Hand, wrist, and elbow injuries
Anatomical Structures
Radial Styloid Process
Ulnar Styloid Process
Metacarpophalangeal Joint (Mp)
Proximal Interphalangeal Joint (Pip)
Distal Interphalangeal Joint (Dip)
Anatomical Snuffbox
Elbow:
Articulations of the humerus, radius, and ulna. [ olecranon process ]
Medial collateral ligament:
3 portions, anterior, posterior, oblique
The anterior fibers are tight in extension, while the posterior fibers are tight in flexion [ beyond 90 degrees ] The posterior fibers are fan shaped and thin when compared to the anterior fibers.
The lateral collateral ligament consists of a capsular thickening which runs from the lateral epicondyle to the annular ligament.
Muscles
Biceps, 2 origins, 1 on the superior region of the glenoid and the other on the coracoid process. Insertion is into the tuberosity of the ulna.
Brachial, originates on the humerus, extends anteriorly across the joint and inserts into the ulna.
Triceps, 3 heads, originates from the inferior posterior glenoid and humerus to insert into the olecranon process of the ulna.
Flexor - pronator group, originates on the medial
Epicondyle, extends down the arm to insert at the wrist and fingers.
Extensor - supinator group, originates at the lateral epicondyle and extends down the forearm dorsally into the wrist and hand.
Olecranon bursae, separates the skin over the tip of the elbow from the pointed end of the ulna.[ Olecranon process ]
Radial - humeral bursae, lies anteriorly between the radial head and the lateral epicondyle between the muscle attachments.
Movements
Elbow:
flexion - extension
wrist:
supination - pronation - ulnar and radial deviation
flexion and extension
Flexion and extension originate at the humeroradial and humeroulnar joints while pronation and supination occur from the radio navicular articulations at the wrist and the radioulnar joint at the elbow.
Bones
carpals, metacarpals, phalanges
Elbow injuries
1. Upper arm contusions
2. Elbow
a. Ulnar nerve contusions (funny bone)
b. Ulnar nerve neuritis from throwing
c. Radial nerve
d. Olecranon bursitis
e. Hyperextension
3. Ligament sprains
a. Medial
b. Lateral
c. Hyper extension
d. Little league elbow
4. Muscular strains
5. Epicondylitis
a. Medial - golfers elbow
b. Lateral - tennis elbow
6. Dislocations
7. Fractures
Hand And Wrist Injuries
[ extensor tendon ]
2. Game keepers thumb
[ ulnar collateral ligament ]
3. Jersey finger
[ profundus tendon ]
4. Tendon injuries
a. Profundus
b. Sublimis
c. Testing for tendon attachment
5. Boutonniere deformity
6. Swan neck deformity
7. Collateral ligament tears
8. Volar plate injuries
9. Colles fracture [ ulna ]
10. Bennett's fracture [ thumb ]
11. Navicular fractures [ limited blood supply ]
12. Anatomical snuffbox
extensor pollicus longus and brevis tendons plus the abductor pollicus longus.
13. Boxers fractures [ metacarpals ] usually the 4th or 5th
14. Lunate dislocations
15. Dislocated fingers "but it’s just a finger"
16. "Smash" injuries to the finger.
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This finger was smashed between a squat bar and the weight rack resulting in an avulsion of the distal tip of the finger and nail. |
| Side view of finger showing the exposed distal phalange. |  |
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Surgical repair of the finger. It was necessary to shorten the distal end of the phalanx. Primary closure of the finger was then completed. The patient will lose approximately 1/4" of the distal end of the finger but otherwise will have full recovery. |