Chapter 19 The Elbow, Forearm, Wrist, and Hand

CHAPTER 19
The Elbow, Forearm, Wrist, and Hand
OVERVIEW

Although fewer sports injuries are sustained in the upper limb than in the lower
limb, the elbow, forearm, wrist, and hand are prone to acute and overuse
syndromes. The elbow is subject to injury in sports because of its broad range of
motion, weak lateral bone arrangement, and relative exposure to soft tissue
damage in the vicinity of the joint. The forearm is indirectly influenced by injuries to
these areas; however, direct injuries can also occur. Injuries to the wrist usually
occur from a fall on the outstretched hand or repeated flexion, extension, or rotary
movements.
Injuries to the hand occur frequently in sports, yet often they are poorly
managed. The fingers are extremely prone to damage when a blow is delivered to
the tip of the finger or when the fingers are violently twisted. Injuries involving the
elbow, forearm, wrist and hand need to be recognized when they occur and should
be treated properly to avoid complications that may result in long-term disability.

LEARNING OBJECTIVES
After studying Chapter 19, the student will be able to:
Identify the bony anatomy of the elbow, forearm, wrist, and hand.
Identify the muscles associated with the elbow, forearm, wrist and hand, and
describe their functions.
Describe methods for prevention of injuries to the elbow, forearm, wrist, and
hand.
Discuss the assessment of injuries to the elbow, forearm, wrist, and hand.
Describe the acute injuries that occur to the elbow, forearm, wrist, and hand.
Describe the chronic injuries that occur to the elbow, forearm, wrist and hand.
Discuss the proper care for the injuries that occur to the elbow, forearm, wrist,
and hand.

KEY TERMINOLOGY

Boutonniere deformity - A rupture of the extensor tendon of the middle phalanx,

forces the DIP joint into extension and PIP into flexion
Boxers fracture A fracture involving the 5th metacarpal
Colles fracture - A fracture of the distal end of the radius
Lateral epicondylitis Also known as tennis elbow, involving the wrist extensors
and supinators
Ganglion - Herniation of the joint capsule or synovial sheath of a tendon
Jersey finger Rupture of the flexor digitorum profundus tendon from its
insertion on distal phalanx making the athlete unable to flex the DIP joint
Mallet finger - Injury caused by a blow from a thrown ball that strikes the tip of
the finger and avulses the extensor tendon from its insertion along with a piece
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Chapter 19 The Elbow, Forearm, Wrist, and Hand

of the bone making the athlete unable to extend DIP joint

Necrosis - Tissue death
Osteochondritis Dissecans - Impairment of blood supply that leads to
fragmentation and separation of the articular cartilage in a joint
Paresthesia Abnormal sensation including tingling or prickling
Subungual hematoma Blood underneath the fingernail or toenail
Trochlea - Medial condyle of the humerus that articulates with the ulna

DISCUSSION QUESTIONS
1.
2.
3.
4.
5.
6.
7.
8.
9.

Why would a serious injury be so devastating to the hand and wrist?

What are some common injuries of the elbow and how should they be managed?
Which conditions at the elbow can cause nerve and circulation damage?
What muscles and associated structures are found in the forearm?
What common injuries occur to the forearm? What causes them? How are they
managed?
What bony and soft tissue structures are in the wrist and hand?
What common injuries may occur in the wrist and hand? What causes them?
How are they managed? Which injuries can lead to serious complications?
How does the thumb differ from the other digits?
Why are finger and hand problems so often mismanaged?

CLASS ACTIVITIES
1. After proper instruction each student should pair up with a partner and practice
injury evaluations at the elbow, forearm, wrist, and hand. Have each student
mimic the symptoms and signs of a particular injury so that his or her partner
can evaluate the joint and name the type of injury.
2. Invite a hand specialist to discuss injuries to the hand and the serious
complications that may arise if injuries are mishandled. The specialist might also
discuss surgical procedures that can be done in repairing bone and soft tissue
injuries.
3. Students, in groups of four or five, should interview an athlete who has
experienced an injury to the upper extremity. On hearing the athlete's account of
the injury, the group should prepare a presentation on the condition including
noted symptoms and signs, management of the condition, surgical repair that
may be indicated, and any long term losses or effects the athlete may
experience.
4. Have each student prepare a three-or four-page report on injuries that may be
sustained in falling on an outstretched hand. Discuss each injury by explaining
the transmitted forces that caused the injury.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.

t
d
j
i

8. l
9. f
10. h
11. k

15.
16.
17.
18.

s
o
m
n
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 19 The Elbow, Forearm, Wrist, and Hand

5. e
6. p
7. a

12. c
13. g
14. u

19. b
20. r
21. q

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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 19 The Elbow, Forearm, Wrist, and Hand

Short Answer
22.Ulnar artery and radial artery
23.Splint in flexion around a gauze roll or a curved splint to avoid full extension of
the digit, which must be avoided at all times.
24.Flexor carpi ulnaris, and flexor carpi radialis.
25.Ulnar
26.The mechanism of injury is usually forceful abduction of the proximal phalanx,
which is occasionally combined with hyperextension.
27.Olecranon bursitis
28.Median nerve
Listing
29.Ulnar collateral ligament
30.Radial collateral ligament
31.Annular ligament
32.Biceps brachii
33.Brachialis
34.Brachioradialis
Essay
35-40.Cause: Repetitive extension of the wrist, which eventually causes irritation
and inflammation to the insertion of the extensor muscle on the lateral
epicondyle
Signs and Symptoms: Aching pain in the region of lateral epicondyle
during and after activity. Pain gradually becomes worse with weakness in the
hand and wrist. Tenderness palpable on lateral epicondyle and pain with
resisted wrist extension and full extension of the elbow.
Care: PRICE, NSAIDS, and analgesics as needed. Rehab includes ROM
exercises, progressive resistance exercises, deep friction massage, hand
grasping while in supination, and avoiding pronation movements.
Mobilization and stretching may be used within pain-free limits. Wearing of
counterforce brace or neoprene elbow sleeve for 1-3 months. Teach proper
skill techniques and use proper equipment.
41-44.Boxers fracture: Fracture of the 5th metacarpal from direct axial force
caused by punching a wall or another person. Point tenderness and possibly
palpable defect in shaft of fifth metacarpal. Swelling is rapid. Refer to MD,
requires reduction and immobilization 3-4 weeks.
Mallet finger: Caused by a blow to the tip of the finger, avulsing the
extensor tendon from its insertion along with a piece of bone. Unable to
extend the distal phalanx, splint in extension 6-8 weeks.
Boutonniere deformity: Caused by a rupture of extensor tendon over the
middle phalanx. DIP joint is in extension and PIP joint is in flexion. Splint PIP
joint in extension for 5-8 weeks.
Jersey finger: Rupture of flexor digitorum profundus tendon from its
insertion on the distal phalanx. DIP joint cannot be flexed and finger is in
extension. May require surgery.
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Chapter 19 The Elbow, Forearm, Wrist, and Hand

NAME ______________________________
SECTION__________

CHAPTER 19 WORKSHEET
The Elbow, Forearm, Wrist, and Hand
MATCHING: Match the structure with the appropriate name.
________1. Annular ligament
________2. Capitate
________3. DIP joint
________4. Distal phalanx
________5. Hamate
________6. Humerus
________7. Lunate
________8. MCP joint
________9. Metacarpal
_______10. Middle phalanx
_______11. PIP joint
_______12. Pisiform
_______13. Proximal phalanx
_______14. Radial collateral
ligament
_______15. Radius
_______16. Scaphoid
_______17. Trapezium
_______18. Trapezoid
_______19. Triquetral
_______20. Ulna
_______21. Ulnar collateral ligament

SHORT ANSWER: Answer the following questions with a brief response.

22.With an elbow injury, where would you check for circulation distal to the injury?
23.How should a fractured phalange be splinted?
24.Name the two muscles that are the main wrist flexors.
25.Injury to the _______________ nerve causes paresthesia into the fourth and fifth
fingers.
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manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 19 The Elbow, Forearm, Wrist, and Hand

26.What is the most common mechanism that leads to gamekeeper's thumb?

27.What injury is most often caused by a direct blow to the olecranon?
28.Which nerve is compressed with carpal tunnel syndrome?
LISTING: List the three major ligaments of the elbow.
29.
30.
31.
List the three main muscles that flex the elbow.
32.
33.
34.
ESSAY:
35-40.Explain the cause, signs and symptoms, and care for lateral epicondylitis.

41-44.Describe the following injuries: Boxers fracture, Mallet finger, Boutonniere

deformity, and Jersey finger.

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2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.