Chapter 20:
The Elbow, Wrist, and Hand
Common Injuries
 Contusions
 Olecranon bursitis
 Ulnar nerve
contusion
 Strains and
sprains
 Epicondylitis
 Fractures
 Volkmann’s
contracture
 Nerve injury
 Dislocations and
subluxations
 Tendonitis
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Common Injuries (cont.)
 Nerve
impingement
and carpal
tunnel
syndrome
 Ganglion cyst
 Boutonniere
deformity
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Special Tests
 Certain tests can be performed that
aid in the evaluation of injury.
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Varus/Valgus Stress Tests
 The varus test (see text Figure 208) applies forces laterally at the
elbow, medially at the wrist. The
valgus test (see text Figure 20-9) is
exactly the opposite.
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Scaphoid Fracture Test
 The anatomical snuff box is where
pressure is exerted over the
scaphoid bone. A pain response
indicates the presence of a fracture.
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Gamekeeper’s Thumb Test
 The first metacarpal is stabilized
while the thumb is passively
abducted. Taping can keep the
thumb from moving laterally.
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Collateral Ligament Test
 The PIP joint is gently stressed in
a varus direction, then the valgus
direction. Pain and/or excessive
laxity indicates injury.
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Finkelstein’s Test
 This tests for deQuervain’s
tenosynovitis. With the thumb within
a fist, move the wrist into ulnar
deviation. Pain on the radial side is
a positive sign.
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Tinel’s Sign
 Tap a reflex hammer on the carpal
tunnel. Tingling or shooting pain in
the palm, thumb, index finger, and
often the long finger indicates
carpal tunnel syndrome.
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Phalan’s Test
 Hold the position (see text Figure
20-27) figure for 60 seconds or
less. Tingling or shooting pain in the
palm, thumb, index, and long
fingers indicates carpal tunnel
syndrome.
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Modified Phalan’s Test
 Holding the position for 60 seconds
produces tingling or shooting pain
in the median nerve branches of the
hand with carpal tunnel syndrome.
(See text Figure 20-28.)
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Elbow/Forearm
Nerve Injuries
 Injury to the three nerves of the
elbow and forearm produces
different effects.
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Ulnar Nerve
 Weakness of wrist flexion and ulnar
deviation
 Flexion loss of DIP joints of the little
and ring fingers
 Loss of flexion and extension of
fingers
 Inability to abduct or adduct fingers
 Inability to adduct thumb
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Median Nerve
 Weakness with flexion and
radial deviation
 Loss of pronation
 Loss of thumb opposition
 Loss of flexion at MCP joints
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Radial Nerve
 Loss of wrist extension and
supination
 Loss of extension at MCP joints
 Inability to extend and abduct the
thumb
 Loss of triceps reflex
 Weakness of elbow flexion
 Ulnar and radial deviation
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Wrist Strengthening
 These exercises are used to
strengthen the wrist after a wrist
or hand injury has healed.
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Wrist Flexion
 Use weights and a padded
bench to strengthen the
forearm flexor muscles.
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Wrist Extension
 Use weights and a padded
bench to strengthen the
forearm extensor muscles.
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