The Elbow, Forearm, Wrist, Hand and Fingers Exsc 240 Foosh Is Everywhere!
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THE ELBOW, FOREARM, WRIST, HAND AND FINGERS EXSC 240 FOOSH IS EVERYWHERE! ¢http://www.youtube.c om/watch?v=WxvoTfm a9zk BONES MUSCLES: FLEXORS Origin? Medial Epicondyle MUSCLES: EXTENSORS Origin? Lateral Epicondyle MUSCULATURE ¢ Pronator Teres: ¢ Origin: Medial Epicondyle ¢ Insertion: Middle, lateral humerus ¢ Action: Pronates forearm , flexes forearm ¢ Flexor Carpi Radialis: ¢ Origin: Medial Epicondyle ¢ Insertion: Base of 2nd/3rd metacarpal ¢ Action: Flexes hand/wrist MUSCULATURE ¢ Palmaris Longus: ¢ Origin: Medial Epicondyle ¢ Insertion: Flexor retinaculum in hand ¢ Action: Flexes hand/wrist ¢ Flexor Carpi Ulnaris: ¢ Origin: Medial Epicondyle ¢ Insertion: Pisiform, hamate, base of 5th metacarpal ¢ Action: Flexes hand/wrist MUSCULATURE ¢ Flexor Digitorum Superficialis: ¢ Origin: Medial Epicondyle ¢ Insertion: Middle phalanges of 2-5 fingers ¢ Action: Flexes middle phalanges of 2-5 fingers ¢ Flexor Digitorum Profundus: ¢ Origin: Medial Epicondyle ¢ Insertion: Front of 2-4 distal phalanges ¢ Action: Flexes distal phalanges of 2-5 fingers MUSCULATURE ¢ Flexor Pollicis Longus: ¢ Origin: Medial Epicondyle ¢ Insertion: Distal Phalanx of thumb ¢ Action: Flexes thumb ¢ Pronator Quadratus: ¢ Origin: Distal anterior ulna ¢ Insertion: Distal anterior radius ¢ Action: Pronates forearm and hand MUSCULATURE ¢ Brachioradialis: ¢ Origin: Distal lateral humerus ¢ Insertion: Styloid process of radius ¢ Action: Flexes Forearm ¢ Extensor Carpi Radialis Longus: ¢ Origin: Distal lateral humerus ¢ Insertion: Base of 2nd metacarpal ¢ Action: Extends hand MUSCULATURE ¢ Extensor Carpi Radialis Brevis: ¢ Origin: Lateral epicondyle ¢ Insertion: 3rd metacarpal ¢ Action: Extends Hand ¢ Extensor Digitorum: ¢ Origin: Lateral epicondyle ¢ Insertion: all 2-4 phalanges ¢ Action: Extends fingers and wrist MUSCULATURE ¢ Extensor digiti minimi: ¢ Origin: Lateral Epicondyle ¢ Insertion: Base of first phalange of 5th finger ¢ Action: Extends 5th finger ¢ Extensor Carpi Ulnaris: ¢ Origin: Lateral epicondyle ¢ Insertion: Base of 5th metacarpal ¢ Action: Extends hand MUSCULATURE ¢ Supinator: ¢ Origin: Lateral Epicondyle ¢ Insertion: Lateral surface of proximal radius ¢ Action: Supinates forearm ¢ Abductor Pollicis Longus: ¢ Origin: Shaft of radius & ulna ¢ Insertion: Base of 1st metacarpal ¢ Action: Abducts thumb, extends thumb, abducts wrist MUSCULATURE ¢ Extensor Pollicis Brevis: ¢ Origin: Distal Radius ¢ Insertion: Base of proximal phalanx of thumb ¢ Action: Extends thumb, abducts hand ¢ Extensor Pollicis Longus: ¢ Origin: Distal half of ulna ¢ Insertion: Base of distal phalanx of thumb ¢ Action: Extends thumb MUSCULATURE ¢ Extensor Indicis: ¢ Origin: Distal Ulna ¢ Insertion: Proximal phalanx of index finger ¢ Action: Extends index finger ¢ Abductor Pollicis Brevis: ¢ Origin: Scaphoid, trapezium ¢ Insertion: Base of proximal phalanx of thumb ¢ Action: Abducts thumb, Opposition MUSCULATURE ¢ Flexor Pollicis Brevis: ¢ Origin: Trapezium, first metacarpal ¢ Insertion: Base of proximal phalanx of thumb ¢ Action: Thumb flexion, aduction, rotation, & opposition ¢ Opponens Pollicis: ¢ Origin: Trapezium ¢ Insertion: Lateral first metacarpal ¢ Action: Opposition MUSCULATURE ¢ Adductor Pollicis: ¢ Origin: 2nd & 3rd metacarpals, capitate, trapezoid ¢ Insertion: Medial base of proximal phalanx of thumb ¢ Action: Adducts thumb ¢ Abductor Digiti Minimi: ¢ Origin: Pisiform ¢ Insertion: Medial base of proximal phalanx of 5th finger ¢ Action: Abducts 5th finger MUSCULATURE ¢ Flexor Digiti Minimi Brevis: ¢ Origin: Hook of hamate ¢ Insertion: Medial base of proximal phalanx of 5th finger ¢ Action: Flexes 5th finger @ metacarpophalangeal joint ¢ Opponens Digiti Minimi: ¢ Origin: Hook of hamate ¢ Insertion: Medial border of 5th metacarpal ¢ Action: Rotates 5th metacarpal MUSCULATURE ¢ Lumbricales: ¢ Origin: Flexor digitorum profundus tendons ¢ Insertion: Tendons of extensor digitorum ¢ Action: Extends fingers @ interphalangeal joints ¢ Palmar Interossei: ¢ Origin: 1st, 2nd, 4th, 5th metacarpal ¢ Insertion: Proximal phalanges of corresponding fingers ¢ Action: Adducts fingers MUSCULATURE ¢ Dorsal Interossei: ¢ Origin: 1-5 metacarpal ¢ Insertion: Proximal phalanges of corresponding fingers ¢ Action: Abducts fingers JOINTS PREVENTION: PROTECTIVE EQUIPMENT PREVENTION Taping Recognition of Strengthening injury of muscles FOREARM/ELBOW INJURIES ELBOW DISLOCATIONS ¢ MOI: Large axial force through forearm while elbow is slightly flexed. FOOSH Olecranon displaces from humerus. ¢ Displaced posteriorly or posteriorlaterally 90% of time ¢ Displacement rarely occurs anterior and lateral, but is possible ¢ S&S: Noticeable deformity, swelling, P!, ¢ Treatment: Splint, refer, monitoring of neurovascular status, ice as needed ¢ Follow-Up: Closed reduction by trained professional, assessment of neurovascular status, begin early active motion. Once motion is regained, can begin to work on strengthening. ELBOW FRACTURES ¢ Locations: ¢ Supracondylar: most common in adolescence ¢ MOI: fall on flexed elbow, hyperextension ¢ Olecranon: Common in skeletally mature individuals ¢ MOI: Direct blows, such as falling on flexed elbow ¢ Radial Head: Common w/ a dislocation ¢ MOI: FOOSH ¢ S&S: Possible deformity, P!, crepitus, swelling, P! w/ active elbow extension, passive elbow flexion ¢ Treatment: Splint, refer, possible reduction, casting ELBOW SPRAINS ¢ Ligaments: UCL & RCL ¢ MOI: ¢ Flexed elbow w/ valgus stress (acute or repetitive): UCL ¢ Flexed elbow w/ varus stress: RCL ¢ S&S: ¢ UCL: Swelling, echymosis, TTP, crepitus medial aspect of elbow ¢ RCL: Swelling, echymosis, TTP, crepitus lateral aspect of elbow ¢ Tissue Test: ¢ UCL: Valgus, moving valgus, ¢ RCL: Varus ¢ Treatment: ¢ PRICE, motion exercises, strengthening of surrounding musculature, fixture of throwing mechanics EPICONDYLAGIA: MEDIAL & LATERAL ¢ Lateral Epicondilitis ¢ Medial Epicondylitis ¢ Overview: ¢ Overview: ¢ Inflammation at the lateral epicondyle of the ¢ Inflammation at the medial epicondyle of the attachments of the extensor muscles. Most attachments of the flexor muscles. Most commonly affects the extensor carpi radialis commonly affects pronater teres. Also known brevis. Also known as “Tennis Elbow” as “Little Leaguers Elbow ¢ MOI: ¢ MOI: ¢ Insidious onset due to repeated, forceful ¢ Insidious onset, due to repeated, forceful flexion of the wrist and pronation of the wrist extension, radial deviation, supination, forearm. Common in young baseball players. or grasping in an overhand position. ¢ S&S: Common in racquet sports. ¢ P!, swelling, crepitus over medial epicondyle, ¢ S&S: P! w/ active wrist extension & passive wrist extension ¢ P!, swelling, crepitus over lateral epicondyle, ¢ Tissue Tests: P! w/ active wrist extension & passive wrist flexion. ¢ Medial Epicondylitis Test ¢ Tissue Tests: ¢ Treatment: ¢ RICE, limit activity, NSAIDS, stretching, ¢ Lateral Epicondylitis test strengthening. R/out growth plate fx. RTP when tolerable ¢ Treatment: ¢ RICE, limit activity, NSAIDS, stretching, strengthening, possible cortisone shot. R/out nerve injury. RTP when tolerable. FOREARM FRACTURES ¢ MOI: q FOOSH ¢ S/s: q Pain & swelling q Disability & deformity q Possible crepitus q TX: q RICE/Split q Prevent/Treat patient for shock q Refer for X-rays q Cast – Time dependent on severity q Rehab ¢ When is RTP? ¢ After cast comes off, rehab ¢ Time established by physician COLLES’ & SMITH FRACTURE ¢ Colles’ Fracture: ¢ MOI: FOOSH q Injury to distal radius Forces radius backward & upward (hyperextension) ¢ Smith fracture: q MOI: Reverse colles’ q Anterior displacement of fracture fragment q Not as a common COLLES’ & SMITH FRACTURE ¢ S/s q Dinner Fork deformity (Colle’s) q Extensive swelling q Possible torn tendons, median nerve damage ¢ Tx q Ice q Splint q REFERRAL! WRIST, HAND & FINGER INJURIES WRIST SPRAINS ¢ MOI q Abnormal or forced movement of Prevention = the wrist q Fall on hyperextended wrist ¢ S/s q Pain ¢ Squeezing, Rice/Sand Bucket, q Swelling Forearm Exercises q Tenderness along wrist q Inability to move ¢ Tx q RICE/NSAIDs q Splint/tape q Refer-X-rays DE QUERVAIN’S DISEASE Stenosing tenosynovitis - “Texters Thumb” ¢ MOI q Synovial Lining inflamed q Repetitive wrist motions q First tunnel of wrist becomes narrowed q Extensor pollicus brevis & abductor pollicus longus ¢ S/s q Aching radiating pain q Painful snapping/catching q Weakness: extension, abduction ¢ Who does it effect? q AT, therapist, physician q Tennis q ? DE QUERVAIN’S DISEASE: TREATMENTS Brace/Splint Anti- inflammatories Ice & Compression CARPAL TUNNEL SYNDROME ¢ Carpal Tunnel Contents q Median nerve & all flexor tendons except flexor carpi ulnaris & palmaris longus pass through carpal tunnel q Flexor Digitorum Profundus q Flexor Digitorum Superficialis ¢ Tx: q Flexor Pollicis Longus ¢ Rest, Immobilization, NSAIDS, ¢ MOI ¢ Chronic = Surgery ¢ Compression of Median nerve q Repeated wrist flexion, trauma ¢ S/s q Benediction Sign/Bishops Deformity q Sensory/motor deficits q Tingling, numbness, paresthesia,pain BOXER’S FRACTURE ¢ MOI ¢ 5th metacarpal fracture ¢ Direct or compressive force ¢ S/s ¢ Pain and swelling ¢ Crepitus or deformity ¢ Tx ¢ RICE ¢ Referral for X-rays ¢ 4 week splinting followed by ROM SCAPHOID FRACTURE COMMONLY MISDIAGNOSED ¢ MOI q FOOSH ¢ S/s q Pain/swelling q Anatomical snuff box q Not usually an obvious deformity (Palpation) ¢ Tx q REFERRAL and X-Ray! q Commonly Misdiagnosed for a wrist sprain q Proper splinting needed q Can cause poor blood supply q Leads to necrosis q Casting: 6 weeks q ROM & Strength emphasis in rehab q 3 months additional protection