Chapter 12 Elbow, Forearm, wrist, and hand - PowerPoint Presentation

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Chapter 12

Elbow, Forearm, wrist, and hand

Educational Objectives

Understand

Anatomy of the elbow, forearm, wrist, and hand

Principles of rehab exercises

Preventive/supportive techniques and protective devices

Identify

components of evaluation format

Recognize

the common injuries

Anatomy

ELBOW

P

ermits

movements of flexion, extension, pronation, and supination.

Delivers and receives accidental blows that can cause bruising, fracture, dislocation or nerve damage.

Excessive stress are placed on elbow in throwing and racquet sports

Anatomy

Humerus

-

largest bone of the upper extremity.

-two articulating condyles at distal end

Ulna-

remains stationary

Radius-

rotates on the ulna as the forearm, wrist, and hand pronate and supinate. The proximal end has a bony protuberance called the olecranon process.

olecranon

process articulates with the proximal radius.

Ligaments, Tendons,

Joints

Very strong ligamentous and muscular support

Attach at the condyles of the

humerus

Medial condyle articulates with the ulna for flexion and extension

Lateral condyle articulates with the radius for pronation and

supination

Ligaments, Tendons, Joints

-

JOINTS

Humeroulnar

Humeroradial

-

LIGAMENTS

Ulnar collateral

Radial collateral

Annular ligaments-adds elbow stability, attaches to the ulna and completely encircles the head of the radius. Helps keep the radius and ulna from separating.

Medial collateral-attached to the

humerus

and the ulna

Lateral

collateral-attached

to the

humerus

and the radius

Muscles-

control

forearm and elbow’s movement

Control

elbow-

Originate

above the elbow on the

humerus

and the scapula.

Biceps

Triceps

Brachialis

Control

forearm, wrist, and

fingers

-

originate on the two epicondyles of the

humerus

.

Flexor carpi

radialis

(flexion and pronation)

Flexor carpi

ulnaris

(flexion and pronation)

Flexor

digitorum

sublimis

(flexion and pronation)

Flexor

pollicis

longus

(

flextion

and pronation)

Extensor

digitorum

communis

(extension and supination)

Extensor carpi radials

longus

and

brevis

(extension and supination

)

Extensor carpi

ulnaris

(extension and supination

)

Extensor

pollicis

longus

(extension and supination)

Tests Elbow

Test for collateral ligaments stability

Valgus or abduction stress-(medial collateral)

Varus

or adduction stress-(lateral collateral)

Epicondylitis

tests-lateral

Resisted wrist extension

Resisted long finger extension

Palmar flexion-pronation stretch

Epicondylitis

tests-medial

Resisted wrist flexion

Wrist extension-supination stretch

Wrist test

Bony integrity tests

Anatomical snuffbox compression-fracture of scaphoid

Murphy’s sign-dislocation of lunate

Common injuries

sprains: 1

st

, 2

nd

, and 3

rd

degrees

Olecranon

brusitis

: inflammation to the olecranon bursa. (direct blow or overuse) Referral, after evaluated basic treatment.

Carpal tunnel syndrome: pressure on the median nerve caused by constriction in the carpal tunnel. Treatment: wrist splints, rest, and medication. Medical re-evaluation is doesn’t get better.

Scaphoid fracture: (

navicular

) fall extended wrist. Poor blood supply. Severe pain, medical treatment required.

Dislocation/subluxation: force placed on a outstretched hand with elbow in extension. Always suspect a fracture. Medical referral.

Epicondylitis

: inflammation of the epicondyle and the tissues adjoining the

humerus

. Elbow joint medial (pitches elbow) and lateral (tennis elbow)

Contusion

Subungual

hematoma: fingernail receives a contusion (bruise), accumulation of blood under the fingernail. Ice and medical referral if swelling is severe.

Rehabilitation

ROM

Elbow: flexion, extension, supination, pronation

Wrist: flexion, extension, radial deviation, ulnar deviation, supination, pronation

Fingers: flexion, extension, abduction, adduction, opposition

Resistance/strengthening exercises

Elbow: arm flexion (bicep curls) arm extension (triceps extension)

wrist, hand, fingers: hand squeeze, finger abduction, pinch grip, lateral/key pinch grip

Return to competition guidelines

Full ROM

Strength, power, and endurance according to athlete and sport

No pain in upper extremity during running, jumping,

or cutting