Elbow, Wrist, Hand Flashcards
what is the common extensor tendon
extensor muscles all attach here
what is the carrying angle
- where joint is created by the humerus axis and forearm axis during full extension in anatomical positiion
- commonly a valgus angle
- allows arm to swing without contracting the hip
Average valgus carrying angle or adults
Females –> 20 degrees
Males –> 15 degrees
- may contribute to UCL laxity
Common elbow fractures
- olecranon
- Radial head or neck
- distal humerus
MOI elbow fractures
- FOOSH to “break your fall”
- Hyperextension
- Direct impact, contact, trauma, direct fall on elbow
S&S elbow fractures
- swelling near back of elbow
- stiffness of elbow
- bruising around elbow/arm
- numbness or weakness in hand or fingers
- tenderness to touch
- pain with rotation of forearm
surgical vs. non-surgical elbow fractures
Surgical –> distal humerus, radial head
non-surgical –> Radial neck, olecranon
Risks with fracture
distal humerus - sharp fragments causing damage, leave athletes in comfortable position during transport
Radial head –> interarticular fracture - bone head splits can cause osteo issues, pin usually put in
S&S of elbow sprains and ligament tears
- localized pain
- point tenderness
- instability with stress test
MOI of elbow sprains and ligament tears
- fall on extended hand (hyperextension injury)
- valgus or varus force
- most common –> repetitive forces irritate and tear ligaments, mostly UCL (tommy john surgery)
-ulnar nerve may be affected - not urgent, no ER needed
Management of sprains and ligament tears
- ice
- rest
- active therapy/treatment
UCL injury
Chronic micro-tearing to UCL leading to rupture (3 degree)
Surgery required for UCL injury? give details
- surgery needed –> Tommy John, introduced by Dr. Frank Jobe
- graft from palmaris longus on same side as injury
- 1 year revcovery
- Graft is stronger than OG ligament
MOI olecranon bursitis
- fall on a flexed elbow
- constant leaning on elbow
- repetitive compression, friction
S&S olecranon bursitis
- tender, swollen, relatively painless
- may rupture
- 50% sudden onset, 50% gradual onset of a couple weeks
- limited flexion - tension increased over bursa
Management olecranon bursitis
- ice
-meds
-donut pad - possible doctor aspiration and/or cortisone
- surgical removal
Tendonitis - lateral epicondylitis, anatomy and common names
- extensor muscle strain at lateral epicondyle region
- common extensor tendon –> extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
- tennis elbow (outside)
- golfers elbow (inside)
MOI Tendonitis - lateral epicondylitis
- overuse of forearm extensor muscles –> overload of wrist extensor muscles, eccentric muscle weakness
- tennis elbow –> overuse of gripping and wrist movements (combo)
S&S Tendonitis - lateral epicondylitis
- long term symptoms, chronic
- pain with shaking hands, turn door handle, squeeze, grip
- strap/brace gives false insertion to reduce tension
Tendonitis - medial epicondylitis anatomy
common flexor tendon –> pronator teres, FCR, palmaris longus, FDS, FCU
MOI medial epicondylitis
- repeated valgus stress to elbow joint –> medial tension
- commonly overuse of forearm flexors –> repetitive loading of flexor forearm tendons
- AKA “little league elbow” or “golfer’s elbow”
S&S medial epicondylitis
- long term, chronic
- swelling, local tenderness
- pain at site and may radiate distally
- pain increases with activity, resistance or valgus stress
Radius fractures
Colle’s - radius bends backward
Smith - distal radius with some dislocation
Ulnar fractures
Ulnar styloid - usually give medial stability, pinned to fix
nightstick - direct impact, heals well
S&S Carpal bone fractures (scaphoid)
- history of FOOSH
- point tenderness in anatomical ‘snuff box’
- pain with upward pressure or compression along long axis
- increased pain with wrist extension and radial deviation
management Carpal bone fractures (scaphoid)
- standard acute –> splint
- physician referral, bone scan or CT scan
concern with Carpal bone fractures (scaphoid)
- non-union
- bone necrosis (death)
- needs surgery
wrist sprain anatomy
- 8 carpal bones –> complex arrangement (2 rows of 4)
- ~20 ligaments stabilize and support wrist
MOI wrist sprain
- FOOSH
- ‘jammed’ wrist, hyperflexion, hyperextension, radial/ulnar deviation
S&S wrist sprain
- minimal swelling, possible bruising
- painful and limited ROM
- grip weakness
- possible sense of popping, grinding
Management wrist sprain
- Ruling out fracture (doc referral, imaging)
- RICE
- OTS brace
- taping
- active therapy
types of hand fractures
Bennett’s fracture:
- articular fracture –> proximal end of metacarpal 1
Boxer’s fracture:
- neck of 4 or 5 (weakest) metacarpal
MOI bennett’s hand fracture
- axial compression,
- ‘Jam’ thumb
- immediate ER referral –> cast, surgery
MOI boxer’s hand fracture
- throw punch
- direct impact
- immediate ER referral –> cast, surgery
Anatomy of finger dislocations
- might involve collateral ligaments and volar plate
types of finger dislocations
- metacarpophalangeal (MCP) –> rare, easy to recognize, hyperextension or shear
- Proximal interphalangeal (PIP) –> most common, hyper extension and axial loading (ball hitting the finger)
- Distal interphalangeal (DIP) –> usually occur dorsally, reduced on its own
S&S finger dislocations
- tight
- local swelling
- pain
- restricted range
management finger dislocations
- immobilization (finger splint, tongue depressor)
- ice bath, hot wax bath
- physician referral (imaging to rule out intra-articular fracture)
Thumb sprains and anatomy
- skier’s or gamekeeper’s thumb
- Tear of ligaments at MP joint
mechanism and management of thumb sprain
- MP joint in extension and forceful abduction
- Doc referral –> imaging
mechanism and management of finger sprains (PIP joint)
- excessive valgus and varus –> collateral ligament sprains
- powertape, “buddy” taping, ice bath/massage
tendon rupture? what to do if they happen
- Jersey finger and mallet finger
- Let the AT know
- 9 days to get surgery after injury (if not tendon shrinks, tightens or recoils)
Jersey finger anatomy, mechanism, and management
- rupture of FDP from distal phalanx
- rapid, forced extension (from active flexion) –> grabbing a jersey
- can’t flex finger all the way
-surgery referral
Mallet finger anatomy, mechanism, and management
- Rupture of extensor tendon from distal phalanx
- can’t straighten finger
- might cause avulsion
- forceful flexion of distal phalanx
- surgery and possible plastic surgeon assessment
Carpal tunnel MOI
- Direct trauma
- Repetitive overuse (bad keyboard position)
- prolonged compression or sustained wrist flexion
carpal tunnel S&S
- pain at night –> relived when shaking hands
- pain, tenderness, tingling, burning on palm side of thumb, index and middle fingertip
- symptoms worsen if wrist is fully flexed or extended or with gripping
carpal tunnel managment
- conservatively (brace?)
- surgery if symptoms persist
