1. Chapter 24: The Forearm, Wrist,
Hand and Finger

2. Anatomy of the Forearm

7. 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?

8. Observation



Visually inspect for deformities, swelling and skin defects
Range of motion
Pain w/ motion
Palpation


Palpated at distant sites and at point of injury
Can reveal tenderness, edema, fracture, deformity,
changes in skin temperature, a false joint, bone
fragments or lack of bone continuity

9. Valgus carrying
angle

10. Gunstock deformity

11. Normal carrying angle
a
b

12. Normal elbow alignment
a
b

13. Dislocations
http://www.youtube.com/watch?
v=RaLQYJOFl6k

14. Elbow Dislocations
• Posterior
What’s Damaged?
UCL
Annular
LCL
Ant. Capsule
Brachialis
Flexor tendons

15. Elbow Dislocations

16. Chronic Injuries

17. Epicondylitis
Medial “little league elbow”
Wrist flex. On follow thru.
Curve balls?
Lateral “tennis elbow”
Backhand

19. Epicondylitis
Cause:
Overuse!!!

20. Epicondylitis
Youth?
Avulsed
epicondylar
growth plates

21. Olecranon Bursitis
 Etiology

Superficial location makes
it extremely susceptible to
injury (acute or chronic)
--direct blow
 Signs and Symptoms


Pain, swelling, and point
tenderness
Swelling will appear
almost spontaneously and
w/out usual pain and heat

22. Recognition and Management of
Injuries to the Forearm
Forearm Contusion

Etiology




Ulnar side receives majority of blows due to arm blocks
Can be acute or chronic
Result of direct contact or blow
Signs and Symptoms


Pain, swelling and hematoma
If repeated blows occur, heavy fibrosis and possibly bony callus
could form w/in hematoma

23. Contusion (continued)

Management


Proper care in acute stage involves RICE for at least one
hour and followed up w/ additional cryotherapy
Protection is critical - full-length sponge rubber pad can be
used to provide protective covering

24. Forearm Fractures
Etiology
 Common in youth due to falls and direct blows
 Ulna and radius generally fracture individually
 Fracture in upper third may result in abduction deformity due
pull of pronator teres
 Fracture in lower portion will remain relatively neutral
 Older athlete may experience greater soft tissue damage and
greater chance of paralysis due to Volkman’s contracture
Signs and Symptoms
 Audible pop or crack followed by moderate to severe pain,
swelling, and disability
 Edema, ecchymosis w/ possible crepitus

25. Management
Initially
RICE
followed by
splinting
until
definitive
care is
available
 Long term
casting
followed by
rehab plan


26. Colles’ Fracture

Etiology



Occurs in lower end of
radius or ulna
MOI is fall on
outstretched hand,
forcing radius and ulna
into hyperextension
Less common is the
reverse Colles’ fracture

27. Colle’s Fracture Cont.
Signs and Symptoms
 Anterior displacement of radius causing visible deformity
(silver fork deformity)
 When no deformity is present, injury can be passed off as bad
sprain
 Extensive bleeding and swelling
 Tendons may be torn/avulsed and there may be median nerve
damage
Management
 Cold compress, splint wrist and refer to physician
 X-ray and immobilization
 Severe sprains should be treated as fractures
 Without complications a Colles’ fracture will keep an athlete
out for 1-2 months
 In children, injury may cause lower epiphyseal separation

28. Smith’s Fracture
MOI – falling on back
of hand forcing wrist
into hyperflexion
Radius displaces
posteriorly
Less common than
colles’ fracture

30. Anatomy of the Wrist, Hand and Fingers

32. T
H
T
C
P T
S
L
Never Lower Tilly’s Pants, Terrible Things
Could Happen
Some
Lovers
Try
Positions
That
They
Can’t
Handle

37. •Blood and Nerve Supply
Three major nerves

Ulnar, median and
radial
Ulnar and radial
arteries supply the
hand

Two arterial arches
(superficial and deep
palmar arches)

38. Activity- Anatomy Review
WRIST AND HAND

39. Assessment of the Wrist, Hand and Fingers
History








Past history
Mechanism of injury
When does it hurt?
Type of, quality of, duration of, pain?
Sounds or feelings?
How long were you disabled?
Swelling?
Previous treatments?

40. Assessment Cont.
Observation







Postural deviations
Is the part held still, stiff or protected?
Wrist or hand swollen or discolored?
General attitude
What movements can be performed fully and rhythmically?
Thumb to finger touching
Color of nailbeds

41. Recognition and Management of
Injuries to the Wrist, Hand and Fingers
Wrist Sprains

Etiology





Signs and Symptoms


Most common wrist injury
Arises from any abnormal, forced movement
Falling on hyperextended wrist, violent flexion or torsion
Multiple incidents may disrupt blood supply
Pain, swelling and difficulty w/ movement
Complications


Can be complicated due to the complex
Carpal fractures are often missed
ligamentous structure

42. Tendinitis /Tenosynovitis

Etiology



Repetitive pulling movements of (commonly) flexor carpi radialis
and ulnaris; repetitive pressure on palms (cycling) can cause
irritation of flexor digitorum
Primary cause is overuse of the wrist
Signs and Symptoms


Pain on active use or passive stretching
Isometric resistance to involved tendon produces pain, weakness
or both

43. Carpal Tunnel Syndrome

Etiology



Compression of median nerve due to inflammation of tendons and
sheaths of carpal tunnel
Result of repeated wrist flexion or direct trauma to anterior aspect
of wrist
Signs and Symptoms

Sensory and motor deficits (tingling, numbness and paresthesia);
weakness in thumb

45. 
Scaphoid Fracture

Most fractured bone in the wrist

-Fx of the bone most commonly from a fall
on outstretched hand

-Complications:
 1.
difficult to confirm with xray
 2. poor blood supply = poor healing
 3. high morbidity rate

46. 
Scaphoid
Fracture

47. Phalange Fracture
 "jammed"


joint surface fx – axial load
Direct blow
Rotational force

49.  Boxer’s Fracture
(Donovan’s fx)

-Fx of the 5th met.

-Mech: axial
compression mostly
caused by punching

50. Finger Dislocations
•IP Joint most common
•Thumb dislocations are severe

51. UCL- Thumb Sprain
Ulnar Collateral Ligament



Mech - abduction and/or hyperextension
3rd Degree - Gamekeepers Thumb




Commonly under dx.
Severe laxity
Chronic instability and dysfunction
Early arthritis