Elbow and Forearm Injuries

1
Elbow and Forearm Injuries

• Taelar Shelton, MS, ATC, LAT, CES

2
Contusions

• Soft tissue or bone contustions
• Usually on the medial aspect
• MOI- collision, repeated blows
• Acute contusions- pain, swelling, hematoma
• Chornic- scars and bony callus
• Treatment- RICE, protection, may need x-ray if
  serious

3
Olecranon Bursitis

• Most common bursitis in the elbow
• Superficial location
• Acute or chronic- direct blow MOI
• SS- pain, warm, point tender, swelling
• Try conservative Rx first- cold compression
• Aspiration if serious

4
Strains

• Muscles around elbow
• Excessive restrictive ROM
• Usually from a fall or repeated microtraumas
• X-ray to r/o avulsion or epiphyseal Fx
• RICE, rehabilitation exercises, theraputic
  ultrasound, cryotherapy (ice)

5
Sprains

• Ligaments around the elbow
• Usually from hyperextension of elbow joint
• SS- pain, shifting of elbow joint,
  click/pop/snap, crepitis, tender to palpation,
  swelling, decrease in function of elbow
• Cold compress, main concern is ROM, do not
  massage, taping may assist in protecting injury

6
Lateral Epicondylitis

• Tennis Elbow is inflammation of extension
  muscles at the lateral epicondyle
• Repetitive extension of the wrist, throwing,
  microtrauma
• SS- pain during flexion/extension exercises,
  pain may radiate down the arm, mild swelling,
  point tenderness
• RICE for actue tendonitis, chronic- bracing or
  taping and rehab

7
Medial Epicondylitis

• Golfers Elbow is inflammation of the flexor
  tendons at the medial epicondyle
• Repetitive flexion of the wrist, pitching, golf
  swing
• Same Rx as tennis elbow

8
Osteochondritis Dissecans

• OCD also occurs in the knee
• Occurs in the bone and articular cartilage
• Impariment of blood supply, causes loose bodies
  in the joint
• Locking joint
• Can require surgery
• Can lead to arthritis

9
Ulnar Nerve Injuries

• Ulnar nerve is involved
• MOI- friction due to valgus force at elbow
• Can be caused by impingment at the elbow
• SSS- parasthesia down ulnar side of forearm,
  numbness and tingling
• Rx- Avoid pressure, can require surgery

10
Dislocation of the Elbow

• FOOSH is a common MOI
• Can dislocate anteriorly, posteriorlly or
  laterally
• Olecranon deformity
• Many ligmaents and tendons can be involved and
  may also cause a Fx
• Referral imediately, reduction by MD, sling,
  immobilize in flexion, rehab

11
Volkmans Contracture

• Complication of a serious injury
• Causes blood flow problems
• SS pain, swelling, muscle spasm, pressure
• Leads to permanaent muscle contracture and
  permanent paralysis in servere cases
• Immediate referral

12
Fractures- Elbow

• Humerus, radius or ulna
• Usually a FOOSH or direct blow MOI
• Higher rate of injury in children
• SS discoloration, swelling, muscle spasm, bone
  displacement is possible, swelling and muscle
  spasm
• Referral for X-ray

13
Wrist/Hand Injuries
14
Contusion

• Ulnar side of forearm and wrist at risk
• Can be acute or chronic
• Pain, swelling, hematoma
• Chronic injury can result in scar tissue
• Treatment- RICE, protection through padding

15
Strains

• Usually from repeated contractions
• Chronic fatigue, irritation in deep forarm
  muscles and tissue
• Rx- strengthening though reisistance exercises,
  rest, heat and ice, supportive wrap

16
Fractures

• Common in youths and children
• FOOSH
• Pain, swelling, deformity and a false joint
• Possibility to develop Volkmanns contratures
• Rx- splint and refer to physician

17
Colles Fx

• Fracture to the distal radius
• FOOSH, hyperextension
• Visible deformity
• Ligaments are usually involved
• Splint and get an xray

18
Carpal Tunnel Syndrome

• Anterior aspect of the wrist
• Transverse ligament can be too tight
• Usually overuse but can be from a direct blow
• Limited space for structures
• SS complain of numbnress and tingling

19
de Quervains Tendosynovitis

• Synovial lining becomes inflammed
• Constant wrist movement makes this worse
• SS aching, radiating pain in the forearm, pain
  with extension of the thumb, may hear a snap with
  movement
• Rx imobilize, ice, rest, antiinflammatory
  medications

20
Scaphoid Fx

• Most common carpal bone fracture
• FOOSH
• Can be misdiagnosed as a sprain
• Poor blood supply to this bone- can lead to
  necrosis
• Need to get an xray and imoblize

21
Hamate Fx

• MOI from the handle of a golf club, tennis
  racquet or baseball bat
• SS wrist pain, weakness
• Usually needs to be casted

22
Wrist Ganglion

• Herniation of the joint capsule or synovial
  sheath of a tendon
• Can aslo be a cyst
• Occurs after a wrist sprain that did not get
  proper Rx
• Rx Apply a pressure pad, surgical removal or
  draw the fluid out

23
Lunate Dx

• Most common bone to dislocate of the carpal bones
• Usually dislocates anteriorly
• Deformity on the palmar aspect
• Murphys sign
• Reduction by a physician