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Chapter 7 - Upper Extremity Injuries Impair peoples’ ability to manipulate the environment. Upper extremity design for motion not for the support of large.

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Presentation on theme: "Chapter 7 - Upper Extremity Injuries Impair peoples’ ability to manipulate the environment. Upper extremity design for motion not for the support of large."— Presentation transcript:


2 Chapter 7 - Upper Extremity Injuries Impair peoples’ ability to manipulate the environment. Upper extremity design for motion not for the support of large loads

3 Shoulder Anatomy n Shoulder complex: n Shoulder girdle: scapula and clavicle n Shoulder joint joint n Sternoclavicular joint: n Modified Ball & Socket n disk n Acromioclavicular joint n AC ligaments n Coracoclavicular joint n Glenohumeral joint: n Scapulothoracic joint

4 Shoulder Anatomy n Glenohumeral Joint n Most mobile joint n Shallow joint cavity n Glenoid labrum n Glenohumeral ligaments n Coracohumeral ligament n Muscular support n Rotator cuff muscles

5 Shoulder Anatomy n Rotator cuff n subscapularis n infraspinatus n supraspinatus n teres minor n Primary source of stability to the shoulder

6 Shoulder Anatomy

7 Shoulder Injuries n AC sprain or separated shoulder n Indirect or direct forces n direct force to acromion with shoulder in adducted position n fall on a outstretched arm n traction to arm n Classification n Type I-III n Type IV > rare n severe forces

8 Shoulder Injuries n Shoulder instability n poor joint cavity n poor ligament n musculature n Intracapsular pressure n Concavity compression n scapulohumeral balance

9 Shoulder Injuries n Anterior Luxation n mostly anterior when arm is abducted, extended and ext. rotated n posterior forces n Posterior luxation n same mechanism reverse n Inferior luxation

10 Shoulder Injuries n Impingement n glenohumeral joint: abduction n supraspinatus and bursae n Categories n Under 35 year: sports or jobs with overhead movement n Older: degeneration n Microtrauma-instability- subluxation-aggravation

11 Shoulder Injuries n Rotator cuff impingements n Extrinsic: structural factors n hook acromion n hypertrophy of supraspinatus n Intrinsic n inflammation of the tissue n Mechanism n work of sports requiring overhead movements n Wheelchair (abductor dominance)

12 Shoulder Injuries n Rupture Rotator cuff n Chain of events: n inflammation n microtears n partial or total rupture n movement adaptations n Supraspinatus rupture most common n Eccentric actions n acceleration phase n decceleratiom phase

13 Shoulder Injuries n Upper arm n two compartments n anterior n posterior n Humeral fractures n 7% of fractures n Direct or indirect n Low & high energy n falls, car crashes, direct loading, violent muscle contraction (throwing)

14 Shoulder Injuries n Biceps tendon injuries n tenosynovitis (repetition) n dislocation (medial) n abduction/ext. rotation n falls outstretched arm n lateral impact n hyperextension n anterior GH dislocation n bicipital grove angulation n rupture: tissue degeneration n SLAP

15 Elbow Anatomy n Hinge joint n Ligament support n MCL:valgus loading n LCL: varus loading n Annular ligament n Muscles n Flexors: biceps, brachialis and brachioradialis n Extensor: Triceps & anconeus

16 Elbow Injuries n Epicondylitis: repeated loading causing microtrauma and tissue degeneration leading to inflammation and tissue weakness n Lateral epicondylitis n tennis players 30-50 years old, poor stroke mechanics, excessive muscle contraction n Overuse of extensor mechanics, pinching and grasping

17 Elbow Injuries n Medial epicondylitis n excessive loading forehand and serve n Advanced players n Wrist motions

18 Elbow Injuries n Valgus Extension Loading n large varus torque n Mechanism n elbow extension n huge internal rotation torque transmitted to elbow

19 Elbow Injuries n Dislocations n more stable, less incidence of dislocation n Axial force to extended or hyper n Avulsion of collateral ligaments

20 Elbow Injuries n Fractures n humeral n Ulnar n olecranon:impact or hyperextension n Radial n axial loading of radius from a fall or dislocation

21 Forearm Anatomy n Two bones n radius & ulna n Two compartments of muscles n anterior: flexor-pronator n posterior:extensor-supinator n Proximal radioulnar joint n Distal radioulnar joint

22 Forearm injuries n Diaphyseal fractures of ulna & Radius n Galeazi: distal 1/3 radius, outstretched arm, blow to dorsum of wrist n Nightstick n Montegia lesion: classification for ulnar fractures n Distal radius: Colles etc.

23 Forearm injuries n Ulnar variance: relative length of ulna and radius n Determined n genetics n elbow pathology n mechanical loading n Ulnar variance in gymnast- premature closure of radial growth plate n Gymnastic: huge loads to the wrist- cartilage degeneration/fractures

24 Wrist & Hand Anatomy n Wrist joints n distal radio ulnar n radiocarpal n intercarpal n Hand joints n CM: n MP: condyloid n IP: hinge

25 Wrist & Hand Anatomy n Strong ligaments n Muscles n control wrist & finger motion n carpal tunnels n Flexor & extensor retinacula

26 Wrist & Hand Injuries n Carpal tunnel (CTS) n result from repetitive stress to tissue n 64% of work injuries n Compressive neuropathy n Wrist flexion/ext and finger movements n Risk factors n exertion n repetitive stress n posture n localized contact n cold

27 Wrist & Hand Injuries n Carpal fractures n compressive loads to hyperextended wrist n hyper flexion n rotation loading against a fixed wrist n Scaphoid n 60-70% n Lunate

28 Wrist & Hand Injuries n Thumb: essential to prehension n Sprain: skiers thumb n fall with thumb in abducted position n tensile loads on MCL n Hyperextension n Bennets fracture (fighting) n Bowler’s thumb: ulnar digital nerve trauma n tingling, sensitivity

29 Wrist & Hand Injuries n Metacarpal & phalangeal injuries n Fractures n Boxers n Dislocations

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