendons and sheaths of carpal tunnel; Repeated wrist flexion
• Signs of injury: Sensory motor deficits; weakness in thumb
• Care: Rest, immobilization, NSAIDs; corticosteroid injection

Question 13

Scaphoid Fx

Answer 13

• Cause: FOOSH, compress scaphoid between radius and 2nd row of carpals
• Signs of injury: swelling, severe pain in snuff box
• Care: Splinted and referred fo X-ray; immobilization lasts 6 weeks, followed by strengthening and stretching; protection against impact loading for 3 additional months

Question 14

Mallet finger

Answer 14

• Cause: Blow contact tip of finger avulsing extensor tendon
• Signs: Pain at DIP, avulsed bone on proximal distal phalanx; Unable to extend distal end of finger
• Care: Surgical repair or splinting

Question 15

Boutonniere Deformity

Answer 15

• Cause: Rupture of extensor tendon dorsal to middle phalanx; forces DIP into extension, PIP into flexion
• Signs: Sever pain; obvious deformity, inability to extend DIP; swelling
• Care: Cold app, splinting of PIP (5-8 weeks); Pt encouraged to flex distal phalanx

Question 16

Jersey Finger

Answer 16

• Cause: Rupture of flex digitorum profundus from insertion on distal phalanx; Often occurs with ring finger
• Signs: DIP cannot be flexed, finger remains extended; Pain and point tenderness over distal phalanx
• Care: Surgical repair, 12-week rehab; can use fluidotherapy for treatment