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Out there in the real world, one athletic training student experienced the following:

One day, I was lifting furniture when I heard a loud "pop" sound in my left wrist. This is the same wrist I broke my freshman year in high school, and it still gives me frequent problems of sprains and instability. I tried flexing my wrist, but that caused a lot of pain. In addition, my lunate bone was subluxing. There was no edema or ecchymosis, but the pain and laxity of my carpal bones worried me. At the time, being an athletic training student, I knew that something was seriously wrong and I needed to undergo testing. The radiography results were negative, and I underwent magnetic resonance imaging (MRI). The MRI results indicated scapholunate dissociation. I had torn my scapholunate ligament, which holds the scaphoid and lunate together. This is the one ligament you do not want to tear because there currently is not much in terms of research or clinical guidelines on how to repair it. Two surgeons said that they could fix it, but I would lose 50% of my range of motion (ROM). With some research, I found a surgeon willing to perform a Brunelli procedure to repair my wrist. Although the Brunelli procedure is more extensive than other procedures, it was possible that I would not lose as much ROM with the Brunelli procedure. This was a risk I was willing to take. I'm glad I took the risk because I now have almost 100% ROM in my affected wrist.

Mitch Howard, AT, ATC

St. Louis, Missouri


learning outcomes

After working through this chapter, you will be able to:

  1. Verbalize the questions to use when obtaining a thorough medical history for an assessment.

  2. Describe the principles of body movement at the hand, wrist, and elbow and the various mechanisms of injury that affect the hand, wrist, and elbow.

  3. Compare and contrast the findings of various special tests and the role of diagnostic tests used during a hand, wrist, and elbow evaluation.

  4. Explain the medical terminology associated with the assessment of musculoskeletal injuries.

  5. Verbalize the standard procedures used for a clinical evaluation of the hand, wrist, and elbow and interpret the findings for differential diagnoses.


Steve Loftus is a linebacker for his college football team. As he attempts to block his opponent during practice, he grabs the opponent's shoulder pads, and his right index finger gets caught in his opponent's jersey. His finger is forced into extension at the same time he is trying to flex his fingers and hold his opponent. After the play, Mr. Loftus walks off the field to be evaluated and tells the athletic trainer he felt a pop when trying to hold onto his opponent. ...

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