1. Upper Extremity Injury Evaluation

2. Anatomy
Shoulder
Elbow
Wrist/Hand
Abdomen/Thorax

3. Shoulder Anatomy Sternum Clavicle Humerus Scapula Manubrium, Body
Xiphoid process
Clavicle
AC Joint
SC Joint
S-Curve
Humerus
Bicipital groove/Biceps Tendon
Scapula
Acromion process

4. Anatomy: Scapula Spine Rotator cuff Superior Angle Medial Border
Acromion Process

5. Anatomy: GH Joint Glenohumeral Joint “Shoulder Joint”
Shallow for extra mobility,
Susceptible to dislocations & labral tears

6. Anatomy: Elbow Humerus Ulna Radius Medial/lateral epicondyles
Olecranon Process
Radius
Head

7. Anatomy: Hand/Wrist Carpal bones (8 bones) Metacarpals Phalanges
1-5 (one = thumb, five = little finger)
Phalanges
14 total
Radius/Ulna
Styloid Process

8. Abdomen & Thorax Anatomy
Vertebrae
Lower ribs
Thorax
Sternum
Ribs

9. 9 Abdominal Regions & 4 Abdominal Quadrants

11. Abdominal Muscles Rectus Abdominis Internal/External Obliques
TranverseAbdominis

12. Muscles of Chest and Back

13. Deformities Swan Neck: Boutonniere: Mallet:
-Flex tendon -Ext tendon Ext tendon
from middle from middle from distal
phalanx phalanx phalanx

14. Deformities Cubitus Valgus: “carrying angle”
Should be present, normal is ~11-16 degrees)
Cubitus Varus: “gunstock deformity”
Cubitus Recurvatum: “hyperextension”

15. Range of Motion
Shoulder: Flexion, Abduction, Adduction, Extension, Int. & Ext. Rotation
Elbow: Flexion, Extension, Pronation, Supination
Wrist & Hand: Flexion, Extension, Ab- & Ad-duction (fingers & thumb), Ulnar & Radial Deviation
Trunk: Flexion, Extension, Lateral Flexion/Bending

16. UE Injury Evaluation

17. Clavicle Fracture “Broken Collarbone” Treatment: RTP: Prevention:
Direct blow to front or side of shoulder
Point tenderness
Pain moving arm
Grating/grinding sensation
Deformity
Swelling
Treatment:
Immobilize arm w/ sling
Shock? Call 911
Ice
Refer
RTP:
4-6 weeks minimum
Released by a physician
Full ROM & Strength
Prevention:
Proper fitting shoulder pads
Proper landing technique

18. AC Sprain “Separated Shoulder” Treatment: RTP: Prevention:
Direct blow to top or side of shoulder
FOOSH: Fall on outstretched hand
Point tenderness over AC
Mild to severe pain raising arm or reaching across body
Deformity: elevation of the clavicle
Treatment:
Rest, Ice
Shock? 911
Refer if Grade II or III (deformity present)
Immobilize arm to body with elastic wrap
RTP:
Full strength & ROM
Released by physician (if seen by doctor)
Prevention:
Proper fitting equipment
Proper landing technique

19. SC Sprain “Shoulder Separation” FOOSH
Direct anterior blow (take caution!)
Point tenderness
Mild to severe pain moving arm across chest & shrugging shoulders
Dizziness (potential blood vessels damage going to brain)
Deformity
Possible unconsciousness; respiratory or cardiac arrest
Treatment:
Rest, ice, immobilize
Refer (maybe for anterior, but definitely for even mild posterior)
Monitor for shock
911 for grade II or III posterior separation
RTP:
Released by physician
Full ROM & Strength
Pain free
Prevention:
Wear appropriate equipment

20. GH Disloc/Subluxation
FOOSH
Direct blow to anterior or posterior shoulder
Intense pain
Carrying angle/Deformity
Instability
Tingling in arm or hand
Felt or heard pop
Inability to move arm or hand
Treatment:
Immobilize, monitor, ice, 911?
RTP:
Released by MD, Full strength & ROM
Prevention:
Shoulder strengthening exercises

21. RC Strain/Tear Treatment: RTP: Prevention: Supraspinatus most common
Poor mechanics
Weak/tight RC
Pain w/ raising or using arm
Weakness
Treatment:
Rest, ice, refer if symptoms persist, immobilize?, monitor?
RTP:
Pain free, full strength & ROM, Cleared by MD
Prevention:
Shoulder strengthening, teach proper mechanics

22. Rib Fracture/Contusion
Direct blow to rib cage
Mild to severe pain with breathing, coughing, sneezing, or laughing
Swelling, bruising
Point tenderness
Deformity
Pain w/ compression of rib cage
Breathing difficulties
Treatment:
Ice, Rest, Compression, 911?
RTP:
Released by MD, Padding
Prevention:
Wear appropriate padding

23. Humerous Fracture Treatment: RTP: Prevention:
Direct blow, torsion injury, compression injury
Severe pain
Deformity, swelling
Severe point tenderness
Inability to move arm
Bluish skin on forearm down to fingers
Tingling & loss of sensation
Treatment:
911, Monitor, Immobilize, Ice
RTP:
Released by MD, Full Strength & ROM
Prevention:
Teach proper landing/falling technique

24. Forearm/Wrist/Hand Fracture
Direct Blow/FOOSH
Numbness, tingling
Severe pain
Deformity, swelling
Point tenderness
Inability to bend or straighten elbow
Treatment:
Ice, Immobilize, monitor, 911?
RTP:
Cleared by MD, pain free, full strength & ROM
Prevention:
Wear padding, teach proper falling technique

25. Bicipital Tendonitis Treatment: RTP: Prevention:
Common in overhead athletes
Repeated forceful contraction or stretch
Weak/inflexible biceps
Mild to severe pain on upper arm
Pain w/ moving arm
Point tenderness over proximal bicipital tendon
Treatment:
Rest, Ice, Change Mechanics
RTP:
Pain free/to tolerance, full strength/ROM
Prevention:
Teach proper mechanics, preseason strengthening/stretching, limit amount of throwing

26. Elbow Disloc/Subluxation
Direct blow, FOOSH, Forced Ext.
Tingling/numbness
Felt/heard a pop
Sense of looseness/giving out
Swelling/Deformity
Inability to bend elbow
Treatment:
Rest, Ice, Immobilize, Monitor, 911?
RTP:
Cleared by MD, Pain free, Full ROM/Strength
Prevention:
Preseason strengthening/stretching biceps, triceps, forearm muscles

27. Ulnar Nerve Contusion Treatment: RTP: Prevention: “Funny Bone”
Direct blow
Tingling down arm/hand
Mild to severe pain
Point tenderness
Loss of grip strength
Treatment:
Rest
RTP:
Full strength, no tingling or numbness
Prevention:
Wear protective padding

28. Tennis Elbow Treatment: RTP: Prevention: Lateral Epicondylitis
Inflammation where the wrist extensors attach to the elbow
Mild to severe pain
Point tenderness over lat. epicondyle
Pain with wrist extension/backhand strokes
Treatment:
Ice, rest, NSAID’s
RTP:
Pain free, full strength
Prevention:
Pre-season strengthening, proper mechanics

29. Golfer’s Elbow Treatment: RTP: Prevention: Common in Baseball/Softball
Medial Epicondylitis
Inflammation where the wrist flexors attach to the elbow
Mild to severe pain
Point tenderness over medial epicondyle
Pain with wrist flexion/overhead motions
Treatment:
Ice, rest, NSAID’s
RTP:
Pain free, full strength
Prevention:
Pre-season strengthening, proper mechanics

30. Epiphyseal Stress Fracture
Growth Plate Fracture
Caution should be taken in young athletes with open growth plates
Repetitive & forceful throwing
Pain on med. elbow that worsens w/ activity
Swelling
Point tenderness above med. epicondyle
Treatment:
Rest, ice, immobilize, monitor, refer to MD
RTP:
Cleared by MD, Full strength/ROM, Pain free
Prevention:
Preseason strengthening, Limited pitch count

31. Elbow Bursitis Treatment: RTP: Prevention:
Acute blow or repetitive blows
Infection
Pain over posterior elbow
Swelling
Warmth?
Treatment:
Rest, Ice, Refer to MD?
RTP:
Released by MD, Pain free
Prevention:
Wear protective padding

32. Wrist Sprain Treatment: RTP: Prevention:
Stretch or tear of lig.’s in wrist
FOOSH or torsion injury
Mild to severe pain
Pain with certain wrist movements
Instability (Grade II & III)
Point tenderness
Swelling/Deformity
Decreased grip strength
Treatment:
Ice, rest, wrap or splint, monitor, refer?
RTP:
Pain free, full strength/ROM
Prevention:
Pre-season strengthening, proper landing techniques

33. Finger Sprain Treatment: RTP: Prevention: “Jammed finger/thumb”
Lig. stretch/tear
Direct blow to finger/twisting of finger
Mild to severe pain
Pain w/ ext. and flex.
Instability (Grade II/III)
Point tenderness/swelling/decreased strength
Treatment:
Ice, Rest, Monitor, Splint?, Refer?
RTP:
Pain free, Full strength/ROM, Tape
Prevention:
Strengthening of hand muscles

34. Finger Dislocation Treatment: RTP: Prevention:
Direct blow to end of finger
Crush injury
Intense pain
Tingling?
Felt or heard a pop
Feels out of place
Deformity/Swelling/Inability to bend or move finger
Treatment:
Ice, Immobilize, Monitor, 911?
RTP:
Cleared by MD, Pain free, Full strength/ROM
Prevention:
Strengthen muscles of hand