- dressing - throwing - grooming - feeding

- Humeroulnar joint, also humeroradial joint - superior radioulnar joint

- synovial - compound joint - single capsule - hinge joint for flexion and extension

- flexion - extension - pronation - supination

- ulnar collateral ligament - radial collateral ligament - annular ligament of radius

- Biceps brachii - Brachialis - Brachioradialis - Triceps brachii - Anconeus - Pronator teres - supinator

EXAM #3 Flashcards by Madison Allen

Bones of the elbow joint complex

Distal humerus (anterior & posterior)
Proximal ulna
Proximal radius
Olecranon process

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Elbow important for:

dressing
throwing
grooming
feeding

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Elbow joint

Humeroulnar joint, also humeroradial joint
superior radioulnar joint

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Elbow joint is…

synovial
compound joint
single capsule
hinge joint for flexion and extension

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Proximal radioulnar joint:
- part of _ _ _ - not needed for flexion/extension
- radial notch of ulna (+) radial head (+) annular ligament
- allows _ and _

elbow joint complex
pronation, supination

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Elbow movements

flexion
extension
pronation
supination

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Elbow movements:
Flexion ROM = _

150 degrees

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Elbow movements:
Extension ROM = _

0 degrees or beyond

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Elbow movements:
Pronation & supination ROM = _

0-90 degrees

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Elbow ligaments

ulnar collateral ligament
radial collateral ligament
annular ligament of radius

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Elbow ligaments:
Provides protection against valgus stresses to the elbow

medial (ulnar) collateral ligament

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Elbow ligaments:
provides protection against varus stresses to the elbow

lateral (radial) collateral ligament

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Elbow ligaments:
Holds radial head in place

annular ligament

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Proximal elbow joint complex is a _, compound joint comprising three articular surfaces ( _, _, _ ) surrounded by a single _ _

synovial
distal humerus, proximal radius, proximal ulna
articular capsule

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Elbow muscles

Biceps brachii
Brachialis
Brachioradialis
Triceps brachii
Anconeus
Pronator teres
supinator

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Elbow muscles:
Biceps Brachii
- Origin: long head - _
- Origin: short head - _

O: long head - glenoid & labrum
O: short head - coracoid process

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Elbow muscles:
Biceps Brachii
- Insertion: _

I: proximal radius

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Elbow muscles:
Biceps Brachii
- Action: _

A: shoulder flexion, elbow flexion, wrist supination

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Elbow muscles:
Brachialis
- Origin: _

humerus

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Elbow muscles:
Brachialis
- Insertion: _

Ulna

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Elbow muscles:
Brachialis
- Action: _

elbow flexion

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Elbow muscles:
Brachioradialis
- Origin: _

humerus

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Elbow muscles:
Brachioradialis
- Insertion: _

distal radius

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Elbow muscles:
Brachioradialis
- Action: _

elbow flexion

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Elbow muscles: Triceps brachii - Origin: long head - _ - Origin: lateral head - _ - Origin: medial head - _

- O: long head - glenoid - O: lateral head - upper part of posterior humerus - O: medial head - middle part of posterior humerus

Elbow muscles: Triceps brachii - Insertion: _

olecranon process of ulna

Elbow muscles: Triceps brachii - Action: _

elbow extension

Elbow muscles: Anconeus - Origin: _

lateral humerus

Elbow muscles: Anconeus - Insertion: _

olecranon and ulna

Elbow muscles: Anconeus - Action: _

elbow extension

Elbow muscles: Pronator teres - Origin: _

medial epicondyle of humerus

Elbow muscles: Pronator teres - Insertion: _

middle radius

Elbow muscles: Pronator teres - Action: _

wrist pronation, elbow flexion

Elbow muscles: Supinator - Origin: _

lateral epicondyle of humerus and lateral ulna

Elbow muscles: Supinator - Insertion: _

radius

Elbow muscles: Supinator - Action: _

supination of elbow

Elbow injuries

- Elbow Bursitis - Elbow Dislocation - Elbow Fracture - Ulnar Collateral Ligament Rupture - Distal Biceps Tendon Rupture - Elbow Arthritis - Elbow Replacement

Elbow injuries: Bursa Sac of Fluid to Protect the Olecranon Process - Allows skin to move freely - Can get injured: ▪ Trauma ▪ Prolonged Pressure ▪ Infection

elbow bursitis

Elbow injuries: Humerus and Ulna become Disarticulated - Extreme Trauma ▪ Fall at High Speed ▪ MVA

elbow dislocation

Elbow injuries: - Can be open or closed - May sever artery or nerve - Reduction may be painful - May or may not require surgery - May not regain full motion

elbow dislocation

Elbow injuries: - Unable to Regain Full ROM - Loss of Elbow Extension - May Be Permanent

elbow arthrofibrosis

Elbow injuries: - Due to trauma - May or may not require surgery - depends on alignment

elbow fracture

Elbow injuries: - Stressed with valgus force at the elbow ▪ Pitchers, Throwers ▪ May rupture ▪ May require surgery

Ulnar collateral ligament rupture

Elbow injuries: - Sharp Pain in Arm - Black and Blue - “Popeye” Sign - Usually does not require surgery

Distal biceps tendon rupture

Elbow injuries: Disruption of the Articular Cartilage of the Humerus or Ulna - May or May Not Have Pain

elbow arthritis

Elbow injuries: - End Stage Operation - For Pain Relief - Hard to Regain Full Motion

elbow joint replacement

Elbow injuries: - End Stage Operation - For Pain Relief - Hard to Regain Full Motion

elbow joint replacement

6 phases of the throwing cycle

1. wind-up 2. early cocking 3. late cocking 4. acceleration 5. deceleration 6. follow-through

Throwing cycle phases: - Shoulder in slight internal rotation (IR) - Minimal abduction - Phase with minimal shoulder stress

Wind-Up

Throwing cycle phases: - Contralateral Hip to 90 degrees Hip Flexion - Shoulder in Neutral Rotation – 0 Internal and 0 External Rotation - End of phase: increased activity of the rotator cuff – Supraspinatus – Infraspinatus – Teres Minor

Early cocking

Throwing cycle phases: - Begins with planting of the striding leg - Scapular retraction - Abduction to 90 degrees - Torso starts to rotate forward - 400 N shear force on anterior shoulder - Increase in supraspinatus, infraspinatus, and teres minor activitycompressive force of 650 N - Maximal ER (up to 180 degrees) - Shoulder Capsule is Tight

Late cocking

Throwing: - Bony twist about the long axis of the humerus - Results in more external ROM

humeral torsion

Throwing cycle phases: - Beginning of forward movement of the arm - Arm internally rotates - Increased activity of : – Pec major – Lats – Serratus anterior - Shoulder rotates at speeds >700 degrees/ sec - Elbow moves from flexion to extension – Early triceps activity - Capsule unwinds

Acceleration

Throwing cycle phases: - Begins when object (ball) is released - Violent eccentric contraction of all muscle groups – Rotator Cuff - Maximal load on joints (posterior shear forces of 400 N, inferior shear forces of 300 N, and compressive force of 1,000 N)

Deceleration

Throwing cycle phases: - Body moves forward with arm until motion stops

follow-through

Throwing cycle phase with maximal external rotation

late cocking

Shoulder injuries

- Laxity and Instability - Superior Labrum Anterior-Posterior (SLAP) lesion - Rotator Cuff Tears - Impingement - Glenohumeral Internal Rotation Deficit (GIRD) - Scapular dyskinesia

The thrower's shoulder must be lax enough to allow excessive external rotation but stable enough to prevent symptomatic humeral head subluxations and functional stability

"Thrower's Paradox"

Throwing: Result of repetitive stresses during the cocking and acceleration phases – May make the shoulder loose – _ – Or too loose – _

- laxity (normal) - instability (abnormal, pathologic)

Shoulder injuries: - Caused by extreme ER - “Peel back mechanism” (Burkhart and Morgan, 1998) - Pain in late cocking phase and loss of velocity of the pitch

Shoulder labrum lesions

Shoulder injuries: - Compression of rotator cuff between acromial arch and humeral head - Superior migration of the humeral head due to fatigue of RC

Shoulder impingement

Shoulder injuries: - Posterior shift in total arc of motion - Increase in length of anterior capsule --> excessive ER - Loss of IR motion

GIRD (Glenohumeral Internal Rotation Deficit)

Shoulder injuries: - Imbalance of scapular muscles secondary to fatigue, direct trauma, or nerve injury - Can lead to: – impingement during late cocking phase – anterior instability

Scapular Dyskinesia

Elbow injuries

Ulnar Collateral Ligament * Ulnar neuritis * Medial epicondylitis * Valgus extension overload syndrome with posterior olecranon impingement

Elbow injuries: - During late cocking phase MCL experiences forces reaching its tensile limit - Leads to microtrauma, ligament attenuation, and eventual rupture

Ulnar collateral ligament (UCL) injury

Elbow injuries: - pediatric injuries

- GIRD - Medial epicondyle apophysitis ("Little leaguer's Elbow)

Elbow injuries: - fatigue fracture, widened epiphyseal line, stress - displaced medial epicondyle fracture - entrapment of epicondyle in joint

Little Leaguer's Elbow

Bones of the hand (fingers to wrist)

- Distal phalanges - Intermediate phalanges - proximal phalanges - metacarpals - carpals

Distal phalanges

Intermediate phalanges

proximal phalanges

metacarpals

Phalanges: Numbered: 1 = _ 5 = _

- thumb - pinky finger

5 joints of the wrist & hand

1. Carpometacarpal (CMC) 2. Metacarpophalangeal (MCP) 3. Proximal Interphalangeal (PIP) 4. Distal Interphalangeal (DIP) 5. Interphalangeal Joint (IP) (Thumb)

All joints of the hand are _ _ with joint capsules

synovial joints

Wrist & hand joints: Distal Carpals and Metacarpals - Function: Helps Cup the Hand – Palmar Cupping - Conforms to Shape of an Object - Maximizes Surface Contact - Increases Sensory Feedback - Enhances Stability

Carpometacarpal (CMC)

Wrist & hand joints: - CMC 1 - Digit 1 (Thumb) to Trapezium is unique - Called a Saddle Joint - Trapezuim looks like a saddle - Allows Many Motions - CMC 2-5 are Different than CMC 1

Carpometacarpal (CMC)

Wrist & hand joints: - Metacarpals to the Phalanges - Convex Metacarpal Head and Concave Base of Proximal Phalanx - Gripping

Metacarpophalangeal (MCP)

Wrist & hand joints: - Proximal Phalanx with Middle Phalanx - Gripping - Proximal Phalanx (PP) is convex - Middle Phalanx (MP) is concave

Proximal Interphalangeal (PIP)

Wrist & hand joints: - Middle Phalanx with Distal Phalanx - Fine Motor Control - Pinching - Threading - Writing

Distal Interphalangeal (DIP)

Wrist & hand movements: Digit 1 = thumb - CMC 1 moves in many directions

- Flexion - Extension - Adduction - Abduction - Circumduction - Opposition

Wrist & hand movements: CMC 2-4

almost no motion

Wrist & hand movements: CMC 5

20 degrees of flexion and abduction

Wrist & hand movements: MCP

- Flexion - Extension - Abduction - Adduction

Wrist & hand movements: MCP flexion/extension motion _ _

increases ulnarly

Wrist & hand movements: MCP unable to abduct nor adduct with MCP _ _

maximal flexion

Wrist & hand movements: PIP

only flexion & extension ( motion increases ulnarly)

Wrist & hand movements: DIP

only flexion & extension ( motion increases ulnarly)

Ulnar grip: With more motion ulnarly at MCP, PIP, and DIP:

- Tighter Grip - Greater Closure - Some objects are wider at digit 2 and narrower at digit 5

Wrist & hand ligaments: Radiocarpal joint - Radial collateral ligament limits _ _

ulnar deviation

Wrist & hand ligaments: Radiocarpal joint - Ulnar collateral ligament limits _ _

radial deviation

Wrist & hand ligaments: Radiocarpal joint - Palmar radiocarpal and ulnocarpal ligaments limits _

extension

Wrist & hand ligaments: Radiocarpal joint - Dorsal radiocarpal ligament limits _

flexion

Wrist & hand ligaments: Carpometacarpal joints (CMC)

intermetacarpal ligaments

Wrist & hand ligaments: _ _ Reinforced By - Joint capsule - Volar plates - Medial collateral ligaments - Lateral collateral ligaments

Metacarpophalangeal Joints

Wrist & hand ligaments: _ _ Reinforced by - Medial and lateral collateral ligaments - Volar plate - Joint capsule

Interphalangeal Joints

Wrist & hand ligaments: Reinforcement of Joint Capsule on Palmar Side -Fibrocartilage -Helps prevent hyperextension - At the MCP, PIP, and DIP Joints

Volar plate

Hand muscles: Muscles who's origin lies outside of the hand itself

extrinsic hand muscles

Hand muscles: wrist flexors

- flexor digitorum superficialis - flexor digitorum profundus

Hand muscles: Flexor Digitorum Superficialis - Origin: _  Insertion: Middle phalanx  Action: Wrist flexion & finger flexion

Medial epicondyle of humerus

Hand muscles: Flexor Digitorum Superficialis - Insertion: _  Action: Wrist flexion & finger flexion

Middle phalanx

Hand muscles: Flexor Digitorum Superficialis - Action: _

Wrist flexion & finger flexion

Hand muscles: Flexor Digitorum Profundus - Origin: _  Insertion: Distal phalanx  Action: Wrist flexion & finger flexion

Medial epicondyle of the ulna

Hand muscles: Flexor Digitorum Profundus - Insertion: _  Action: Wrist flexion & finger flexion

Distal phalanx

Hand muscles: Flexor Digitorum Profundus - Action: _

Wrist flexion & finger flexion

Extrinsic muscles of the wrist & hand

- flexor digitorum superficialis - flexor digitorum profundus - extensor digitorum - extensor indicis - extensor digiti minimi - extensor pollicis longus - extensor pollicis brevis - abductor pollicis longus

Hand muscles: Extensor Digitorum - Origin: _  I: Middle and distal phalanx of digits 2-5  A: Extension of phalanges 2-5, extension of the wrist

Lateral epicondyle of humerus

Hand muscles: Extensor Digitorum - Insertion: _  A: Extension of phalanges 2-5, extension of the wrist

Middle and distal phalanx of digits 2-5

Hand muscles: Extensor Digitorum - Action: _

Extension of phalanges 2-5, extension of the wrist

Hand muscles: Extensor Indicis - Origin: _  I: Base of the 2nd phalange  A: Extension of the index finger

Distal ulna

Hand muscles: Extensor Indicis - Insertion: _  A: Extension of the index finger

Base of the 2nd phalange

Hand muscles: Extensor Indicis - Action: _

Extension of the index finger

Hand muscles: Extensor Digiti Minimi - Origin: _  I: Base of the fifth phalanx  A: Extension of the little finger

Lateral epicondyle of the humerus

Hand muscles: Extensor Digiti Minimi - Insertion: _  A: Extension of the little finger

Base of the fifth phalanx

Hand muscles: Extensor Digiti Minimi - Action: _

Extension of the little finger

Hand muscles: Extensor Pollicis Longus - Origin: _  I: Base of the distal phalanx of thumb, dorsal surface  A: Extension of the thumb

Posterior surface of the ulna

Hand muscles: Extensor Pollicis Longus - Insertion: _  A: Extension of the thumb

Base of the distal phalanx of thumb, dorsal surface

Hand muscles: Extensor Pollicis Longus - Action: _

Extension of the thumb

Hand muscles: Extensor Pollicis Brevis - Origin: _ - I: Base of the proximal phalanx of the thumb, dorsal surface - A: Extension of the thumb

Posterior surface of the radius

Hand muscles: Extensor Pollicis Brevis - Insertion: _ - A: Extension of the thumb

Base of the proximal phalanx of the thumb, dorsal surface

Hand muscles: Extensor Pollicis Brevis - Action: _

Extension of the thumb

Hand muscles: Abductor Pollicis Longus - Origin: _ - Insertion: Base of 1st metacarpal, dorsal surface - Action: Abduction of the thumb

Posterior radius and ulna

Hand muscles: Abductor Pollicis Longus - Insertion: _ - Action: Abduction of the thumb

Base of 1st metacarpal, dorsal surface

Hand muscles: Abductor Pollicis Longus - Action: _

Abduction of the thumb

Hand muscles: Muscles who's origin and insertion lie within the hand itself

intrinsic hand muscles

- opponens digiti minimi - abductor digiti minimi - flexor digiti minimi brevis - flexor pollicis brevis - abductor pollicis brevis -adductor pollicis - opponens pollicis - lumbricals - palmar interossei - dorsal interossei

Hand muscles: Opponens Digiti Minimi - Origin: _

Hamate bone

Hand muscles: Opponens Digiti Minimi - Insertion: _

5th metacarpal

Hand muscles: Opponens Digiti Minimi - Action: _

Flexes the 5th metacarpal

Hand muscles: Abductor Digiti Minimi - Origin: _ - Insertion: Proximal phalanx of 5th digit - Action: Abduction of the 5th digit

The pisiform bone

Hand muscles: Abductor Digiti Minimi - Insertion: _

Proximal phalanx of 5th digit

Hand muscles: Abductor Digiti Minimi - Action: _

Abduction of the 5th digit

Hand muscles: Flexor Digiti Minimi Brevis - Origin: _

Hamate bone

Hand muscles: Flexor Digiti Minimi Brevis - Insertion: _

Proximal phalanx of the 5th digit

Hand muscles: Flexor Digiti Minimi Brevis - Action: _

Flexion of the 5th digit

Hand muscles: Flexor Pollicis Brevis - Origin: _

Trapezoid, Trapezium and Capitate bones

Hand muscles: Flexor Pollicis Brevis - Insertion: _

Proximal phalanx of the thumb

Hand muscles: Flexor Pollicis Brevis - Action: _

Flexion of the thumb

Hand muscles: Abductor Pollicis Brevis - Origin: _

Scaphoid and Trapezium

Hand muscles: Abductor Pollicis Brevis - Insertion: _

Proximal phalanx of the thumb

Hand muscles: Abductor Pollicis Brevis - Action: _

Abduction of the thumb

Hand muscles: Adductor Pollicis - Origin: _

Capitate bone, 2nd and 3rd metacarpal bones

Hand muscles: Adductor Pollicis - Insertion: _

Base of the proximal phalanx of thumb

Hand muscles: Adductor Pollicis - Action: _

Adduction of the thumb

Hand muscles: Opponens Pollicis - Origin: _

Trapezium Bone

Hand muscles: Opponens Pollicis - Insertion: _

1st metacarpal bone

Hand muscles: Opponens Pollicis Action: _

Flexes and abducts the 1st metacarpal

Hand muscles: Lumbricals - Origin: _

Tendons of flexor digitorum profundus

Hand muscles: Lumbricals - Insertion: _

Metacarpal bones

Hand muscles: Lumbricals - Action: _

Extends interphalangeal joints

Hand muscles: Palmar Interossei - Origin: _

Radial sides of metacarpals 1,2,4, and 5

Hand muscles: Palmar Interossei - Insertion: _

Extensor expansion

Hand muscles: Palmar Interossei - Action: _

Adducts 1st,2nd,4th and 5th digits toward the middle finger

Hand muscles: Dorsal Interossei - Origin: _

Each of the two metacarpal bones between which it inserts

Hand muscles: Dorsal Interossei - Insertion: _

Base of proximal phalanx of the 2nd, 3rd, and 4th digits

Hand muscles: Dorsal Interossei - Action: _

Abducts the 2nd, 3rd and 4th digits from an axis through the 3rd digit

Hand injuries

- mallet finger (baseball finger) - Dupuytren’s Contracture - Tenosynovitis “Trigger Finger” - Carpal Tunnel Syndrome - Hand Fractures - Boutonniere Deformity - Gamekeeper’s/Skier’s Thumb

Hand injuries: - MOI: Ball or other object strikes the tip of the finger or thumb, the force damages the thin tendon that straightens the finger (extensor tendon) - S/S: The finger is usually painful, swollen, and bruised. The fingertip may droop noticeably - Rx: Usually splinting of finger to hold it straight

Mallet Finger (Baseball Finger)

Hand injuries: - MOI: Progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis - S/S: The fingers affected by Dupuytren's contracture bend normally but they can't be straightened completely. Usually not painful - Rx: Non-surgical: Focus on restoring full extension to the affected fingers - Surgical: Excision of fibrotic parts of fascia

Dupuytren’s Contracture

Hand injuries: - MOI: Often idiopathic, but can result from repetitive overuse of the hand. Leads to inflammation of the tendon and synovial sheath - S/S: Tendon may thicken or form a nodule, preventing smooth extension of the finger. Finger may lock in flexion, or “trigger” suddenly into extension - Rx: Non-Surgical usually involves splinting - Surgical: Tendon release

Tenosynovitis “Trigger Finger”

Hand injuries: - MOI: Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist - May occur from repetitive wrist/hand motion - May occur after trauma/injury - Occur 3x more often in females (possibly smaller carpal tunnel) - Often insidious onset - Often misdiagnosed - s/s: Usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers - Symptoms may 1st appear at night with sustained wrist flexion - Often symptoms are on both sides

Carpal Tunnel Syndrome

Hand injuries Tunnel is composed of: - _: Transverse Carpal Ligament - _: Triquetrum and Lunate - _: Pisiform - _: Scaphoi

- Roof - Floor - Medial Wall - Lateral Wall

Structures within Carpal Tunnel

- Median Nerve - Flexor Digitorum Profundus (4 tendons) - Flexor Digitorum (4 tendons) - Flexor Pollicis Longus

Hand injuries: - Rx: PT: Stretching and strengthening exercises - Wrist splinting - Anti-inflammatory drugs - Surgery: Carpal Tunnel Release - One of the most common surgeries performed in the United States - Recommended if symptoms last for 6 months - Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve - Can be performed endoscopically or open

Carpal Tunnel Syndrome

Hand injuries: - MOI: Variety of possible causes, usually traumatic in nature - Occur in metacarpals and phalanges - S/S: History of traumatic injury to the hand - Pain in the finger or hand - Swelling - Inability to flex or extend the finger - Deformity of the finger - Non-Surgical: Casting/Splinting, 4-6 weeks, ROM and Strength afterward - Surgical: - ORIF: Open reduction with internal fixation - Manually re-align broken bone - Insert screw/pin or plate to fixate bone - Casting/Splinting - ROM and strength

Hand Fractures

Hand injuries: Finger Fracture Surgeries - All hardware inside the body

Internal Fixation

Hand injuries: Finger Fracture Surgeries - Part of hardware is outside the body

External Fixation

Hand injuries: - MOI: Commonly the central slip of the extensor tendon tears or pops off its attachment on the bone when the finger is jammed from the end, forcing the PIP joint to bend - S/S: The finger is painful and swollen around the PIP joint. The PIP joint may not straighten out completely under its own power - Non-Surgical: - Splinting of the PIP joint for six weeks should allow the bone to heal and prevent the boutonniere deformity from occurring - Will only work if injury is relatively new - Surgical: - May be indicated if deformity has had time to develop - Surgery may be required to reconstruct and rebalance the extensor hood - Many types of surgeries, none completely successful

Boutonniere Deformity

Hand injuries: - MOI: Any hard force on the thumb that pulls the thumb away from the hand can cause damage to the ulnar collateral ligament - S/S: The MCP joint becomes painful and swollen - Thumb feels weak when you pinch or grasp - May see bruise-like discolorations on the skin around the joint - Nonsurgical Rx: - If the thumb ligaments are only partially torn, they usually heal without surgery - Your thumb will be immobilized for four to six weeks in a special cast - Surgery: - Usually indicated with full ligament tears - Involves repair of the ligament with stitches that anchor them back to the bone

Gamekeeper’s/Skier’s Thumb

Forearm bones

- radius - ulna

Radius: Bony Landmarks

- Head - Radial styloid process - Carpal articular surface - Ulnar notch

Ulna: Bony Landmarks

- Head - Ulnar Styloid Process - Radial notch

Carpal Bones: "PT's Love Sports However Can't Take Time"

- Pisiform - Triquetrum - Lunate - Scaphoid - Hamate - Capitate - Trapezoid - Trapezium

Carpal bones: proximal row

- Pisiform - Triquetrum - Lunate - Scaphoid

Carpal bones: distal row

- Hamate - Capitate - Trapezoid - Trapezium

Forearm & wrist bones: - Classification: short bones - Arrangement: 8 bones arranged in proximal and distal rows of four - Function: Movement - These 8 bones give flexibility to the wrist - Pisiform: a sesamoid bone (embedded within flexor carpi ulnaris tendon)

carpal bones

Forearm movements

- supination - pronation

Forearm movements: supination ROM = _ degrees

0-90

Forearm movements: pronation ROM = _ degrees

0-90

Wrist movements

- flexion - extension - radial deviation - ulnar deviation

Wrist movements: flexion ROM = _ degrees

0-80

Wrist movements: extension ROM = _ degrees

0-70

Wrist movements: radial deviation ROM = _ degrees

0-25

Wrist movements: ulnar deviation ROM = _ degrees

0-40

Forearm joints

- proximal radioulnar joint - distal radioulnar joint

Forearm joints: - Allows Pronation and Supination - Convex head of radius and concave radial notch of ulna

Proximal Radioulnar Joint

Forearm joints: - Also allows Pronation and Supination - Convex head of ulna and concave ulnar notch of radius

Distal Radioulnar Joint

Forearm joints: _ Radioulnar motion - Axis is from radial head to ulnar head - _: radius crosses over ulna - _: radius and ulna lie side-by-side

- Pronation - Supination

Wrist joints

- Radiocarpal joint - Midcarpal joint

Wrist joints: - Carpal articular surface of radius articulates with the row of proximal carpal bones

Radiocarpal Joint

Wrist joints: - Row of proximal carpal bones articulates with row of distal carpal bones

Midcarpal Joint

Wrist joints: - Carpal articular surface of radius is concave - Both proximal and distal articular surfaces of row of proximal carpal bones are convex - Proximal articular surface of row of distal carpal bones is concave

Concave - Convex Rule

Wrist joint movements: Neutral to full flexion is mainly midcarpal joint motion

Flexion

Wrist joint movements: Neutral to full extension is mainly radiocarpal joint motion

Extension

Forearm ligaments

- interossesous membrane - annular ligament - Triangular Fibrocartilage

Forearm ligaments: - Binds radius & ulna together - Allows transmission of forces

Interosseous Membrane

Forearm ligaments: - Goes around radial head and attaches to ulna like “staple”

Annular Ligament

Wrist ligaments: Radiocarpal Joint

- Ulnar Collateral Ligament - Radial Collateral Ligament - Triangular Fibrocartilage (aka articular disc)

Forearm ligaments: - Triangular in shape - Located between head of ulna and row of proximal carpal bones - Helps approximate ulna and radius

Triangular Fibrocartilage

Wrist ligaments: - Ulnar collateral ligament: limits excess radial deviation - Radial collateral ligament: limits excess ulnar deviation

Midcarpal Joint

Forearm muscles: Wrist Flexors _ - 4/5 have common origin (medial epicondyle of humerus) - All located in anterior forearm Wrist Extensors _ - All have common origin (lateral epicondyle of humerus) - All located in posterior forearm Forearm Pronators/Supinators _ - All have common insertion (radius)

- (5) - (4) - (3)

5 Wrist flexor muscles

1. Flexor Carpi Radialis* 2. Flexor Carpi Ulnaris* 3. Palmaris Longus* 4. Flexor Digitorum Superficialis* 5. Flexor Digitorum Profundus

Wrist Flexors: Flexor Carpi Radialis - Insertion: _

metacarpals

Wrist Flexors: Flexor Carpi Radialis - Action: _

wrist flexion & radial deviation

Wrist Flexors: Flexor Carpi Ulnaris - Insertion: _

carpals

Wrist Flexors: Flexor Carpi Ulnaris - Action: _

wrist flexion & ulnar deviation

Wrist Flexors: Palmaris Longus - Insertion: _

fascia

Wrist Flexors: Palmaris Longus - Action: _

wrist flexion

Wrist Flexors: Flexor Digitorum Superficialis - Insertion: _

middle phalanx

Wrist Flexors: Flexor Digitorum Superficialis - Action: _

wrist flexion & finger flexion

Wrist Flexors: Flexor Digitorum Profundus - Insertion: _

distal phalanx

Wrist Flexors: Flexor Digitorum Profundus - Action: _

wrist flexion & finger flexion

4 Wrist Extensor muscles: Common origin = lateral epicondyle of humerus

1. Extensor Carpi Radialis Longus 2. Extensor Carpi Radialis Brevis 3. Extensor Carpi Ulnaris 4. Extensor Digitorum

Wrist Extensors: Extensor Carpi Radialis Longus - Insertion: _

metacarpals

Wrist Extensors: Extensor Carpi Radialis Longus - Action: _

wrist extension & radial deviation

Wrist Extensors: Extensor Carpi Radialis Brevis - Insertion: _

metacarpals

Wrist Extensor muscles: Extensor Carpi Radialis Brevis - Action: _

wrist extension

Wrist Extensor muscles: Extensor Carpi Ulnaris - Insertion: _

metacarpals

Wrist Extensor muscles: Extensor Carpi Ulnaris - Action: _

wrist extension & ulnar deviation

Wrist Extensor muscles: Extensor Digitorum - Insertion: _

middle & distal phalanx digits 2- 5

Wrist Extensor muscles: Extensor Digitorum - Action: _

wrist extension & finger extension

3 Wrist Pronators/Supinators:

1. Pronator Teres 2. Pronator Quadratus 3. Supinator

Wrist Pronators: Pronator Teres - Origin: _

med. epicondyle

Wrist Pronators: Pronator Teres - Action: _

pronation

Wrist Pronators: Pronator Quadratus - Origin: _

ulna

Wrist Pronators: Pronator Quadratus - Action: _

pronation

Wrist Supinators: Supinator - Origin: _

lat. epicondyle and ulna

Wrist Supinators: Supinator - Action: _

supination

Wrist & forearm injuries

- Colles Fracture - Scaphoid Fracture - Lateral Epicondylitis - Medial Epicondylitis

Wrist & forearm injuries: - MOI: FOOSH (fall on out-stretched hand) - Dx: radiography confirms - Tx: long arm cast 3 wks, short arm cast 3 wks, splint 6 wks - PT: ROM and strengthening

Colles Fracture (distal radius fracture)

Wrist & forearm injuries: - MOI: FOOSH - Dx: tenderness over the scaphoid, radiographs - Prognosis: fair due to tenuous blood supply - Tx: long arm cast 6 wks + short arm cast 6 wks

Scaphoid Fracture

Wrist & forearm injuries: - At-risk: anyone who uses repetitive wrist extension: tennis players (backhand), painters, carpenters - MOI: repetitive abnormal forces cause microtears/fibrosis of common extensor tendon - Pathology: if injury is chronic or sub-acute then likely tendonosis is present instead of tendonitis - S/S: gradual aching pain over lateral elbow region aggravated by use wrist extensors - Tx: PT focuses on stretching / eccentric strengthening of common extensor tendon - May contribute to: - Weak or inflexible shoulder / wrist muscles - Tennis: improper backhand, tightly strung racket, too narrow grip

Lateral Epicondylitis (Tennis Elbow)

Wrist & forearm injuries: - At-risk: anyone who uses repetitive wrist flexion: golfers, pitchers, carpenters, rock climbers - MOI: repetitive abnormal forces cause microtears/fibrosis of common flexor tendon - Pathology: if injury is chronic or sub-acute then likely tendonosis is present instead of tendonitis - S/S: gradual aching pain over medial elbow region aggravated by use wrist flexors - Tx: PT focuses on stretching / eccentric strengthening of common flexor tendon - May contribute to: - Weak or inflexible shoulder / wrist muscles - Carrying heavy suitcase, chopping wood, frequent use of other hand tools

Medial Epicondylitis (Golfers Elbow)

Forearm & wrist surgeries: - Candidates: patients with displaced, unstable, or non-union scaphoid fractures - Procedure: open-incision; if bone graft is used it is usually harvested from the pelvis; pin or screw is inserted to approximate the fracture

Scaphoid Surgery

Forearm & wrist surgeries

- scaphoid Surgery - prosthetic arm

EXAM #3 Flashcards

(235 cards)