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76 Cards in this Set

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Bones of the elbow
-humerus
-radius
-ulna
humerus anterior
-Lateral epicondyle
-Capitulum
-Trochlea
-Coronoid fossa
-Medial epicondyle
humerus posterior
Lateral epicondyle
Capitulum
Trochlea
Olecranon fossa
Medial epicondyle
radius
head
neck
shaft
ulna
Olecranon process
Coronoid process
Shaft
joints of the elbow
humeroulnar
humeroradial
proximal radioulnar
humeroulnar joint
true hinge joint
flexion and extention only
humeroradial joint
capitulum of humerus and proximal radius
motion restricted to 2 degrees adjacent to humeroulnar joint
muscles acting on the elbow
Biceps brachii
Brachialis
Brachioradialis
Triceps brachii
Pronator teres
Supinator
Brachioradialis
Origin – distal humerus
Insertion – distal radius
Action – flex elbow in neutral position
Innervation – radial n. (C6)
Pronator teres
Origin – medial epicondyle
Insertion – radius
Action – pronate wrist
Innervation – median n. (C7)
Supinator
Origin – lateral epicondyle
Insertion – proximal radius
Action – supinate wrist
Innervation – radial n. (C6)
Bicep Brachii
Origin – short head = coracoid process; long head = glenoid
Insertion – proximal radius
Action – supinate wrist and flex elbow
Innervation – musculocutaneous n. (C6)
Brachialis
Origin – distal humerus
Insertion – proximal radius
Action – flex elbow
Innervation – musculocutaneous n. (C6)
Elbow Flexion
Brachialis >> biceps brachii>brachioradialis
elbow extension
triceps brachii
elbow pronation
-rotation of radius around ulna
-pronator=quadratus>pronator teres
elbow supination
supinator > biceps brachii
nerves of the elbow
musculocutaneous
median
radial
ulnar
triceps brachii
Origin – long head = glenoid; lateral & medial heads = posterior humerus
Insertion – proximal ulna
Action – extend elbow
Innervation – radial n. (C7-T1)
musulocutaneous nerve
motor - flexors of arm
sensory - lateral forearm
median nerve
motor - anterior forearm
sensory - laterl palm of hand, including thumb, index finger, middle finger, and lateral half of ring finger
radial nerve
motor - arm and forearm extensors
sensor - posterior arm and forearm
ulnar nerve
motor - forearm flexors
sensory - medial hand, including medial half of ring finger and little finger
throwing mechanics at elbow
-Significant phases for elbow motion = late cocking, acceleration, deceleration
-Most valgus stress in early acceleration
late cocking phase
Elbow flexion increases
Triceps higher activity than flexors
Wrist extensors active
acceleration phase
Elbow rapidly extends with strong triceps action
Strong wrist/finger flexor activity
deceleration phase
Elbow flexors reach peak intensity (eccentric)
Triceps activity diminishes rapidly
ulnohumeral dislocation
Deformity
Pain and swelling, particularly medially
loss of function
Considered medical emergency
R/O circulatory, nerve impairment
Immediate immobilization
Closed reduction under anaesthesia ASAP
radioulnar dislocation
Subluxed/dislocated radial head
Nursemaid’s or housemaid’s elbow
Pulled-elbow syndrome
Longitudinal traction on extended and pronated upper extremity
little league elbow
skeletally immature athlete
avulsion of medial epicondyle w/ 2 degree tension stress
LL elbow etiology
Cocking and acceleration phases cause considerable forces at elbow
-Medial = UCL injury, avulsion of medial growth plate, strain of flexor muscles, ulnar neuropathy
-Lateral = lateral epicondylitis, cartilage injury, loose bodies
-Follow through causes hyperextension
-Bone spurs, avulsion fracture
LL elbow signs and symptoms
Non-limiting ache during performance - limiting ache and post-activity ache
Localized tenderness, swelling, ecchymosis
LL elbow management
-“Crow-hop method”
-Curveball, slider, knuckleball, forkball developed after age 14 – 15
-2 appearances/week, 3 days rest in between
-Age 8-10 = 50 pitches/game
-Age 11-14 = 70 - 75 pitches/game
-Age 15-18 = 90 – 105 pitches/game
management 2
Activity modification (limit at home throwing)
Rest/immobilization X 2-3 weeks
No throwing for 12 weeks
Surgery if persistent medial instability/ulnar neuropathy
elbow tendonitis
Intrinsic factors
-Genetic predisposition
-Uncorrected sport-imposed deficiencies
-Muscular imbalance
-Joint laxity
Extrinsic factors
-Training errors
-Equipment
-Sport technique
-Environmental conditions
Medial epicondylitis
“Golfer’s elbow”
Valgus stress to medial elbow
Acceleration phase of throwing
Palpable tenderness @ and 1-2 cm distal to medial epicondyle
Pain with resisted wrist flexion
Pain with forearm flexor muscle stretch
Lateral epicondylitis
“Tennis elbow”
Eccentric overload to forearm extensor muscles
Deceleration phase of throwing
Faulty mechanics, poorly fitted equipment, age are contributing factors
Palpable tenderness @ and 1-2 cm distal to lateral epicondyle, radial head
Pain with resisted wrist extension
Pain with forearm extensor muscle stretch
Olecanon bursitis
“Student’s elbow”
Fall on flexed elbow, constant pressure, repetitive pressure/friction, repetitive flexion/extension, infection
50% trauma/acute onset; 50% insidious/chronic
Palpable tenderness and swelling @ olecranon
Medial/Ulnal collateral ligament sprain
-late cocking, acceleration phase of throwing
-ulnar nerve often involved
-tommy john surgery
Valgus extension overload syndrome
poor mechanics, infelxibility, fatigue
Ulnar neuritis
Associated with MCL sprain/rupture
Tensile stress along ulnar nerve
Positive Tinel’s sign
Tingling, numbness along medial forearm and into ring and little finger
Weak grip
Overuse elbow injury management
Inflammatory/pain control
-PRICEMM
Activity modification
Control/eliminate injury producing activity
Stretching/flexibility
Strengthening
Modify equipment, mechanics/technique
Bracing/taping
bones of the wrist and hand
Radius
Ulna
Carpals
Metacarpals
Phalanges
Carpals proximal row
scaphoid
lunate
triquetrum
pisiform
carpals distal row
trapezium
trapezoid
capitate
hamate
metacarpals
1-5, lateral to medial
Proximal end = base
Distal end = head (knuckle)
Shafts (bodies)
phalanges
Bones of the digits (miniature long bones)
Proximal end = base
Distal end = head
Thumb has 2, all others have 3
joints of the wrist and hand
Distal radioulnar
Radiocarpal
-TFCC
Carpometacarpal
Metacarpophalangeal
Interphalangeal
muscles acting of the wrist and hand
Extrinsic
Intrinsic
Flexor-pronator
Extensor-supinator
Retinacula
Tendon sheaths
movements of the wrist
sagittal plane - flexion and extension
frontal plane - radial and ulnar deviation
-circumduction
movements of the hand
Flexion/extension
-Fingers & thumb
Abduction/adduction
-Fingers & palmar
Opposition (thumb only)
nerves of the wrist and hand
median
ulnar
radial
median nerve
Motor = flexor muscles of wrist and hand, intrinsic flexor muscles on radial side of palm
Sensory = lateral 2/3rds of palm and dorsum of 2nd and 3rd fingers
ulnar nerve
Motor = portions of flexor muscles of wrist, most of intrinsic hand muscles
Sensory = 5th and half of 4th finger on both dorsum and palm
radial nerve
Motor (deep branch) = most of extensor-supinator muscle group
Sensory (superficial branch) = dorsum of hand
injuries to the wrist and hand
bone
ligament
tendon
nerve
fractures of the wrist and hand
radius
scaphoid
metacarpals
radius fractures
Colles’ fracture
-“dinner fork deformity”
-Within 1-1½ inches of wrist joint
-Distal segment displaces dorsally
Smith’s fracture
-Opposite of colles’
-Distal segment displaces volarly
-Median nerve injury associated
Surgery (ORIF) is often indicated
Scaphoid fracture
Fall on outstretched hand
Palpable tenderness @ anatomical snuffbox
Pain with wrist extension/radial deviation
Scaphoid fracture management
Nonunion or aseptic necrosis
Long-arm thumb cast - short-arm thumb cast - silicone spica splint
Bennett's fracture
1st metacarpal
Thumb hyperabduction
Pinning (< 3 mm) or ORIF
Boxer's fracture
5th metacarpal
Closed fist punch
Palpable deformity
Acute fracture management
Assess circulatory and nerve status
Ice, compression, immobilization
Splint/immobilize hand/fingers in position of function
Slight wrist extension
Slight finger flexion
sprain / dislocation
Wrist sprain/dislocation
Gamekeeper’s thumb
Finger sprain/ dislocation
wrist sprain / dislocation
Axial loading on proximal palm during fall with outstretched hand producing wrist hyperextension
Palpable tenderness, swelling
Pain with active or passive wrist extension
Marked deformity with dislocation
Ice, compression, immobilization
Pain/inflammation control
Brace/tape/splint as appropriate
gamekeepers thumb
aka “skier’s thumb”
Sprain of ulnar (medial) collateral ligament of MP joint of thumb
Forceful abduction of thumb away from hand
Palpable tenderness, swelling at MP joint
Pain with valgus stress
Manage by controlling pain/inflammation, taping, splinting
finger sprain/dislocation
-Excessive varus/valgus stress and hyperextension
-Injury often at proximal attachment of ligament
-Palpable tenderness, swelling, limited ROM
-Deformity with dislocation
-Assess neurovascular status
-Ice, compression, immobilization
-R/O fracture
-“Buddy taping”
strains of the wrist and hand
Tendon rupture
Jersey finger
Mallet finger
Boutonniere deformity
Tendonopathy
De Quervain’s
Trigger finger
Nerve entrapment
Carpal Tunnel
jersey finger
-Rapid, forceful extension of distal phalanx, avulsing/rupturing finger flexor tendon
-Inability to flex distal phalanx
-Surgery within 7-10 days to reattach tendon
Mallet finger
-Rapid, forceful flexion of distal phalanx, avulsing/rupturing finger extensor tendon
-Inability to extend distal phalanx
-Splint for 6-8 weeks in full extension
Boutonniere deformity
-Rapid, forceful flexion of PIP joint against resistance
-Rupture of extensor tendon at middle phalanx, leaving no active extensor mechanism over PIP joint
-Deformity develops over 2-3 weeks as flexors dominate, without extensor presence
-Splint in full extension for 6 weeks
Dequervain's tenosynovitis
-Common in racquet sports
-Repetitive use of thumb and ulnar deviation
-Excessive friction between 2 tendons sharing common sheath
-Palpable tenderness with painful thumb movements
-Pain reproduced with resisted thumb abduction and stretching wrist/thumb in ulnar deviation
-Pain/inflammation control, rest, activity modification
-Thumb spica splint immobilization
Trigger finger
Most common in ring and middle finger
Results in crepitus finger “locking” in flexion
Inflammation control, splinting
Steroid (cortisone) injection
Carpal tunnel syndrom
Compression of median nerve within carpal tunnel
Pain, numbness, tingling, burning on palmar aspect of thumb, index, middle finger
Diminished grip/pinch strength
Symptom reproduction with compression over carpal tunnel
carpal tunnel syndrome management
Splint wrist in slight extension, particularly at night
Inflammation control, activity modification
Steroid injection
Surgery