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Elbow, Wrist, Hand, and Fingers

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Title: Elbow, Wrist, Hand, and Fingers


1
Elbow, Wrist, Hand, and Fingers
2
  • Elbow Anatomy
  • A. The elbow joint is an intricate collection of
    bones, muscles, ligaments, and nerves. It permits
    movements which are used in numerous sports. From
    this joint run the muscle and nerves that control
    and the detailed movements of the hand, wrist,
    and fingers. The elbow and forearm are important
    functional links between the shoulder and the
    intricate mechanisms of the hand. The ability to
    perform athletic skills involving the upper
    extremities is dependant on the integrity on the
    bones, ligaments and muscles of the elbow and
    forearm. The upper limb is prone to acute and
    overuse syndromes.
  • B. Bones
  • 1. The elbow joint is composed of three bones
    the HUMERUS is the largest bone of the arm and is
    similar to the femur of the leg, in that it has
    two articulating condyles at its lower end these
    are known and the LATERAL and MEDIAL EPICONDYLES.

3
  • 2. Just as knee ligaments and tendons attach to
    the femurs condyles, arm ligaments and tendons
    use the distal knobs of the humerus as a base of
    attachment the lateral distal end of the humerus
    forms the CAPITULUM, and the medial end forms the
    TROCHLEA the capitulum is a rounded knob that
    articulates with the head of the radius the
    trochlea is a spool-shaped projection that fits
    into the notch of the head of the ulna.
  • 3. In anatomical position the ULNA is located on
    the medial (little finger) side and the RADIUS on
    the lateral (thumb) side of the forearm in this
    position, both bones are nearly parallel the
    ulna acts as a stationary axil as the radius
    turns around it as the forearm and hand rotate
    the ulna is a large bone proximally but becomes
    narrower as it extends distally towards the
    wrist the OLECRANON process of the ulna extends
    posteriorly, preventing hyperextension of the
    elbow the radius is much larger distally at the
    wrist and narrows as it extends proximally to the
    radial head the radius is closely approximated
    to the ulna distally and proximally however, it
    has a radial bow in its mid-portion separating it
    from the ulna.

4
  • 4. An INTEROSSEOUS MEMBRANE connects the two
    bones in the forearm the distal ends of both the
    radius and ulna are known as the STYLOID
    PROCESSES .
  • C. Ligaments
  • 1. The elbow is considered to have very strong
    ligamentous and muscular support the elbow is
    stabilized by MEDIAL (ULNAR) and LATERAL (RADIAL)
    COLLATERAL LIGAMENTS the MCL is attached to the
    humerus and the ulna, and the LCL is attached to
    the humerus and the radius.
  • 2. Adding further to the elbow stability is the
    ANNULAR ligament this ligament attaches to the
    ulna and completely encircles the head of the
    radius the annular ligament keeps the radius and
    ulna from separating.

5
  • D. Muscles and Tendons
  • 1. The BICEPS muscle extends from the humerus and
    scapula to the radius the primary function of
    the biceps group is flexion of the elbow.
  • 2. The TRICEPS muscle also originates from the
    humerus(two sites) and scapula and attaches to
    the ulna this muscle groups primary function is
    extension of the elbow.
  • 3. The BRACHIALIAS attaches on the humerus and
    inserts on the ulna the brachialias group
    assists in elbow flexion.
  • 4. The BRACHIORADIALIS also assists with flexion
    and originates on the lateral humerus and
    attaches to the medial radius.
  • 5. The elbow permits not only flexion and
    extension but also supination and pronation of
    the forearm and hand. Pronation is produced
    primarily by the PRONATORS (Pronator Teres and
    Pronator Quadratas) supination is performed by
    the supinator muscles.

6
  • E. Other Structures
  • 1. The BICIPITAL BURSA and the OLECRANON BURSA
    are closed, fluid filled sacs that cushion the
    tendons of the biceps muscle. And the area
    between the olecranon process and the skin,
    respectively.
  • F. RANGE OF MOTION
  • 1. As discussed previously, the elbow moves in
    flexion and extension the elbow in connection
    with the forearm moves in supination and
    pronation.
  • G. Blood and Nerves Supply
  • 1. Deep within the elbow lie the BRACHIAL and
    MEDIAL ARTERIES that supply the area with
    oxygenated blood.
  • 2. The nerves that innervate the elbow are the
    RADIAL AND MEDIAN NERVES.

7
  • A. The wrist is that area of articulation between
    the forearm and hand precise functioning of the
    hand and wrist is essential to almost every type
    of athletic activity functional anatomists
    sometimes refer to the hand and wrist as the
    reason for the upper extremity both structures
    are frequently used during athletic activity and
    often function as a single unit together they
    permit a incredible array of intricate movements
    and also observe to absorb or transmit forces
    caused by falls or traumatic contact.
  • B. Bones
  • 1. The wrist contains the CARPAL BONES, the
    distal ends of the RADIUS and ULNA, and the
    proximal ends of the metacarpals.
  • 2. The eight carpal bones of the wrist are named
    according to their general shape and appearance
    they are arranged in two rows, proximal and
    distal, each consisting of four bones the
    proximal row from radial(thumb) side to ulnar
    (little finger) side is composed of the NAVICULAR
    OR SCAPHOID (boat-shaped), the LUNNATE(moon-shaped
    ) the TRIQUETRUM (greater multangular),

8
  • TRAPEZIOD (lesser multangular), CAPITATE
    (head-shaped), and HAMMATE (hooked) bones.
  • 3. THE METACARPALS of the hand are identified by
    numbers 1-5, beginning on the lateral side with
    the metacarpal of the thumb each metacarpal has
    a slightly curved shaft and two extremities a
    base, which articulates proximally with the
    carpals, and a head, which articulates distally
    with the phalanges the heads of the metacarpals
    form the knuckles on the back of the hand,
  • 4. THE PHALANGES form the bony skeleton of the
    fingers or digits there are 14 phalanges in each
    hand two for the thumb and three for each of the
    remaining four fingers the bony anatomy of all
    five fingers essentially the same starting
    proximally, middle, and distal phalanges, or as
    the first, second and third phalanges they
    resemble the metacarpals in shape and appearance.

9
  • 5. The proximal joint between phalanges is
    referred to as the PROXIMAL INTERPHALANGEAL JOINT
    (PIP),while the distal joint it known as the
    DISTAL INTERPHALANGEAL JOINT(DIP) the joint
    between the metacarpals and phalanges is the
    METACARPAL PHALANGEAL JOINT (MIP)
  • C. Ligaments
  • 1. The wrist is composed of many ligaments that
    bind the carpal bones to one another, to the ulna
    and radius, and to the proximal metacarpal bones
    the ULNAR COLLATERAL LIGAMENT extends from the
    tip of the styloid process of the ulna to the
    medial carpal bones The RADIAL COLLATERAL
    LIGAMENT extends from the styloid process of the
    radius to the navicular bone.
  • 2. Located on the palmar surface of the wrist is
    the CARPAL TUNNEL, formed by the arched carpal
    bones and numerous ligaments, through which pass
    nerves and tendons.

10
  • 3. Ulnar collateral ligaments and radial
    collateral ligaments are found at each MCP, PIP,
    and DIP joint also, VOLAR PLATE LIGAMENTS are
    found on the pulnar surface of each of the above
    joints.
  • D. Muscle Tendons
  • 1.crossing the palmar surface of the wrist and
    passing through the carpal tunnel are the FLEXOR
    TENDONS.
  • 2. Crossing the dorsal surface of the wrist are
    the EXTENSOR TENDONS of the fingers.
  • E. Other Structures
  • 1. Of particular portions is a landmark called
    the ANATOMIC SNUFFBOX, which is formed by three
    extensor tendons the tendons forming the
    snuffbox become prominent, when the thumb is
    extended the navicular lies just below the
    anatomic snuffbox and this surface landmark is
    used to locate and palpate this most frequently
    fractured carpal bone.

11
  • F. Range of Motion
  • 1. The wrist can move in both flexion and
    extension as well as abduction (radial
    deviation), adduction (ulnar deviation),and
    circumduction
  • 2. The four fingers flex, extend, abduct, and
    adduct, whereas the thumb the most important
    digit) can perform flexion,extension,abduction,add
    uction, and opposition(thumb to finger).
  • G. Blood and Nerve Supply
  • 1. The arteries that supply the wrist, hand, and
    fingers are the RADIAL and ULNAR ARTERIES.
  • 2. The three major nerves of the wrist, hand, and
    fingers are the ULNAR, RADIAL, AND THE MEDIAN
    NERVES.

12
  • A. injuries involving the elbow and forearm are
    common in athletic activity. The elbow is subject
    to injury because of its broad range of motion,
    weak lateral bone arrangement, and relative
    exposure to soft-tissue damage. Many different
    types of force and stress are applied about the
    elbow during the various activities involved in
    different sports. A variety of athletic injuries
    can result from direct trauma to the area,
    indirect trauma such as falling on an
    outstretched hand, or acute and chronic stresses
    associated with throwing and swinging activities.
  • B. Common Injuries
  • 1. Contusions because of its lack of padding and
    its general vulnerability, the elbow often
    becomes contused during contact sports.
  • A. direct blows to the tissue around the elbow
    can result in bruising and subsequent
    bleeding,producing stiffness during function and
    active range of motion, and swelling
  • b. the contusion should be treated immediately
    with cold and pressure for at least 24 hours.

13
  • 2. Elbow Hypertension hypertension injury occurs
    when the elbow is fully extended and is then
    forced past its normal range of motion this
    often happens when the athlete tries to stop a
    fall by landing on an outstretched hand with the
    elbow locked.
  • A. the ahtlete will hold the elbow in a bent
    position and will be apprehensive about trying to
    straighten the arm signs and symptoms include
    swelling throughout the joint, general
    tenderness, and pain.
  • B. initial treatment consists of cold,
    compression, and elevation when the athlete is
    allowed to resume activity, the joint must be
    protected from reaching full extension one way
    to do this is with a restrictive tape job.
  • 3. Elbow Dislocation dislocationof the elbow has
    a high incidence in sports activity and is caused
    most often by a fall on the outstretched hand
    with the elbow in a position of hyperextension or
    by severe twist while it is in a flexed position
    the bones of the ulna and radius may be displaced
    backward, forward, or laterally most commonly
    both the ulna and radius are forced
    backwardligaments are stretched and torn

14
  • Because so many arteries and nerves pass through
    the elbow joint, dislocation of a bone could
    cause serious damage to circulation or to the
    nervous system permanent paralysis of the
    fingers, hand and arm is a possibility with elbow
    dislocations.

15
Elbow Dislocations
  • Signs and symptoms are immediate pain with a
    total loss of function in the elbow and obvious
    deformity numbness along the medial side of the
    elbow and forearm is often present, indicating
    neurological injury frequently there are
    associated fractures.
  • All elbow dislocations should be properly
    immobilized and referred to a physician
    immediately

16
Tennis Elbow (lateral epicondylitis)
  • Tennis elbow is, in most cases, an inflammation
    of the lateral epicondyle of the humerus that is
    caused by overuse, weakness, poor technique, lack
    of flexibility, or inadequate warm-up in tennis
    a racquet that is strung too tightly or that has
    improper hand grip size can lead to tennis elbow

17
Tennis Elbow (cont.)
  • Besides treating the symptoms of tennis elbow,
    the cause of the problem also needs to be
    corrected
  • There may be little swelling with tennis elbow
    the athlete may experience general weakness of
    the muscles of the lower arm pain may be
    centered at the epicondyle or it may radiate down
    the arm
  • Management of this condition usually includes use
    of a sling, rest, and ice

18
Little League Elbow
  • Numerous muscular-related injuries can be grouped
    under the heading little league elbow besides
    young baseball players, athletes in other sports
    can also suffer from this condition the cause is
    often too much stress on the elbow in younger
    athletes, when the muscle is stronger than the
    bone to which it is attached, a chip of bone can
    be pulled away by the muscle it is also possible
    for the ulnar nerve, which crosses the medial
    epicondyle of the humerus, to be injured

19
Little League Elbow (cont.)
  • In this case, the athlete will feel numbness,
    tingling, or weakness in the forearm, hand, and
    fingers this injury can occur to either the
    medial or lateral side of the elbow
  • Treatment is similar to tennis elbow

20
Forearm Fractures
  • Fractures of the forearm are particularly common
    among active children and occur as the result of
    a blow or fall on the outstretched hand
    fractures to the ulna or the radius singly are
    much rarer than simultaneous fractures to both
  • The break usually presents all the signs and
    symptoms of any fracture including pain,
    swelling, and deformity
  • Treatment consists of ice, immobilization, and
    referral to a physician

21
Colles Fracture
  • This particular fracture is a fracture of the
    distal radius and/or ulna the mechanism of
    injury is usually a fall on the outstretched hand
  • In most cases there is a visible deformity to the
    wrist, extensive swelling, and pain
  • Management is consistent with treatment for any
    fracture

22
Wrist Sprain
  • A sprain is by far the most common wrist injury
    and in most cases is the most poorly managed
    injury in sports it can be caused by any
    abnormal, forced movement of the wrist falling
    on the hyperextended wrist is the most common
    cause repeated sprains may disrupt the blood
    supply and consequently the nutrition to the
    carpal bones

23
Wrist Sprain (cont.)
  • Signs and symptoms include generalized wrist
    swelling, tenderness, inability to flex the
    wrist, and absence of appreciable pain or
    irritation over the navicular bone
  • Initial treatment consists of ice and
    compression it is important to have the athlete
    begin hand strengthening exercises as soon as
    possible taping the wrist for support can
    benefit healing and help prevent further injury

24
Wrist Fractures
  • The same mechanism or injury for wrist sprains
    will often cause a fracture wrist fractures
    occur most often to three bones the radius, the
    ulna and the navicular fractures of the radius
    and ulna are more obvious than a fractured
    navicular in a navicular fracture there is
    normally no displacement of fragments and such an
    injury may be erroneously evaluated as a wrist
    sprain

25
Wrist Fractures (cont.)
  • A fractured navicular will cause pain just distal
    to the radius and point tenderness will be found
    upon palpation of the anatomical snuffbox
  • Lack of treatment can leave the athlete with a
    permanently painful wrist any athlete who has
    had a wrist injury and has tenderness in the area
    of he navicular should be considered to have a
    fracture until proven otherwise
  • Management includes ice and splinting for
    referral to a physician

26
De Quervains Disease
  • This condition is a common form of tenosynovitis
    (inflammation of the tendon and its surrounding
    synovial sheath) of the wrist
  • Repetitive ulnar deviation(adduction) and
    gripping(very common in racquet sports) can
    inflame these tendons in their closed space
    resulting in pain when using the thumb,
    stiffness, and pinch weakness swelling and
    tenderness are present along the athletes radial
    aspect of the wrist
  • Treatment includes immobilization, rest, and ice

27
Wrist Ganglion Cyst
  • The wrist ganglion is often seen in sports it is
    considered by many to be herniation of a sheath
    of a tendon which permits a portion of the
    underlying tissue to come through it the
    herniated sac forms a cystic enlargement that
    gradually fills with fluid and may become quite
    large it usually appears slowly after a wrist
    sprain but can occur without any trauma a
    ganglion generally appears on the dorsal side of
    the wrist but can also occur on the palmar side

28
Contd
  • The cystic mass may vary in consistency from very
    soft to very firm and is generally not painful to
    the touch as it increases in size, it may be
    accompanied by mild pressure discomfort a
    ganglion that is painful or limits motion should
    be examined by a physician
  • Most methods of treatment do not prevent the
    ganglion from returning surgical removal is the
    best of the various methods of treatment

29
Carpal Tunnel Syndrome
  • The carpal tunnel is a canal in the palmar
    surface of the wrist formed by the arched carpal
    bones and various ligaments this tunnel contains
    the median nerve and nearly all the flexor
    tendons constriction or narrowing within the
    carpal tunnel and subsequent pressure on the
    median nerve are called Carpal Tunnel Syndrome
    this condition can result from swelling secondary
    to trauma or more commonly by repeated wrist
    muscular activity constriction of the median
    nerve can restrict motor function and sensation
    along the nerve distribution of the hand

30
Contd
  • Referral to a physician is appropriate
    occasionally, a persistent nerve compression
    requires surgical decompression
  • Athletes suffering from this condition often
    complain of numbness and tingling that increase
    with use and may occur at night

31
Hand and Finger Injuries and Injury Management
  • There are few sports in which the hands are not
    used in some manner and athletes hands are
    constantly exposed to various types of forced
    movements and direct trauma as a result, a wide
    variety of athletic injuries to the hands can
    occur many are relatively minor and are never
    reported because there is a tendency by many
    athletes to underestimate or minimize injury to
    this area of the body, injuries to the hands can
    develop into long-term disability if not
    recognized and cared for properly

32
Subungual Hematoma
  • The hand and phalanges, having an irregular bony
    structure combined with little protective fat and
    muscle padding, are prone to bruising in sports
    a particularly common contusion of the
    fingernail this is an extremely painful
    condition because of the accumulation of blood
    underneath the fingernail

33
  • The athlete should place the finger in ice water
    until the bleeding ceases and the pressure of
    blood should then be released a common method
    for releasing the pressure of the subunununungual
    hematoma is to use either a needle or the
    straightened end of a paper clip heat the tip
    until red-hot and then do something to it to help
    the pain go away to the side of the bleeding you
    should be having fun highlighting trapped the
    blood all the blood is released the nail should
    be kept clean and dry

34
Mallet Finger
  • Mallet finger is common in sports particularly in
    baseball where the finger looks like a mallet
    hammer it is caused by playing girly sports like
    baseball where the ball strikes the tip of the
    finger and avulses or something like that the
    extensor tendon from its insertion along with a
    piece of bone

35
Contd
  • This injury is characterized by pain, swelling,
    and tenderness at the IHOP joint, as well as the
    inability of the athlete to actively flex at this
    joint while the proximal and middle finger joints
    are held straight
  • The finger should immediately be cut off or
    splinted in extension cold should be applied so
    you look cool see a physician

36
Finger Sprains
  • The phalanges, particularly the thumb are prone
    to sprains caused by a blow to the tip of the
    finger or by twisting
  • Signs and symptoms include pain, marked swelling,
    and bleeding into the joint as well as tenderness
    at the site of the injury and an increase in pain
    on reproduction of the stress that caused the
    injury

37
Contd
  • A sprain can occur at any of the fingers joints
    (MCP, PIP, or DIP) and involve troy thomas
    wearing dresses with skylar summers putting on
    his mothers make up any of the ligaments at each
    joint (UCL, RCL, or Volar Plate) the joint most
    commonly sprained is the elbow this is the
    finger joint with the greatest amount of flexion
    and estension Jammed Fingers or spraines are
    very painful right after they occur but the pain
    usually subsides quickley. Longer lasting pain
    above and below the joint may indicate a fracture.

38
First aid
  • Normal first aid procedures are appropriate for
    finger sprains the finger may be taped to a
    non-injured one for protective support.

39
  • Gamekeepers Thumb A sprain of the ulnar
    collateral ligament of the MCP joint of the
    thumb is commonly among athletes, especially
    really gay ones, like derek spackman the
    mechanism of injury is usually a forceful
    abduction of the proximal phalange, which is
    occasionally combined with hyperextension this
    ligament provides the stability necessary for
    normal gripping and pitching this injury is
    often overlooked or dismissed as a sprained
    thumb. If it is not cared for, weakness and
    swelling will occur.

40
  • Signs and symptoms are local tenderness, swelling
    and increased and increased pain on abduction of
    the thumb. Instability will be present if the
    ligament is torn.
  • The thumb will be splinted to above the wrist and
    referral to a physician should be made.

41
Finger Dislocations
  • Finger dislocations the same mechanisms causing
    finger sprains may result in dislocations. This
    happened to troy thomas once and he peed in his
    pants for he was exceedingly angry. These
    dislocations may remain displaced or may reduce
    spontaneously.

42
  • It is good practice to refer all athletes with
    dislocations to a physician, no matter how minor
    thte injury may seem inadequate treatment may
    lead to permanent instability and deformity of
    the joint.

43
Metacarpal Fractures
  • Fractures of the hand frequently occur in
    athletics and result from the same mechanisms of
    injury previously described because these
    fractures involve small bones, they are often
    thought to be minor injuries and this treated
    casually

44
  • Finger stiffness, mal-alignment and functional
    disability may be consequences of hand fractures
    fractures of the metacarpals usually result from
    a direct blow to the area or to the metacarpal
    head, which transmits the force down the shaft of
    the bone
  • Signs and symptoms include pain, deformity,
    swelling and abnormal mobility in some cases no
    deformity occurs
  • All suspected fractures should be examined by a
    physician

45
  • Boxers fracture a fracture of the neck of the
    fifth metacarpal usually results from a punch
    leading with the little finger
  • Bennetts fracture a fracture of the base of the
    1st metacarpal

46
Elbow Injury Evaluation
  • History
  • What happened? How? Position?
  • Characteristics of pain? Local or General?
  • Previous Injuries?
  • What makes it better or worse?
  • Numbness? Or stuff like that?
  • Locking or crepitus during movement?
  • Were symptoms immediate or gradual?

47
  • Inspection
  • Swelling
  • Dislocation
  • Deformities
  • Whenever confornted with an injured elbow,
    inspect and compare both elbows to note any
    differences in symmetry. Note exactly where the
    swelling is located. Note the alignment of both
    arms and the ability for full extension.

48
  • Palpation
  • Bony and soft tissue
  • Palpation of the injured elbow or forearm is used
    to identify specific structures that may be
    involved in the injury. This is accomplished by
    accurately locating all areas of tenderness and
    swelling, as well as any other physical signs
    that may assist in recognizing the injury. Begin
    palpation away from the suspected area of injury.

49
  • Palpate the following structures
  • Humerus
  • Medial and lateral epicondyles
  • Olecranon process
  • Ulna
  • Radius
  • Biceps
  • Triceps
  • Brachialis
  • Brachioradialis
  • Pronators
  • Supinators
  • Medial collateral Ligament
  • Lateral Collateral Ligament
  • Annular Ligament

50
Special Tests
  • Range of motion
  • Active
  • Active movements should be performed first to
    evaluate the range of motion and the integrity of
    the muscles

51
  • Passive
  • Generally the only passive movements that are
    performed with elbow injuries are those that
    evaluate the integrity of the medial and lateral
    collateral ligaments these valgus and varus
    tests will be discussed under stress tests

52
  • Resistive
  • Resistive movements are used to further evaluate
    the integrity of muscles to apply resistance
    against elbow flexion, stabilize the arm or elbow
    with one hand and apply resistance to the
    movement proximal to the wrist with the other hand

53
  • Strength
  • Resistive movements should be used to compare
    muscular strength between extremities weaknesses
    should be noted

54
Stress Tests
  • Stress tests should never be used until you are
    sure there is no associated fracture or
    dislocation
  • Valgus test testing for integrity of the medial
    collateral ligament cup injured elbow of the
    athlete in one hand and grasp the wrist with the
    other hand flex the elbow to 15 to 20 degrees.
    Instruct the athlete to relax the muscles of the
    upper extremity place a force inward in an
    attempt to open up the medial side of the elbow

55
  • Varus test
  • Testing for integrity of the lateral collateral
    ligament exact same as valgus test except apply
    force outward.

56
  • Tennis elbow test testing for tennis elbow
    (lateral epicondylitis) the examiner should
    apply resistance to the athletes extended hand
    with the elbow flexed to 45 degrees a positive
    tennis elbow test will be moderate to severe pain
    at the lateral epicondyle

57
Wrist, Hand, and Finger Injury Evaluation
  • History
  • What happened? How? Position?
  • Characteristics of pain? Local or general?
  • Previous injuries?
  • What makes better or worse?
  • Numbness or other stuff like that?
  • Were symptoms immediate or gradual?

58
  • Inspection
  • Swelling
  • Discoloration
  • Deformities
  • Notice the positioning and functioning of the
    injured hand as you talk with the athlete. Are
    there any postural deviations? Carefully inspect
    the injured hand for signs of trauma that can
    indicate what type of force has been applied.

59
  • Palpation
  • Bony and soft tissue
  • Gently palpate those areas suspected of being
    injured to locate such physical signs as
    tenderness deformity, swelling, or crepitus.

60
  • Palpate the following structures
  • Radial styloid process
  • All eight carpal bones,
  • Ulnar styloid proccess
  • Metacarpal bones
  • Phalanges
  • Webbed space between thumb and index finger

61
  • Moving in continuous motion ask the injured
    athlete to make a tight fist and then straighten
    the fingers notice u whether each digit moves
    easily through a complete range of motion at each
    joint finger abduction and adduction can be
    elevated be instructing the athlete to spread
    their fingers apart and bring them back together
    again each of the digits and each motion of the
    finger can be evaluated separately if necessary
    the active range of motion of the finger can be
    evaluated separately if necessary the active
    range of motion for the thumb consists of
    flexion, extension, abduction, adduction, and
    opposition instruct the athlete to perform each
    of these motions and observe the movement.
  • B. Passive
  • passive range of motion can be used to further
    evaluate the integrity of a joint whenever
    active range of motion is limited or restricted,
    passive motion may be implemented to evaluate the
    available range as with all areas of the body,
    passive range of motion must be performed gently
    and cautiously so no further damage results all
    motions described under active movements can be
    evaluated passively

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  • C. Resistive
  • resistive movements are used to further evaluate
    to integrity of muscles apply resistance against
    the active movements to assist in identifying
    specific painful areas to apply resistance
    against wrist flexion, stabilize athletes forearm
    with one hand and apply resistance to movement
    against the palm of the athletes hand with your
    other hand to evaluate wrist extension apply
    resistance against the back of the athletes hand
    it is not necessary to resist radial and ulnar
    deviation because these muscles are evaluated
    during flexion and extension. Finger flexion is
    often resisted as a functional unit instruct the
    athlete to flex all fingers into a fist as you
    curl and lock your fingers into theirs to attempt
    to pull the fingers into extension to resist
    finger extension, curl your fingers over the
    athletes fist and instruct the athlete to extend
    to fingers as you apply resistance to resist
    finger abduction, instruct the athlete to spread
    his/her fingers as far apart as possible attempt
    to push each set of to fingers together to test
    finger adduction, instruct the athlete to keep
    the fingers together as you

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  • Attempt to pull them apart resistance can be
    applied in a similar manner to each individual
    joint resistance to thumb opposition can be
    accomplished by instructing the athlete to touch
    the top of the little finger with the top of the
    thumb attempt to pull the two apart with your
    index finger.
  • 2. Strength
  • A. resistive movements should be used to compare
    muscular strength between extremities weaknesses
    should be noted

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Stress Tests
  • A. stress tests are used to facilitate the
    assessment of athletic injuries of the wrist and
    hand because of the delicate and intricate
    makeup of this area of the body, various types of
    stress are usually necessary to complete to
    assessment process.
  • (1) Finklesteins test testing for de Quervains
    disease the athlete makes a fist with the thumb
    tucked inside the wrist is then deviated into
    ulnar flexion

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  • Sharp pain is a positive sign for Quervains
  • (2)Phalens test testing for carpal tunnel
    syndrome the athlete is instructed to flex both
    wrists as far as possible and press them
    together this position is held for approximately
    one minute if this test is positive, pain will
    be produced in the region of the carpal tunnel.
  • (3) ganglion cyst test testing for a ganglion
    cyst the athlete should flex his/her wrist and
    the examiner should provide resistance against
    extension if pain is elicited the test is
    positive.
  • (4) valgus test testing for integrity of the
    medial collateral ligaments at each joint of the
    fingers with the injured finger extended, the
    examiner should hold the end of the finger with
    his/her fingers and place a gentle force at each
    joint inward with the thumb in attempt to open
    the medial side of that joint differences in the
    laxity of the MCL should be noted.
  • (5) varus test testing for integrity in the
    lateral collateral ligaments at each joint of the
    fingers

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  • With the injured finger extended the examiner
    should hold the end of the finger with his/her
    thumb and place a gentle force at each joint
    outward with a finger in an attempt to open the
    lateral side of that joint differences in the
    laxity of the LCL should be noted.
  • (6) gamekeepers thumb test testing for a sprain
    of the ulnar collateral ligament of the thumb
    the examiner should resist thumb abduction the
    test is positive if the procedure elicits pain.
  • (7) percussion test testing for metacarpal and
    phalangeal fracture the examiner should give a
    percussive blow to an extended phalange and
    metacarpal with the vibratory force traveling
    straight down the shaft of the bones pain is a
    positive sign for this test.
  • 4. Functional Tests
  • A. functional movements or activities can be
    beneficial to the assessment of wrist, hand, and
    finger injuries often observing an athlete
    perform those activities that reproduce painful
    symptoms will be helpful

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  • However, for the most part, functional movements
    are used to determine when an athlete with a
    wrist, hand, or finger injury can return to full
    activity.
  • 5. Neurological
  • A. reflexes the brachioradialis (C6) reflex can
    be tested for wrist, hand, and finger injuries
    to test this reflex, place the athletes elbow in
    flexion and support the forearm using a reflex
    hammer, tap the brachioradialis tendon at the
    distal end of the radius the normal response is
    slight elbow flexion.
  • B. you may also test the biceps and triceps
    reflexes compare the reflex responses
    bilaterally and note any differences between the
    two sides
  • C. sensations sharp and dull sensations should
    be compared bilaterally note any differences
    between the two sides.

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  • 6. Circulatory
  • A. pulse A pulse should be taken at the brachial
    artery and the radial artery. Normal pulse rate
    for adults is 60 to 80 beats per minute.
  • B. nail bed perfusion fingernails
  • C. blood pressure normal blood pressure is
    120/80.
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