Elbow Wrist Hand
Terms
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- Median Nerve Muscles
- Flexor digitorum superficialous 1/2 of profundus pronator teres and quadratus 1/2 lumbrials thenar eminence wrist flexors
- Finger Joint Dislocation
- Mechanism of injury is forceful hyperextension or compression. If no fractures are involved co-ban can be used for edemcontrol. Buddy taping to adjacent finger is used for protection and to encourage ROM.
- Structures that pass through the tunnel
- Median Nerve. 4 Flexor digitorum Superficialis Tendons. 4 Flexor digitorum Profundus tendons. Flexor Pollics longus tendon.
- Boxer's Fracture
- Fracture of the neck of the fifth metacarpal. This is the most common fractured metacarpal. Mechanism of injury is impact with a closed fist, as with punching someone or something.
- Elbow Dislocation Treatment
- Treatment depends on the amount of tissue damage and if fractures are involved. If the brachialis is involved, massage, passive stretching and resistive exercise are contraindicated due the risk of myositis ossification. Recurrence occurs in only 1-2% of cases that don't involve fractures or injury during childhood
- Cubital Tunnel Syndrome Expected Signs/symptoms
- The pt complains of medial elbow pain and paresthesia in the ulnar nerve distribution
- Ulnar Collateral Ligament Expected Signs/symptoms
- pt. complains of pain on the medial aspect of the elbow, and there is tenderness to palpation of the ligament. The pt may also have paresthesia in ulnar nerve distribution. Valgus stress test causes pain and/or reveals joint laxity. Young pts may experience an avulsion fracture of the medial epicondyle
- Ulnar Nerve Muscles
- Hypothenar eminence, flexor digitorum profundous 1/2 palmer interossi dorsal interossi adductor pollics 1/2 lumbricals.
- Ulnar Collateral Ligament Treatment
- Conservative treatment consists of a period of rest followed by strengthening. Surgical repair or reconstruction (Tommy John Surgery) using an autograph (the pts own tissue) may occur with complete ruptures. Generally, athletes can return to a throwing sport 22-26 weeks after surgery.
- Medial Epicondylitis (Golfer's elbow/little league Elbow) Treatment
- Same as LAEP (Start with rest and modalities to reduce inflammation (ice, iontophoresis or phonophoresis). Some physicians may use cortisone injections to reduce inflammation (limit of 3). A Tennis Elbow Strap may be used to reduce tenison at the site of inflammation. Pt must avoid aggravating activites to expect improvement. Stretching and strengthening should be gradual to avoid aggravative tissue -use pain as a guide. Cross Fiber massage may be used to break adhesions and increas circulation. Conserviatve treatment may be trived for several months before surgery is considered.)
- Median Nerve Sensation
- radial 2/3 of ventral surface of hand
- Lateral Epicondylitis (tennis elbow) Treatment
- Start with rest and modalities to reduce inflammation (ice, iontophoresis or phonophoresis). Some physicians may use cortisone injections to reduce inflammation (limit of 3). A Tennis Elbow Strap may be used to reduce tenison at the site of inflammation. Pt must avoid aggravating activites to expect improvement. Stretching and strengthening should be gradual to avoid aggravative tissue -use pain as a guide. Cross Fiber massage may be used to break adhesions and increas circulation. Conserviatve treatment may be trived for several months before surgery is considered.
- Ulnar Collateral Ligament Pathology
- Most often injured from repetitive valgus forces experienced during over hand throwing
- Mallet Finger
- Avulsion of DIP extensor tendon. Mechanism of injury is forced flexion of DIP joint. Treatment is with immobilization followed by blocked ARM exercises to regain flexion.
- Ape Hand Deformity
- Median nerve dysfunction causes atrophy of the thenar eminence. The palm flattens, making it resemble an ape's hand.
- Claw Hand Deformity
- Ulnar nerve dysfunction causes muscle atrophy of intrinsic hand muscles. Contractures leave the fingers in flexion at the PIP and DIP joints and hyperextension at the MCP joins.
- Cubital Tunnel Syndrome Treatment
- Rest, avoidance of aggravating activites and protective padding, followed by ROM exercises. Surgical decompression is considered if conservative treatment fails.
- Lateral Epicondylitis (tennis elbow) Pathology
- Repetitive microtrauma to the wrist extensors and or supinator most commonly the extensor carpi radialis brevis, which causes chronic inflammation at its proxmial attachment.
- DeQuervain's Tenosynovitis Treatment
- Splinting to rest the tendons and avoidance of aggravating factors. Anti-inflammatory medications. Modalities for pain and edema control Exercises to maintain/regain mobility and strength.
- Radial Nerve Sensation
- Posterior Forearm and radial 2/3 of dorsal surface of hand.
- Medial Epicondylitis (Golfer's elbow/little league Elbow) Pathology
- Repetitive trauma to the flexor carpi redialis or pronator teres causes chronic inflammation at their proxmial attachment on the humerus. Associated with baseball pitching, golfing, swimming and occupations that require strong grips and or pronation.
- Distal Radius Fractures Pathology
- Mechanism of injury is a foosh (usually an older person). Colles' fracture - distal radius displaces Dorsally ; results in dinner fork deformity. Smith's fracture -distal radius displaces ventrally ; less common.
- Boutonniere Deformity
- Rupture of the central slip of the extensor mechanism causes hyper extension of the DIP join adn flexion of the PIP joint. Mechanism of injury is forced flexion of finger or a progression of Rheumatoid Arthritis. (RA) Treatment is with immoblitization (splinting) followed by exercises to regain mobility and strength.
- Ganglion Cysts
- Ganglion cysts are a weak spot in the synovial lining of tendon sheaths or joints. These lumps are usually seen on dorsal aspect of wrist or hand. They may be treated with needle asperation if painful, but they may come back. Pt are not usually seen in therapy for this diagnosis.
- Ulnar Nerve Compression at Guyon's Canal
- Repeitive or prolonged pressure on the ulnar nerve as it passes between the hook of hamate and the pisiform causes parestheia in the ulnar nerve distribution of the hand and weakness of the intrinisc mucles of the hand. 1/2 lumbricals Hypothenar Eminence Palmer and Dorsal Interossi and Adductor Pollics.
- Dupuytren's Contracture
- Tightening of palmar fasic causes a flexor contracture of the 4th and 5th digits. Cause is unknown, but may have genetic component. May be surgically released if function is affected.
- Game Keeper's Thumb/Skier's Thumb/Goalkeepers Thumb
- Injury to the unlar collateral ligament of the thumb MCP joint. Mechanism of injury is a torsional (twisting) force applied to an abducted thumb. Treatment for incomplete tears is immobilization, followed by flexion and extension ROM. ABD stresses are avoided initially. Complete tears are repaired surgically.
- Distal Radius Fractures Treatment
- Rehab is similar regardless of method of fixation (cast, ORIF, or external fixation), only the timetable is different. In all cases, ROM to surrounding joints (Shoulder, elbow, and fingers) is very important to decrease edema maintain ROM prevent atrophy. Once immobilization is ended AROM is started immediately. PROM os started soon after. The pt is then progressed to strengthening exercises. Possible complications include carpal tunnel sundrome, reflex sympathetic distrophy and extensor pollics longs (EPL) rupture. EPL rupture is believed to occur from rubbing of the tendon around the fracture site. the pt is then unable to extend the thumb IP join and surgical repair is indicated.
- Carpal Tunnel Syndrome (CTS) Surgery
- If conservative treatment fails, a surgeral release of the flexor retinaculum may be performed. Initially, the pt needs to avoid active wrist flexion past neutral, and finger flexion with the wrist flex to prevent bowstringing of the flexor tendons. Post-op rehab includes desensitization training, nerve gliding and tendon gliding exercises and scar tissue mobilization.
- Carpal Tunnel Syndrome (CTS) Expected Signs/symptoms
- pts complain of pain with reptitive or sustained use of the hand, numness and tingling in the thumb and first 2-3 fingers, pain at night, and clumsiness, or weakness of the hand.
- Lateral Epicondylitis (tennis elbow) Expected Signs/symptoms
- pt complains of pain along the later aspect of the elbow, with tenderness to palpation at the lateral epicondyle. Pain may radiate down the forearm or up to the shoulder. Onset is usually gradual, starting with pain only during certain activites. Common problematic activites/occupations: computer work, construction, or janitorial work, assembly line work, gardening. As the problem progresses, the pain becomes constant and starts interfering with ADL's. Pain Increases with passive stretch of wrist extensors (Full wrist flexion with elbow extended and forearm pronated) and with resisted wrist extension or forearm supination. Pts typically have decreased grip strength due to pain.
- Swan Neck Deformity
- Trauma to the lateral extensor tendons or a progression of RA causes flexion of the DIP and MCP joints and hyperextension of PIP joint.
- Medial Epicondylitis (Golfer's elbow/little league Elbow) Expected Signs/symptoms
- Similar to lateral epicondylitis, expect a different set of muscles. Pain increases with passive stretch of wrist flexors (Full wrist extension with elbow extended) or with resisted wrist flexion or forearm pronation. Pts will have decreased grip strength due to pain. The Ulnar nerve may also be involved.
- Cubital Tunnel Syndrome Pathology
- Consists of entrapment of the ulnar nerve as it runs between olecranon and the medial epicondyle
- Elbow Dislocation Pathology
- Usually a result of elbow hyperextension during a foosh. May rupture the ulnar collateral ligament brachialis muscle or the wrist flexors or extensors. Fractures occur in 25-50% of the cases, with fracture of the head of the radius being the most common.
- Ulnar NerveSensation
- ulnar 1/3 of hand
- Scaphoid Fractures
- This is the most common carpal Injury. The mechanism of injury is a FOOSh (more common in young people). pt has pain in the anatomical snuff box. This fracture is often missed on inital x-ray and may be mistaken as a wrist sprain. Compromised blood supply to the scaphoid following injury means healing may take as long as 20 weeks. in some cases, avascular nercosis may occur.
- Carpal Tunnel Syndrome (CTS) Treatment
- pt ed. includes keeping the wrist in neutral position. if this is a work-related injury, an ergonomic evaluation of the pts workstation is important to reduce aggravating factors. The pt is often given a splint to wear at night and/or during the day to keep the wrist in a neutral position. Cortisone injections may be used to decrease inflammation. Median nerve glides are an important component of rehab. It is important not to aggravate symptoms if strengthening exercises are performed.
- Wrist Sprains
- This is usually a diagnosis of exclusion. If the pt experienced minor trauma, and fractures and ligament ruptures are ruled out, the pt is given this diagnosis. Treatment focuses on pain and edema control and maintaning ROM. Taping or splinting may be used for pain control. All exercises need to be done in a pain-free range.
- Radial Nerve Muscles
- Triceps Anconeus Brachioradalis,wrist/finger extensors, supinator abductor pollics longus.
- DeQuervain's Tenosynovitis Expected Signs/symptoms
- Burning pain over the radial aspect of the wrist (anatomical snuff box) Pain may radiate up the forearm or distally into the hand. Decreased pinch and grip strength. Pain increases with resisted thumb abduction and extension.
- Elbow Dislocation Expected Signs/symptoms
- The initial injury presents with rapid swelling, severe elbow pain and a shortened forearm with the olecranon pushed posteriorly
- DeQuervain's Tenosynovitis Pathology
- Inflammation of tendon sheaths of abductor pollics longs and extensor pollics brevis. This is usually an overuse injury
- Carpal Tunnel Syndrome (CTS) Pathology
- Compression of the medial in the carp tunnel. the carpal tunnle consists of the carpal bones dorsally and the transverse carpal ligament volarly. Compression may be associated with tendinitis, tenosynovitis, pregnancy, arthritis, or trauma. Space within the carpal tunnal is reduced even more positions of wrist flexion and extension.