Injuries to the Elbow, Forearm,
Wrist & Hand
Bones and Joints of the Elbow
Bones
• Humerus
• Radius
• Ulna
Joints
• Humeroulna = humerus & ulna
• Humeroradial = humerus & radius
• Radioulna = radius & ulna
Nerves of the Elbow
• 3 Nerves of the
Elbow
– Radial
– Median
– Ulnar
Medial View
Lateral View
ROM for Elbow Joint
Tests for Active Range of Motion
• ROM test for flexion
• ROM test for extension
• ROM test for elbow supination
• ROM test for elbow pronation
Manual Muscle Tests for Elbow
• Biceps, Triceps, Pronators, Supinators
Injuries to the Elbow & Forearm
• Fractures
Mechanism of injury
1. falling on outstretched
hand
2. direct blow
Usually affect lower end of humerus
Treatment
1. Splint and send to ER
Olecranon Process Fracture
Injuries to Elbow & Forearm
• Dislocation/Subluxation
Mechanism of Injury
1. Falling on an outstretched arm
2. Limb is twisted severely
Rollerblading, football, skateboarding, hockey carry
increased risk
Treatment
1. Immobilize and send to ER
2. Do not attempt to reduce
Elbow Dislocation
Injuries to Elbow & Forearm
• Sprains
Mechanism of Injury
1. Hyperextension at elbow
Stress Tests for Joint Laxity
1. Valgus – apply lateral force (open joint up medially)
tests for laxity of ulnar collateral
ligament
2. Varus - apply medial force (open joint up laterally)
tests for laxity of radial collateral
ligament
Perform both tests with elbow straight and 30°
Injuries to Elbow & Forearm
• Impingement – pinching of soft tissue such
as bursa, tendon, or nerve between the
ends of 2 bones (Ulnar Nerve)
Mechanism of Injury
1. Repeated stress
2. Direct blows
Special Test
1. Tinel’s Sign – tap the ulnar nerve, tingling
down arm indicates + sign
Injuries to Elbow & Forearm
• Bursitis
– Olecranon bursitis most common
– Symptoms include pain, swelling, point
tenderness
– Treat with ICE technique
Injuries to Elbow & Forearm
• Biceps Brachii Rupture
Mechanism of injury
1. Pulling motions (gymnastics, rowing, weight
lifting
Symptoms
1. Pain
2. Swelling (bulge in biceps)
3. Loss of motion/strength
Treatment
1. Immobilize & send to physician
Injuries to Elbow & Forearm
• Epicondylitis
– Inflammation of the medial or lateral epicondyle
of the humerus.
Lateral Epicondylitis
1. affects extensors
2. called “tennis elbow”
Medial Epicondylitis
1. affects flexors
2. called “little league elbow” or “golfer’s elbow”
• Epicondylitis
Mechanism of Injury
1. Chronic overuse of athletes who twist forearm
during throwing or swinging
Symptoms
1. pain & tenderness around elbow
2. twisting motion will cause pain
Treatment
1. RICE
2. brace
Injuries to Elbow & Forearm
• Volkmann’s Contracture
– Damage to muscles of forearm due to injury to blood
supply
Mechanism of injury
1. fracture, dislocation, muscle spasm, or
swelling reduces blood supply
Treatment
1. Activate EMS
Anatomy of Wrist and Hand
Bones
• Wrist
– 8 carpal bones
• Hand
– 5 metacarpals
– 5 phalanges
Muscles
• Flexors (anterior side)
– Flexor carpi radialis
– Flexor carpi ulnaris
• Extensors (posterior side)
– Extensor carpi ulnaris
– Extensor carpi radialis longus
Anterior
Posterior
Injuries to Wrist and Hand
• Carpal Tunnel
Syndrome
– Inflammation of the
median nerve of
wrist/hand
Injuries to Wrist and Hand
• Fractures
– Mechanism of injury
1. Direct blows
2. Falling on outstretched hand
– Colles’ Fracture – distal radial fracture
– Navicular Fracture – navicular (schaphoid) bone
of wrist
• Pain in the anatomical “snuff box”
• Slowest healing bone in body (low blood supply)
Injuries to Wrist and Hand
• Dislocation/Subluxation
– Mechanism of injury
1. direct blow from a ball or
other object
Injuries to Wrist and Hand
• Sprains
– Wrist sprains caused by hyperextension or
hyperflexion
– Thumb (Gamekeeper’s thumb)
• Sprain of ulnar (medial) collateral ligament
• Caused by abduction of thumb
• Gamekeeper’s Thumb Test – application of valgus
stress on thumb joint
Injuries to Wrist and Hand
• Impingement (median or ulnar nerve)
– Caused by repeated stress
– Phalen’s Test
1. Place athlete’s hands back to back
2. Grasp palms with one hand
3. Tingling or numbness + sign
Injuries to Wrist and Hand
• Tendonitis
– Caused by overuse
– Finkelstein’s Test (thumb tendon)
1. make a fist with thumb under fingers
2. place hand around athletes fist
3. apply isometric resistance as they flex in an ulna
direction
Injuries to Wrist and Hand
• Mallet Finger (“baseball finger”)
– Flexion of the distal phalangeal joint
– Caused by direct blow to outstretched finger
– Tears extensor tendon
– Can’t actively extend finger
– Splint & refer to physician
Injuries to Wrist and Hand
• Boutonniere
Deformity
– Abnormal contracture
of phalange where
proximal joint flexes
and distal extends due
to tendon rupture