Recognition and Management of Elbow Injuries

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Recognition and Management of Elbow Injuries
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• Olecranon bursitis
• Cause result of direct blow superficial
  location makes it prone to injury
• SS ?
• Care ice packs, compression, padding, possible
  aspiration

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• Elbow strains
• Cause excessive resisted motion such as a fall
  on outstretched hand with elbow in extension that
  forces joint into hyperextension
• SS pain with active and resistive movement,
  point tenderness in muscle, tendon or muscle
  belly
• Care RICE rehab, modalities, x-ray if loss of
  motion

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• Ulnar Collateral Ligament Injuries
• Cause valgus force from repetitive trauma
• SS medial elbow pain, tenderness over UCL,
  laxity
• Care Rest, rehab strengthening, modalities,
  correct throwing mechanics, possible surgery
  tommy john

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• Epicondylitis
• Cause repeated forearm flexion and extension
  movements small micro-tears at muscle
  attachments
• SS pain at epicondyles during forced wrist
  flexion/extension radiating pain, point
  tenderness, mild swelling
• Care rest, modalities for pain, rehab, brace

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• Elbow dislocation
• Cause fall on outstretched arm with elbow in
  hyperextension, twist with elbow in flexion
• SS ?
• Care call 9-1-1, referral for reduction, sling,
  ice

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• Little League Elbow
• Cause occurs in 10-25 young pitchers caused
  by repetitive microtrauma that occurs from
  throwing and not from the type of pitch thrown
  includes many disorders of growth in the pitching
  elbow that may include
• an accelerated apophyseal growth region plus a
  delay in the medial epicondylar growth plate
• A traction apophysitis with a possible
  fragmentation of the medial epicondylar apophysis
• An avulsion of the medial epicondyle of the
  radial head
• Osteochondrosis of the humeral capitellum
• A nonunion stress fx of the olecranon epiphysis

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• SS onset is usually slow, in the beginning
  the athlete may have a flexion contraction, with
  tightness of anterior joint capsule and weakness
  of triceps muscle, complains of locking or
  catching, ? ROM of forearm supination/pronation
• Care RICE, NSAIDs, no throwing until full ROM,
  stretching, triceps strengthening, correct
  throwing techniques

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• The Forearm, Wrist, Hand and Fingers

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Forearm Injuries

• Colles Fracture
• Cause fall on outstretched hand, forcing
  forearm backward and upward into hyperextension
• SS deformity of wrist, profuse swelling
• Care cold, splint wrist, forearm in sling,
  x-ray, immobilize for 1-2 months

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Injuries to the Wrist

• Sprains/Strains
• Cause - sprain most common, most poorly
• managed abnormal forced movements or
  falling on hyperextended wrist
• SS generalized swelling, tenderness, limited
• range of motion
• Care RICE, modalities, rehab strengthening,
• taping

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• Scaphoid fractures
• Most frequently fractured carpal bone
• Without proper splinting, the scaphoid fx may
  have difficulty healing due to inadequate blood
  supply
• Cause force on the outstretched hand
• SS same as severe sprain swelling and point
  tenderness in anatomical snuffbox
• Care ice, splinting, xray, immobilization
  usually 6wks, rehab

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• Wrist ganglion
• Cause herniation of joint capsule or synovial
  sheath usually appears slowly after wrist
  strains
• SS lump, pain, feels soft, rubbery or very
  hard
• Care aspiration of cyst, chemical
  cauterization with a pressure pad, surgical
  removal

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Injuries to the Hand and Fingers

• Dislocations of the phalanges
• Cause force is directed upward from palmar side
  displacing either 1st or 2nd joint dorsally,
  resulting in tearing of supporting capsular
  tissue with hemmorhaging
• SS deformity, pain, swelling
• Care reduction, xray, splinting

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• Gamekeepers Thumb (UCL sprain of MCP joint)
• Cause forceful abduction combined with
  hyperextension
• SS pain over UCL, weak and painful pinch,
  tenderness, swelling
• Care refer to orthopedic, splint usually 3wks,
  rehab, taping

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• Mallet finger
• Cause force that strikes the tip of finger,
  avulsing the extensor tendon
• SS ?
• Care RICE, xray, splint in extension

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• Boutonniere deformity
• Cause trauma to tip of finger rupturing the
  extensor tendon dorsal to the middle phalanx
• SS severe pain inability to extend DIP
  joint swelling point tenderness obvious
  deformity
• Care ice splinting xray