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CHAPTER 19 The Elbow, Forearm, Wrist, and Hand OVERVIEW Although fewer sports injuries are sustained in the upper limb than in the lower limb, the elbow, forearm, wrist, and hand are prone to acute and overuse syndromes. The elbow is subject to injury in sports because of its broad range of motion, weak lateral bone arrangement, and relative exposure to soft tissue damage in the vicinity of the joint. The forearm is indirectly influenced by injuries to these areas; however, direct injuries can also occur. Injuries to the wrist usually occur from a fall on the outstretched hand or repeated flexion, extension, or rotary movements. Injuries to the hand occur frequently in sports, yet often they are poorly managed. The fingers are extremely prone to damage when a blow is delivered to the tip of the finger or when the fingers are violently twisted. Injuries involving the elbow, forearm, wrist and hand need to recognized when they occur and treated properly to avoid complications that may result in long-term disability. LEARNING OBJECTIVES After studying Chapter 19, the student will be able to: Identify the bony anatomy of the elbow, forearm, wrist, and hand. Identify the muscles associated with the elbow, forearm, wrist and hand, and describe their functions. Describe methods for prevention of injuries to the elbow, forearm, wrist, and hand. Discuss the assessment of injuries to the elbow, forearm, wrist, and hand. Describe the acute injuries that occur to the elbow, forearm, wrist, and hand. Describe the chronic injuries that occur to the elbow, forearm, wrist and hand. Discuss the proper care for the injuries that occur to the elbow, forearm, wrist, and hand. KEY TERMINOLOGY Boutonniere deformity - A rupture of the extensor tendon of the middle phalanx, forces the DIP joint into extension and PIP into flexion Boxers fracture – A fracture involving the 5th metacarpal Colles fracture - A fracture of the distal end of the radius Lateral epicondylitis – Also known as tennis elbow, involving the wrist extensors and supinators Ganglion - Herniation of the joint capsule or synovial sheath of a tendon Jersey finger – Rupture of the flexor digitorum profundis tendon from its insertion on distal phalanx. making the athlete unable to flex the DIP joint Mallet finger - Injury caused by a blow from a thrown ball that strikes the tip of the finger and avulses the extensor tendon from its insertion along with a piece of the bone making the athlete unable to extend DIP joint Necrosis - Tissue death Osteochondritis Dissecans - Impairment of blood supply that leads to fragmentation and separation of the articular cartilage in a joint Paresthesia – Abnormal sensation including tingling or prickling Subungual hematoma – Blood underneath the fingernail or toenail Trochlea - Medial condyle of the humerus that articulates with the ulna DISCUSSION QUESTIONS 1. 2. 3. 4. 5. 6. 7. Why would a serious injury be so devastating to the hand and wrist? What are some common injuries of the elbow and how should they be managed? Which conditions at the elbow can cause nerve and circulation damage? What muscles and associated structures are found in the forearm? What common injuries occur to the forearm? What causes them? How are they managed? What bony and soft tissue structures are in the wrist and hand? What common injuries may occur in the wrist and hand? What causes them? How are they managed? Which injuries can lead to serious complications? 8. How does the thumb differ from the other digits? 9. Why are finger and hand problems so often mismanaged? NAME ______________________________ SECTION__________ CHAPTER 19 WORKSHEET The Elbow, Forearm, Wrist, and Hand MATCHING: Match the structure with the appropriate name. ________1. ________2. ________3. ________4. ________5. ________6. ________7. ________8. ________9. _______10. _______11. _______12. _______13. _______14. _______15. _______16. _______17. _______18. _______19. _______20. _______21. Annular ligament Capitate DIP joint Distal phalanx Hamate Humerus Lunate MCP joint Metacarpal Middle phalanx PIP joint Pisiform Proximal phalanx Radial collateral ligament Radius Scaphoid Trapezium Trapezoid Triquetral Ulna Ulnar collateral ligament SHORT ANSWER: Answer the following questions with a brief response. 22. With an elbow injury, where would you check for circulation distal to the injury? 23. How should a fractured phalange be splinted? 24. Name two muscles that are the main wrist flexors. 25. Injury to the _______________ nerve causes paresthesias into the fourth and fifth fingers. 26. What is the most common mechanism that leads to gamekeeper's thumb? 27. What injury is most often caused by a direct blow to the olecranon? 28. Which nerve is compressed with carpal tunnel syndrome? LISTING: List the three major ligaments of the elbow. 29. 30. 31. List the three main muscles that flex the elbow. 32. 33. 34. ESSAY: 35-40. Explain the cause, signs and symptoms, and care for lateral epicondylitis. 41-44. Describe the following injuries: Boxers fracture, Mallet finger, Boutonniere deformity, and Jersey finger.