Unit 4:Understanding Athletic-Related Injuries to the Upper Extremity

1
Unit 4Understanding Athletic-Related Injuries to
the Upper Extremity

• Elbow Injuries
• David Smith

2
Objectives

• Describe the basic anatomy of the arm and elbow
• Explain common arm and elbow injuries that occur
  with athletic participation
• Identify common signs and symptoms of arm and
  elbow injuries
• Explain common tx parameters performed by an ATC
  for elbow injuries

3
Anatomy of the elbow

• Hinge joint involving three major bones
• Humerus, ulna, and radius
• Ulna is hooked to humerus to form a tight joint
• Radius rests against the humerus and is able to
  rotate
• Allowing for pronation and supination

4
(No Transcript)
5
(No Transcript)
6
Ligaments

• Joint capsule
• Like shoulder, surrounds the elbow
• Gives general stability
• Ulnar collateral ligament
• Helps stabilize medial aspect of elbow
• Radial collateral ligament
• Helps stabilize the lateral aspect of elbow

7
Ligaments cont.
8
Ligaments cont...

• Annular ligament
• Helps hold radius and ulna together near elbow
  joint
• Interosseus membrane
• Joins the radius and ulna together, keeps bones
  from separating

9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
Muscles

• Triceps brachii
• Elbow extension
• Biceps brachii
• Elbow flexion
• Wrist flexors
• Attach at medial epicondyle of humerus
• Wrist extendors
• Attach at lateral epicondyle of humerus

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Muscles cont...

• Very important to check distal pulse and
  sensations to check for blood vessel or nerve
  damage
• Several small nerves run through the small
  spacesand grooves around the elbow on their way
  to the hand

18
Distal Radial Pulse
19
Preventing Elbow Injuries

• Not frequently injured
• Usually overuse injuries
• chronic inflammation and pain
• Tennis and baseball common sports
• Strengthen and stretch larger muscles, ignore
  smaller muscles
• Wrist flexors and extensors

20
Preventing Elbow Injuries

• Proper equipment
• Excessive stress on elbow musculature can result
  in using a racket with a grip that is too small
• Alter activities
• Taking breaks after long throwing days if playing
  baseball

21
Treating Elbow Injuries and Conditions

• Ligament Injuries
• 1-3 Sprains
• Ulnar collateral ligament
• Radial collateral ligament

22
Ligament Injuries

• Ulnar Collateral Ligament Sprain
• Most commonly injured due to stress placed on
  elbow by hitting tennis ball
• Direct blow may also cause disruption pf UCL

23
Ligament Injuries

• Valgus Stress
• medial part of joint would separate or spread
  apart as the forearm moves laterally
• Common in contact sports or if falling on
  outstretched arm
• Sprain characterized by medial elbow pn and
  swelling, laxity.
• Tx RICE, splinting, r/o fx by referral for
  x-ray. Rehab includes strengthening wrist
  flexors- help to provide stability

24
Ligament Injuries

• Radial Collateral Ligament Sprain
• Rare
• Characteristics same as UCL sprain but on the
  lateral aspect
• TX Focus on strengthening the wrist extensors,
  provide dynamic stability

25
Muscle and Tendon Injuries

• Caused by excessive resistive forces or overuse

26
Muscle and Tendon Injuries

• Elbow Flexor Strain
• Loaded movement, elbow and shoulder together
• Two joint muscle- movement created at more than
  one joint
• Characterized by pain and swelling, weakness
• TX RICE, mild stretching and strengthening

27
Muscle and Tendon Injuries

• Elbow Extensor Strain
• Excessive resistance to the triceps
• Falling and attempting to break fall with an
  outstretched arm
• Assess carefully, can be an avulsion fracture of
  ulna
• TX Same as elbow flexor strain

28
Muscle and Tendon Injuries

• Wrist flexor strain
• Can result from excessive resistance during wrist
  flexion movements or overuse
• Pain over medial epicondyle or humerus or in the
  front of the forearm
• TX RICE and modified activity, stretching and
  strengthening

29
Muscle and Tendon Injuries

• Wrist extensor strains
• Excessive resistance during wrist extension or
  overuse
• Pain over lateral epicondyle of humerus
• TX Same as wrist flexion

30
Muscle and Tendon Injuries

• Lateral epicondylitis
• Tennis elbow
• result of poor mechanics and continual use over a
  long period of time
• wrist extensor tendons at lateral epicondyle of
  the humerus become chronically inflamed
• Pain over lateral epicondyle and minimal swelling
• TX reduce pain and inflammation, RICE, support,
  limiting activity, mild stretching and
  strengthening, medication

31
Muscle and Tendon Injuries

• Medial Epicondylitis
• Little League Elbow
• Inflammation of wrist flexor tendons
• result of repetitive throwing
• Pain over medial epicondyle
• TX Same as lateral epicondylitis and decrease
  throwing
• monitor ulnar nerve- watch for numbness,
  tingling, or excessive pain

32
Bone Injuries

• Bone fx to distal end of humerus
• Not common
• Due to very powerful mechanisms of injury
• hand planted on ground and someone forcing the
  arm into excessive side bending
• Wrestling?
• Fx between condyles
• Direct impact
• BOTH ARE A MEDICAL EMERGENCY DUE TO COMPRESSION
  ON NERVE OR ARTERY

33
Fracture Distal end of Humerus
34
Fracture of Condyles
35
Bone Injuries

• Epiphyseal and Avulsion fx
• More common on medial epicondyle or olecranon
  aspect
• Severe pn and deformity- avulsion fx
• Ulna Dislocation
• Fairly tight joint
• Very traumatic
• Violent hyperextension or a severe blow
• Obvious deformity, medical emergency

36
Avulsion Fracture
37
Bone Fragment in Elbow Joint
38
Other common injuries

• Hyperextension
• Fall on outstretched arm or receive blow to elbow
• Problems
• Sprain the ligaments at the anterior aspect of
  elbow
• Strain the musculature at the anterior aspect of
  elbow
• Receive a painful bony compression if the
  olecranon process impacts the humerus
• TX RICE, or referral, hyperextension tape job

39
(No Transcript)
40
Other common injuries

• Olecranon Bursitis
• fluid to build up at the tip of the elbow from a
  traumatic force (usually a blunt blow to tip of
  elbow)
• TX Compression wraps, massage, stim, US, protect
  with padding,
• MD to drain the fluid (???)

41
(No Transcript)
42
Elbow Dislocation

• Reduce if medical personnel is available
• If no medical personnel present needs to ER for
  x-rays and reduction
• May compromise nerves and arteries.
• Check distal pulse after reduction

43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
(No Transcript)