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April 5 - ch19 elbow, forearm, wrist and hand.doc

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University of Alberta
Physical Education and Sport
Brad Kern

April 5 – Ch 19 elbow, forearm, wrist and hand Elbow Fractures Causes of Elbow Fractures • Fall on flexed elbow or from direct blow • Fracture can occur in any one or more of the bones • FOOSH often fractures humerus above condyles or between condyles Signs of an Elbow Fracture • May or may not result in visual deformity • Hemorrhaging, swelling, muscle spasm Caring for an Elbow Fracture • Ice and sling for support – refer to physician Anatomy of the Forearm • Flexors are on anterior aspect of the forearm and attach at the medial epicondyle • Extensors are the opposite (posterior and lateral) Assessment of the Forearm History • What was the cause? • What were the symptoms at the time of injury, did they occur later, were they localized or diffuse? • Was there swelling and discoloration? • What treatment was given and how does it feel now? • When did the injury occur? Observation • Visually inspect for deformities, swelling and skin defects • ROM • Pain with motion Palpation • Palpated at distant sites and at points of injury • Can reveal tenderness, edema, fracture, deformity, changes in skin temperature, a false joint, bone fragments, or lack of bone continuity Recognition and Management of Injuries to the Forearm Forearm Contusion Causes of Forearm Contusions • Ulnar side receives majority of blows due to arm blocks • Can be acute or chronic. For chronic, we are talking about repetitive blows to the forearm • Result of direct contact or blow Signs of A Forearm Contusion • Pain, swelling, and hematoma • If repeated blows occur, heavy fibrosis and possibly bony callus could form with hematoma Caring for a Forearm Contusion • Proper care in acute stage involves RICE for at least one hour and followed up with additional cryotherapy • Protection is critical – full length sponge rubber pad can be used to provide protective covering Forearm Splints and Other Strains Cause of Forearm Splints and Other Strains • Forearm strain – most come from severe static contraction • Cause of splints – repeated static contractions (creates minute tears in connective tissues of forearm) Signs of Injury • Dull ache between extensors • Weakness and pain with contraction • Point tenderness in interosseus membrane Caring for Forearm Splints and other strains • Treat symptomatically • Strengthen forearm • Utilize cryotherapy, thermotherapy and wraps for support and protection • We can also recommend rest • We could also use sleeve to help compress Forearm Shaft Fractures Causes of Forearm Shaft Fractures • Common in youth – due to falls and direct blows • Fracturing ulna or radius singularly is rarer than simultaneous fractures to both Signs of A Forearm Shaft Fracture • Audible pop or crack followed by moderate to severe pain, swelling, and disability • Edema, ecchymosis with possible crepitus • Older athletes may experience extensive damage to soft tissue structures Caring for a Forearm Shaft Fracture • RICE, NSAIDs, splint, immobilize and refer to physician • Athlete is usually incapacitated for 8 weeks Colles Fracture Causes of a Colles Fracture • Occurs in lower end of radius or ulna • MOI is fall on extended wrist, forcing radius and ulna into hyperextension (displacement occurs posteriorly) • Distal fracture specific to hyperextension wrist fracture • A smith fracture involves falling on flexed wrist (this is less common and displacement occurs anteriorly) Signs of a Colles Fracture • Visible deformity (silver fork deformity) • When no deformity is present, injury may be passed off as bad sprain • Extensive bleeding and swelling • Tendons may be torn/avulsed and there may be median nerve damage Care for a Colles fracture • Cold compress, splint wrist and refer to physician • Xray and immobilization • Without complications a Colles fracture will keep an athlete out for 1-2 months Anatomy of the wrist, hand and fingers • Hand has metacarpals • You have 8 small carpal bones • The palm of your hand is made up of the metacarpals • Then they branch out to the phalanges • Thumb only has 2 phalanges. Proximal and distal • Know carpal bone* • Triquetral, lunate and and scaphoid articulate with the wrist • Most commonly fractured is the scaphoid • If the hamate or pisiform bone is in pain, your ulnar nerve may be damaged • You have ulnar radial ligaments around the wrist • There are many ligaments between the radius and ulna which hold the 2 bones together • Flexor retinaculum is important in development of carpal tunnel syndrome • All the flexors run through the carpal tunnel • Know table 19-3** • Extrinsic muscles originate outside of the hand (ex. Digitorums) • Intrinsic originate inside the hand and insert on the inside of the hand Assessment of the Wrist, Hand, and Fingers
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