111

Injuries to the Arm, Injuries to the Arm, Wrist, and HandWrist, and Hand

PE 236PE 236Juan Cuevas, ATCJuan Cuevas, ATC

222

Anatomy ReviewAnatomy Review

The bones The bones of the arm of the arm are the are the ________, ________, radius, radius, and ____.and ____.

33

Anatomy Review Anatomy Review (continued)(continued)

Joints of the arm allow _______/extension Joints of the arm allow _______/extension and pronation/__________ at the elbow.and pronation/__________ at the elbow.

Joints of the wrist allow flexion/extension Joints of the wrist allow flexion/extension and radial & ulnar deviation.and radial & ulnar deviation.

44

AnatomyAnatomy

55

Anatomy Review Anatomy Review (continued)(continued)

668

Soft Tissue Injuries to Soft Tissue Injuries to the Upper Armthe Upper Arm

Contusions and FracturesContusions and Fractures

Such injuries are common in contact Such injuries are common in contact sports.sports.

Muscle tissue is compressed between skin Muscle tissue is compressed between skin and bone.and bone.

Repeated episodes can result in Repeated episodes can result in myositis ossificans _____________.myositis ossificans _____________.

77

Soft Injuries to the Upper Soft Injuries to the Upper Arm (continued)Arm (continued)

Myositis Ossificans TraumaticaMyositis Ossificans Traumatica

Chronic inflammation of the muscle that Chronic inflammation of the muscle that results in the development of _______ tissue results in the development of _______ tissue within the muscle. within the muscle.

Myositis ossificans traumatica develops Myositis ossificans traumatica develops over weeks or months and is often over weeks or months and is often ignored during the early stages.ignored during the early stages.

8813

Fractures of the Fractures of the Upper ArmUpper Arm

Although rare, such fractures may be associated Although rare, such fractures may be associated with activities that involve ________ between with activities that involve ________ between participants or high speed falls.participants or high speed falls.

Signs and symptoms include:Signs and symptoms include:

Severe pain in upper arm.Severe pain in upper arm. _________ & loss of function and unwillingness to _________ & loss of function and unwillingness to

use arm.use arm. Muscle spasm.Muscle spasm. Athlete reports an audible snap or pop at the time of Athlete reports an audible snap or pop at the time of

injury.injury. Sensory loss in forearm, if radial nerve is affected.Sensory loss in forearm, if radial nerve is affected.

99

1010

Fractures of the Upper Fractures of the Upper Arm (continued)Arm (continued)

First aid includes:First aid includes:

Immediate application of ice Immediate application of ice and compression.and compression.

Properly constructed splint.Properly constructed splint. ________________ bandage. ________________ bandage. Treatment for shock and Treatment for shock and

transport immediately to transport immediately to medical facility.medical facility.

1111

Elbow InjuriesElbow Injuries

Sprains and DislocationsSprains and Dislocations

The three joints that comprise the elbow are The three joints that comprise the elbow are bound together by several ligaments.bound together by several ligaments.

Ulnar & radial collateral ligaments protect elbow Ulnar & radial collateral ligaments protect elbow from valgus and varus forces.from valgus and varus forces.

(_____________)(_____________) Sprains also result from both valgus and varus Sprains also result from both valgus and varus

forces that occur as the arm is trapped in a forces that occur as the arm is trapped in a vulnerable position.vulnerable position.

Elbow dislocations constitute extreme _______.Elbow dislocations constitute extreme _______.

1212

Ligament InjuriesLigament Injuries Ulnar Collateral Ligament tearUlnar Collateral Ligament tear

Overuse injuryOveruse injury ___________ pitchers___________ pitchers

Signs and SymptomsSigns and Symptoms ________ elbow pain________ elbow pain Pop sensationPop sensation Medial elbow swelling Medial elbow swelling

TreatmentTreatment SURGERY – “___________”SURGERY – “___________”

• Elbow ligament reconstructionElbow ligament reconstruction

131316

Elbow Dislocations Elbow Dislocations (continued)(continued)

Mechanism for this Mechanism for this injury includes falling injury includes falling either on a flexed or either on a flexed or fully extended arm. fully extended arm. The deformity is The deformity is usually obvious. usually obvious. (___________)(___________)

1414

1515

Elbow Dislocation Elbow Dislocation (continued)(continued)

First aid includes:First aid includes:

Application of ice & Application of ice & compression.compression.

Application of splint Application of splint & sling-and-swathe & sling-and-swathe bandage.bandage.

Monitoring distal Monitoring distal pulse.pulse.

Treatment for _____.Treatment for _____. Summon EMS.Summon EMS.

1616

Elbow / Forearm Elbow / Forearm FracturesFractures

Signs and symptoms include:Signs and symptoms include:

Recent history of elbow trauma.Recent history of elbow trauma. Significant pain and _____________.Significant pain and _____________. Immediate swelling.Immediate swelling. Deformity in cases of displaced fractures.Deformity in cases of displaced fractures.

If forearm feels cold & clammy, and the athlete If forearm feels cold & clammy, and the athlete reports numbness in the hand, the forearm’s reports numbness in the hand, the forearm’s blood supply is ______________.blood supply is ______________.

1717

181821

Elbow Forearm Elbow Forearm Fractures Fractures

(continued)(continued)First AidFirst Aid

Immediate application of ice, but Immediate application of ice, but avoid avoid compressing the jointcompressing the joint..

Application of _____ (avoid moving elbow Application of _____ (avoid moving elbow bones) and support of the arm in a sling.bones) and support of the arm in a sling.

Treatment for shock.Treatment for shock. Arrange for transport to medical facility.Arrange for transport to medical facility.

191922

Epicondylitis of the ElbowEpicondylitis of the Elbow

Medial epicondyle is the Medial epicondyle is the attachment site of the forearm attachment site of the forearm _______ and ulnar collateral _______ and ulnar collateral ligament.ligament.

Lateral epicondyle is the Lateral epicondyle is the attachment site of forearm attachment site of forearm _________ and radial collateral _________ and radial collateral ligaments.ligaments.

Sports that require gripping Sports that require gripping combined with wrist movements combined with wrist movements place much stress on the place much stress on the epicondylar region.epicondylar region.

202023

Epicondylitis of the Epicondylitis of the ElbowElbow

(continued)(continued) Little League baseball pitching (“______________”) and Little League baseball pitching (“______________”) and

golf (“golfer’s elbow”) associated with medial epicondyle golf (“golfer’s elbow”) associated with medial epicondyle injury.injury.

““____________________________” involves the lateral humeral epicondyle ” involves the lateral humeral epicondyle and the tendon of the extensor carpi radialis brevis muscle. and the tendon of the extensor carpi radialis brevis muscle.

• Factors include:Factors include: excessive number of strokes.excessive number of strokes. incorrect technique.incorrect technique. racket handle that’s too small.racket handle that’s too small. change in racket materials.change in racket materials. grip that’s too tight.grip that’s too tight. muscle imbalance.muscle imbalance.

2121

Epicondylitis of the Epicondylitis of the ElbowElbow

(continued)(continued)Signs and symptoms Signs and symptoms

include:include:

Pain and swelling in the Pain and swelling in the region of one or both region of one or both epicondyles.epicondyles.

Pain that worsens with Pain that worsens with activity.activity.

First aid is not First aid is not practical, but if practical, but if symptoms worsen:symptoms worsen:

Apply ice and Apply ice and compression.compression.

Refer to physician if Refer to physician if pain persists.pain persists.

222227

Elbow Injuries Elbow Injuries (continued)(continued)

Contusions of the ElbowContusions of the Elbow

Blows to the elbow are common; the Blows to the elbow are common; the majority result in temporary symptoms.majority result in temporary symptoms.

Exception involves the __________ bursa.Exception involves the __________ bursa.

Repeated irritation of the bursa can result Repeated irritation of the bursa can result in inflammation (Olecranon ________).in inflammation (Olecranon ________).

2323

Contusions of the Contusions of the Elbow (continued)Elbow (continued)

Signs and symptoms include:Signs and symptoms include: Swelling around the olecranon Swelling around the olecranon

process.process. Pain and stiffness, especially when Pain and stiffness, especially when

elbow is ___________.elbow is ___________. Elevated skin temperature over Elevated skin temperature over

olecranon process, skin may be taut, olecranon process, skin may be taut, and joint may show signs of internal and joint may show signs of internal hemorrhage.hemorrhage.

First AidFirst Aid Apply ice and compression.Apply ice and compression. In cases of bursitis, refer to a In cases of bursitis, refer to a

physician.physician.

2424

252529

Wrist and Forearm Wrist and Forearm InjuriesInjuries

2626

272730

Wrist and Forearm Injuries Wrist and Forearm Injuries (continued)(continued)

Anatomy of the wristAnatomy of the wrist Complex structure due to small size and Complex structure due to small size and

large number of tendons that serve the large number of tendons that serve the ______________________________.______________________________.

Major vessels and nerves pass through Major vessels and nerves pass through this region.They are:this region.They are:• Ulnar and radial arteries and veins.Ulnar and radial arteries and veins.• Ulnar, __________, and radial nerves.Ulnar, __________, and radial nerves.

282831

Wrist and Forearm Wrist and Forearm Injuries (continued)Injuries (continued)

Distal forearm fractures Distal forearm fractures are rare in sports.are rare in sports.

_________ fracture, _________ fracture, a a transverse fracture of transverse fracture of the ____________,the ____________, is is the most serious.the most serious.

2929

Colles’ FractureColles’ Fracture

Signs and symptoms include:Signs and symptoms include:

History of significant trauma.History of significant trauma.

Deformity; severe swelling that may affect hand Deformity; severe swelling that may affect hand and fingers; severe pain; and significant loss of and fingers; severe pain; and significant loss of wrist, hand, or finger motion.wrist, hand, or finger motion.

(_____________)(_____________)

Loss of sensation in either hand or fingers may occur.Loss of sensation in either hand or fingers may occur.

3030

Colles’ Fracture Colles’ Fracture (continued)(continued)

First AidFirst Aid

Immediately apply ice, compression, and Immediately apply ice, compression, and elevation.elevation.

Do not use iceDo not use ice if you suspect the vascular if you suspect the vascular or nerve supply is affected. or nerve supply is affected.

Treat for shock and transport to medical Treat for shock and transport to medical facility.facility.

3131

Wrist FracturesWrist Fractures Fractures of __________ bones common in sports.Fractures of __________ bones common in sports.

Most common wrist fractures involve ________ bone Most common wrist fractures involve ________ bone and tend to occur at the “waist,” the narrowest portion and tend to occur at the “waist,” the narrowest portion of the bone.of the bone.

Deformity is typically not present. Deformity is typically not present.

When in doubt, refer to physician.When in doubt, refer to physician.

3232

Wrist Fractures Wrist Fractures (continued)(continued)

Signs and symptoms includeSigns and symptoms include::

History of wrist trauma with popping or History of wrist trauma with popping or snapping sensation. snapping sensation.

Pain with movement, wrist feels locked, Pain with movement, wrist feels locked, and a positive “_____________” test.and a positive “_____________” test.

3333

3434

Wrist Fractures Wrist Fractures (continued)(continued)

First AidFirst Aid

Apply I.C.E. Apply I.C.E.

Apply a splint that immobilizes wrist.Apply a splint that immobilizes wrist.

Support with sling-and-swathe bandage, Support with sling-and-swathe bandage, leaving fingertips exposed to monitor blood leaving fingertips exposed to monitor blood flow beyond the splint.flow beyond the splint.

353545

GanglionsGanglions

Ganglion results from a Ganglion results from a ___________of the ___________of the synovium surrounding a synovium surrounding a tendon.tendon. Herniated area becomes filled Herniated area becomes filled

with fluid.with fluid. Some ganglions are soft; Some ganglions are soft;

others are hard and painful.others are hard and painful.

3636

Ganglions Ganglions (continued)(continued)

First AidFirst Aid Some ganglions spontaneously regress.Some ganglions spontaneously regress. Leave alone, if possible.Leave alone, if possible. They can be _______________ removed.They can be _______________ removed.

373747

Hand InjuriesHand InjuriesHand FracturesHand Fractures

Fractures can occur to Fractures can occur to any of the ___ bones any of the ___ bones in the hand.in the hand.

383848

Hand Fractures Hand Fractures (continued)(continued)

____________________________ Mechanism includes Mechanism includes

blows with a clenched blows with a clenched fist.fist.

Fracture involves Fracture involves ______________ ______________ metacarpal bone(s) metacarpal bone(s) near the proximal near the proximal end(s).end(s).

Metacarpals can be Metacarpals can be fractured by a crushing fractured by a crushing mechanism.mechanism.

Phalangeal fractures Phalangeal fractures are common in sports.are common in sports.

3939

Hand Fractures Hand Fractures (continued)(continued)First AidFirst Aid

Apply I.C.E.Apply I.C.E. Apply splint and Apply splint and

sling & swathe sling & swathe bandage.bandage.

• Leave _________ Leave _________ exposed.exposed.

• An isolated An isolated phalangeal fracture phalangeal fracture can be buddy-can be buddy-taped to an taped to an adjacent finger.adjacent finger.

Refer athlete to a Refer athlete to a physician.physician.

404051

Sprains and Sprains and Dislocations of the Dislocations of the

HandHand– Gamekeeper’s thumb.– Mallet finger.– Boutonnière deformity.

____________________ thumb involves sprain of the ulnar collateral ligament of the thumb.

– Mechanism of injury is a ______ force to the MP joint of the thumb.

– Thumb will be unstable.

414152

GameKeeper’s GameKeeper’s ThumbThumb

Signs and symptoms Signs and symptoms include:include:

History of an History of an appropriate injury appropriate injury mechanism.mechanism.

Pain over the area of Pain over the area of the ulnar collateral the ulnar collateral ligament (________).ligament (________).

SURGERY!SURGERY!

424255

Mallet (Baseball) Mallet (Baseball) FingerFinger

Injury involves distal Injury involves distal phalanx.phalanx.

Mechanism is a blow Mechanism is a blow to the _________ to the _________ while extending it from while extending it from a flexed position.a flexed position.

Injury often occurs in Injury often occurs in baseball / basketball.baseball / basketball.

4343

Mallet (Baseball) Mallet (Baseball) Finger (continued)Finger (continued)

Signs and symptoms include:Signs and symptoms include:

______ deformity is the MOST important ______ deformity is the MOST important sign.sign.

Recent trauma to fingertip.Recent trauma to fingertip. Point tenderness on dorsal side of the Point tenderness on dorsal side of the

base of distal phalanx.base of distal phalanx. Inability to ________ fingertip.Inability to ________ fingertip.

4444

Mallet (Baseball) Mallet (Baseball) Finger (continued)Finger (continued)

First aid care involves:First aid care involves: Immediate application of I.C.E.Immediate application of I.C.E. Immediate application of splint Immediate application of splint

with the DIP joint extended.with the DIP joint extended. _____________________!!!_____________________!!! Do not letDo not let the distal phalanx fall the distal phalanx fall

back into flexed position.back into flexed position.

Elevate arm in simple sling.Elevate arm in simple sling. Refer to medical care facility.Refer to medical care facility.

454558

BoutonniBoutonnièère re DeformityDeformity

Injury involves Injury involves proximal proximal interphalangeal (___) interphalangeal (___) joint. Extensor joint. Extensor tendon is ___ in half tendon is ___ in half as it crosses the as it crosses the dorsal surface of the dorsal surface of the PIP.PIP.

Mechanism of injury Mechanism of injury is a blow while the is a blow while the finger is _________ finger is _________ during active during active extension.extension.

464660

BoutonniBoutonnièère Deformity re Deformity (continued)(continued)

Signs and symptoms (continued):Signs and symptoms (continued):

Joint becomes painful, swollen, then stiff.Joint becomes painful, swollen, then stiff.

If uncorrected, deformity will develop.If uncorrected, deformity will develop.

Deformity is characterized by Deformity is characterized by ___________ of MP & DIP with _______ ___________ of MP & DIP with _______ of PIP.of PIP.

4747

BoutonniBoutonnièère re Deformity Deformity (continued(continued))

First AidFirst Aid

Apply I.C.E.Apply I.C.E. Elevate in simple sling.Elevate in simple sling. Refer athlete to a physician.Refer athlete to a physician.