Elbow to Hand Flashcards
Medial epicondyle =
flexors
Lateral epicondyle =
extensors
How many ROM at PIP and DIP?
2
How many ROM at wrist?
6
How many ROM at elbow?
4
How many ROM at MCP?
- 4 at fingers
- 5 at thumb
What is the 5th ROM for the thumb at the MCP?
- Diagonal motion
- Opposition
- What allows you to make grips with fingertips
- 5th ROM
- Only done actively
- 5 ROM at MCP of thumb
Flexion of the fingers is…
bringing the fingers into the palm
Extension of the fingers is …
fingers away from the palm
Adduction of the fingers is…
bringing fingers together
Abduction of the fingers is…
spreading fingers apart
Muscles at front of arm in anatomical position are…
flexors
Wrist flexors generally start at the…
medial epicondyle (common flexor origin)
Muscles at back of arm in anatomical position are…
extensors
Wrist extensors generally start at the …
lateral epicondyle (common extensor origin)
Describe the base of the thumb muscles.
- Make movement of thumb more controlled: thenar eminence
- 3 muscles
Describe the base of the pinky muscles.
- Hypothenar eminance
- 3 muscles
What are PAD muscles?
Muscles on palm side of hand and adduct fingers together
What are DAB muscles?
Muscles on dorsal (back) of hand abduct fingers apart
The brachial artery splits into what?
- radial artery
- ulnar artery
Where does the radial nerve run?
posterior surface of arm: triceps, extensor etc.
Where does the median nerve run?
anterior surface of arm, down to thumb, index, and middle finger
Where does the ulnar nerve run?
medial surface of arm down to pinky and ring fingers
What is the special condition for the elbow and hand?
carrying angle
Describe carrying angle.
- Carrying angle
- Stand, put arms in anatomical position
- Arm straight down = 0 degrees, any deviation
- In most people : 15 degrees
- Arms do not run into legs when walking
- Carrying things won’t run into body
Lateral and medial epicondylitis are considered ______ injuries.
Overuse
Medial epicondyle is commonly known as …
golfer’s elbow
Lateral epicondyle is commonly known as …
tennis elbow
Why can’t we use the terms golfer’s elbow and tennis elbow?
they can change based on MOI
Wrist flexors are working too much =
inflammation at medial epicondyle
Wrist extensors are working too much =
inflammation at lateral epicondyle
Which epicondylitis is more common?
lateral
What are the signs and symptoms of lateral and medial epicondylitis?
- Low grade chronic local inflammation
- Movement causing the muscles to contract will be painful
- Pain with palpating muscles: tight and sore
- Can get irritation of ulnar nerve with medial epicondylitis
Continued epicondylitis can lead to …
- Can gradually decrease their ROM at the elbow
- Can make it harder to flex or extend the elbow fully
What are the 4 general stages of overuse injuries?
- Stage 1: Starts only being painful after activities
- Stage 2: Starts being painful at end of event and after
- Stage 3: Starts affecting their performance, painful during as well as after
- Stage 4: Hurts all the time
Give an example of correcting faulty mechanics that cause epicondylitis.
somebody who plays tennis and does more wrist movement than arm movement
How do we manage lateral or medial epicondylitis?
- correct faulty mechanics
- Calm down symptoms
- Calm down swelling, spasm, pain
Describe the braces that people often wear when they have lateral or medial epicondylitis?
- Straps that go around
- Bubble that goes overtop point of pain
- Won’t actually solve problem
- Designed to put pressure just below where you have pain, so that the part above that is now not working
- Solves pain issue, but not actually doing anything else
- Can cause the next part to be tight/painful
What is the special test for epicondylitis?
stretch the muscles that would be tight
Describe the lateral epicondylitis test.
- Extensors
- Arm straight
- Flex wrist
- Hand overtop
- Positive: pain at lateral epicondyle (not stretching)
Describe the medial epicondylitis test.
- Flexors
- Straight arm
- Extend wrist and fingers
- Hand overtop
- Positive: pain at medial epicondyle (not stretching)
Why is the elbow the strongest joint in the body based on only bone structure? What does this mean for injury to it?
- Fits together like a tight puzzle
- Requires the most violent force to dislocate
What is the MOI for elbow dislocation?
- Foosh when arm is already in hyperextension
- Arm in flexion, violent twist
What is the most common direction to dislocate the elbow?
- Most common to pop ulna out backwards
- Can go in any other direction depending on force but not that common
Dislocating the elbow usually comes with …
- Complete rupture of all of our ligaments, most of muscles
- Common to fracture radial head
- Dislocation backwards means it rams into humerus
Do elbows sublux?
no, need to go to hospital to put back in place
What are the signs and symptoms of a dislocated elbow?
- Lots of bruising and bleeding
- Lots of blood flow in front of elbow
- Lots of swelling
- Very common to have nerve symptoms down the hand
- Tingling
- Numbness
- No pulse = ambulance
- Tingling and numbness = ambulance
- Almost always call ambulance
How do we manage elbow dislocations?
- Surgically repaired
- Very lucky to get them back to 80% ROM and 80% strength
- 2 years recovery
- 2 seasons or career ending
What is the MOI for olecranon bursitis?
- Hit elbows lots
- Bursa on elbow
- Using elbows as leverage tool at work
- Overuse injury
- ***Exception of 1 acute trauma
What is the exception of 1 acute trauma for olecranon bursitis?
- Ex. falling on elbow in hockey with no elbow pads
- Active acute bursitis
- Amount of trauma can almost rupture bursa
- Needs to be drained
What are the signs and symptoms of olecranon bursitis?
- Inflammation at bottom of elbow
- Causes pain
- Every time you hit elbow = pain
How do we manage chronic olecranon bursitis?
- Decrease swelling
- Decrease pain
- Current
- Laser
- Elbow can permanently look like that from scar tissue buildup
How do we manage acute olecranon bursitis?
Drain in arm that continues to drain fluid
Fractures are specific to the …
radius and ulna
Where do the radius and ulna fracture?
- can do one or both
- can fracture anywhere along the bone due to the amount of trauma they see
Mid shaft fractures of the radius and ulna is a result of a ….
direct blow
What can FOOSH do to the radius and ulna?
- can crush bones up and down
- fractures at top or bottom
Why are the radius and ulna often displaced when fractured?
Lots of muscles that can create lots of force can displace bones, pull it out of place
What are the signs and symptoms of radius and ulna fractures?
- Will always see a deformity
- Arteries and nerves run right next to the bones, can disrupt these
- Bleeding, lack of pulse
- Tingling, numb
How do we splint radius and ulna fractures?
in the position we find them
How do we manage radius and ulna fractures?
- X rayed multiple times to make sure everything is back in the right spot
- Might have pins and plates if they can’t get bones to stay together
- Likely to have temporary pins and plates, will be removed
- Braced or casted for a period of time
- Need to get ROM and strength back
What are the complications that can arise from using pins and plates for radius and ulna fractures?
- Pins and plates will generally restrict ROM (less active, less healing)
- superficial pins and plates: can have problem with electric current on it
What is the special test for radius and ulna fractures?
- Compression
- Tuning fork
How does the tuning fork work?
- Creates vibration that travels through bone
- Helps find fractures, finds if they are healed
What is the MOI for muscle strains and ruptures in the wrist and forearm?
Violent contractions or violent stretches of muscles beyond ROM
What are the signs and symptoms of a grade 1 muscle strain in the wrist and forearm?
- Mild
- Mild symptoms
- Stretching
What are the signs and symptoms of a grade 2 muscle strain in the wrist and forearm?
- Damage
- Tearing
- Loss of function (muscle contraction)
What are the signs and symptoms of a grade 3 muscle rupture in the wrist and forearm?
- Rupture
- Very difficult to do this because there are so many muscles helping each other out
- Generally a direct blow or avulsion fracture (fracture off tendon attachment)
What is the special test for muscle strains and ruptures in the wrist and forearm?
resisted ROM
What is resisted ROM testing?
- Pain = 1st degree
- Pain + lack of strength = 2nd degree
- No strength = 3rd degree
How do you manage muscle strains and ruptures in the wrist and forearm?
- Surgically repaired for ruptures
- Work on ROM
- Work on strength
- Dexterity
Describe dexterity.
- Ability to do pincer or whole hand grips
- Fine tuning of movement
Describe the ligaments of the elbow.
- Annular ligament goes around the head of the radius and holds it to the ulna
- Ulnar ligament
- Radial ligament
Describe the ligaments of the wrist.
- Most ligaments are called where they are
- Ulnar ligament (medial side in anatomical position)
- Radial ligament (lateral side in anatomical position)
Describe the ligaments of the fingers.
- Ulnar collateral ligament on medial side of each finger
- Radial collateral ligaments on each finger
- Ligaments on front and back surfaces
- Volar ligaments on front (palm side)
- Dorsal ligaments on posterior side of hand
- Can sprain any depending on MOI
What is the MOI of elbow sprains?
- valgus force or varus force
- Valgus force more common
- Only sprain in the body that is related to overuse
What people often sprain their ulnar collateral ligament?
- baseball pitchers
- Throwing a baseball is valgus force on ulnar collateral ligament
- Can create ulnar collateral ligament sprain from just one trauma, but most pitchers will see it from multiple traumas
What is Tommy John surgery?
Replacing and reinforcing the ulnar collateral ligament
What is the most common MOI of wrist sprains?
fall into hyperextension
Describe what is sprained in the wrist when falling into hyperextension.
- Will sprain any ligament on the front side
- If they have a little bit of radial or ulnar deviation we can see collateral ligament sprains as well
Describe finger sprains.
- Some sort of force that looks like dislocation force (varus, valgus)
- Jammed straight down will still create a sprain
- 1st, 2nd, 3rd degree
How do we manage elbow, wrist, and finger sprains?
- immobilize for a longer period of time
- difficult to put modalities on them (esp. finger)
- tend to use laser, manual therapy
- cross friction to break down scar tissue
- normal rehab at elbow and wrist
Why do we immobilize elbow, wrist, and finger sprains for a longer period of time?
- to make them scar down so that they are stable in
that joint - Doesn’t mean that they are restricted from play
- Keep joint in tight position
Why do we use laser and manual therapy for elbow, wrist, and finger sprains?
Want scar tissue to begin with, but want them to go down eventually
What will too much scar tissue after elbow, wrist, and finger sprains do?
- decrease ROM
- If fingers can’t come together, they are weaker
Describe what normal rehab at elbow and wrist look like.
- Make them as strong as you possibly can
- Work on ROM
- Make sure they have full ability to do their sport
- Make sure they still have their dexterity
- Make sure they still have sensation in all fingers
- Tend to have less impact on cardio, flexibility, and proprioception
What is the special test for elbow, wrist, and finger sprains?
varus and valgus stress test
Describe varus and valgus stress tests.
- Only done in full extension
- 1st degree: just pain, no laxity
- 2nd degree: pain and laxity
- 3rd degree: no pain, lots of laxity
- 3rd degree finger sprain is typically a dislocation
Why are varus and valgus stress tests different in the wrist and fingers?
- because they have that ROM
- Take them to the end of their ROM and then do the stress test
What is the MOI of carpal tunnel syndrome?
- Overuse at the wrist
- repetitive movement at the wrist (generally wrist flexion)
- Or repeated contusion trauma
Wrist pain is usually diagnosed as …
carpal tunnel syndrome
What is happening anatomically for someone with carpal tunnel syndrome?
- Happens specifically at the carpal tunnel
- At crease in wrist
- Carpal bones
- Sheath of muscle around
- Bones and muscle form tunnel with nerves and vessels passing through
Describe the inflammation that blocks the carpal tunnel.
- One or more of the tendons are inflamed
- Or inflammation because of some sort of contusion
What nerves come through the carpal tunnel?
- Ulnar nerve
- median nerve
What are the signs and symptoms of carpal tunnel syndrome?
- Pins and needles or numbness in hand from inflammation
- Nerve symptoms can be sensory or motor (can’t move or decreased strength)
- Pain at the tunnel
- Generally gets to the stage where they have decreased sensation or motor function at the hand
How do we manage carpal tunnel syndrome?
- Correct faulty biomechanics
- Decrease inflammation that is causing the symptoms
- Current
- Laser
- Ultrasound
- Usually can’t stop the inflammation/action
Describe carpal tunnel surgery.
- Designed to relieve the symptoms but not necessarily correct the problem
- Cut retinaculum at top to relieve pressure
- Loosen anything that is stuck together
- Doesn’t actually solve the problem why they have it in the first place
- Doesn’t get rid of the inflammation
- Decrease scar tissue from where they did surgery
What is the special test for carpal tunnel syndrome?
phalens test
Describe the phalens test.
- Wrists together so they flex carpal tunnel
- Hold this position for a minute
- Positive: Pain in the wrist
- Positive: Sensory of motor symptoms into hands
What is false carpal tunnel syndrome?
- Pain at front of forearm and wrist
- Can give you neurological symptoms down arm
- Not caused by MOI directly to the wrist
- Tightness in neck, shoulder, traps that presses on a nerve can send symptoms down arm
- Referred pain
- Ex. concert pianist, secretary
What is the most common fracture in the wrist?
- scaphoid fracture
- Very common in skiers and snowboarders (thumbs down first)
Describe the location and shape of the scaphoid.
- Bone in the middle of anatomical snuff box
- Scaphoid is shaped like a bowtie
- 2 different pieces: easy to fracture down the middle
- very difficult to see on x ray
- less blood supply to that part of the bone (thin bone)
What is the MOI of a scaphoid fracture?
- FOOSH
- Generally more of their weight on the front side
- Putting pressure on the scaphoid bone
Why is having a thin scaphoid a problem?
- Decreased healing ability = necrosis (tissue break down)
- Bone physically breaks down between 2 pieces of scaphoid = scaphoid permanently in 2 pieces
What are the signs and symptoms of a scaphoid fracture?
- Decreased ROM in all planes
- Pain in snuff box with movement in thumb
- Bruising on base of thumb (palm)
How do we manage scaphoid fractures in a cast?
- Forearm cast up to thumb
- Cast for generally 6 weeks
- No movement in thumb or only at IP joint
- Get bones lying close as they can
- Re x ray every couple of weeks for 6 weeks to make sure that healing is proper
How do we manage scaphoid fractures once the cast is off?
- Once cast is off, increase ROM, increase strength in wrist as well as both of their thumb joints
- Do all regular modalities once out of cast
- Generally do not ultrasound over fractures or healed fractures for at least a year
What would having 2 separate pieces of scaphoid do?
could decrease some ROM but won’t affect lifestyle too
much
What is the special test for scaphoid fractures?
long bone pressure
Describe the long bone pressure test.
- Bend thumb and mcp and push down
- Positive: pain where scaphoid is
Fractures of MCP, PIP, and DIP joints =
- broken
- little pieces of bone could be floating around
Dislocation of MCP, PIP, and DIP joints =
separation
_____ and ______ of MCP, PIP, and DIP joints usually come together.
fractures and dislocations
______ are easier to deal with in the hand than _______.
dislocations, fractures
What is the MOI of MCP, PIP, and DIP dislocations?
- generally a force to any one of sides
- Biggest dislocations with varus or valgus force at one joint
What is the MOI of MCP, PIP, and DIP fractures?
- axial load
- Load going straight down through the bone
What is the MOI of MCP, PIP, and DIP dislocations and fractures?
rotation
Pushing on a fractured bone in the hand usually…
moves fracture
How will most people try to relocate their own fingers?
- One pull from the end
- Still need to go to the hospital to make sure nothing is fractured, everything is in the right place
How do we manage MCP, PIP and DIP dislocations?
- Put bones back together, stabilize until it scars
- not necessarily be mandatory stabilized
How do we manage MCP, PIP and DIP fractures?
- mandatory immobilization
- Usually plastic splints (used to be metal)
Why do we use plastic splints?
- Easier to not have to take off if they have to x ray again
- Protects whole finger
What are the rules for finger taping?
- Can’t leave pinky out by itself
- Must be taped 4-5, 2-3
- Can put 3-4-5 if needed
- Not allowed to tape finger by himself for 6-8 weeks
How long does the MCP, PIP, and DIP joints take to heal?
- Average of 6 weeks to heal joint
- Can be 8 weeks if more complicated
- Must tape their fingers together or wear brace for this period
- Can take it off and work on ROM after week 2-3
- Tend to be long standing because people don’t tend to rehab or take care of them
What ROM exercises should we do for MCP, PIP, and DIP joints?
- Both flexion and extension
- More concerned about full extension (muscles that do this are not as strong)
- More flexion activities with hand, but have big impact on life if they can’t extend fingers
- Use elastic band for exercises
What is the special test for dislocations of the MCP, PIP, and DIP joints?
no special test
What is the special test for fractures of the MCP, PIP, and DIP joints?
- Palpating
- Tuning fork
What happens in jersey finger?
strain to the flexor tendon
What is the MOI for jersey finger?
finger gets caught and pulled into extension
What are the signs and symptoms of a grade 1 jersey finger?
- Mild
- Stretch
- Can physically move it
- Pain in palm surface of finger that was affected
What are the signs and symptoms of a grade 2 jersey finger?
- Torn part of it
- Decreased ability to flex finger
What are the signs and symptoms of a grade 3 jersey finger?
- Rupture
- Usually ruptures from top of proximal phalange
- Physically can not flex finger
- Gets surgically repaired
How do we manage jersey finger?
- 3rd degree held in a brace in almost dislocation
- 2-3 weeks then exercises ROM, but put brace back on after
What is gamekeeper’s thumb also known as? What is happening?
- skier’s thumb
- Ex. ski poles get stuck, hands keep going forward
- Sprain to ulnar collateral ligament of MCP of thumb
- On web-side of thumb at MCP joint
What is the MOI of gamekeeper’s thumb?
abduction of MCP at thumb
What are the signs and symptoms of a grade 1 gamekeeper’s thumb?
- Mild
- Pain
- Local inflammation
What are the signs and symptoms of a grade 2 gamekeeper’s thumb?
- Tearing
- Laxity
What are the signs and symptoms of a grade 3 gamekeeper’s thumb?
- Rupture
- Rare to surgically repair because web will make sure thumb doesn’t go too far
How do we manage gamekeeper’s thumb?
As much strength in thenar eminence as we can so that we can make thumb movements as strong as possible
What is the special test for gamekeeper’s thumb?
valgus stress test
Describe the valgus stress test for gamekeeper’s thumb.
- 1st degree: Pain
- 2nd degree: Pain with laxity
- 3rd degree: Only laxity
Why do we avoid metal for splints?
- On route to hospital: needs to be removed for x-rays = uncomfortable
- Comfort: metal gets cold
- Usually only taped or plastic
- We can melt and mold plastic
What are we concerned about in rehab of the hand?
- grip strength
- finger dexterity
