UPPER EXTREMITY INJURIES Objective 2: Recognize common injuries to the upper extremity…

ANATOMY BONES Ulna Radius Carpals Metacarpals Phalanges

ANATOMY BONES Clavicle Scapula Humerus Spine of the scapula Acromion process Glenoid fossa/cavity Humerus Epicondyles*

AC Joint Clavicle Acromion Acromion Spine of the Scapula Glenohumeral Joint Glenoid Fossa Humerus Scapula

ARTICULATIONS OF THE UE Shoulder Acromioclavicular Glenohumeral Elbow Humoradial Humoulnar Proximal Radioulnar Distal Radioulnar

Articulations of the Upper Extremity Cont… Wrist Distal Ulna, Radius, Scaphoid, Lunate, Trapezium, Pisiform, Triquetrum, Trapezoid, Capitate, Hamate, and Metacarpals. Metacarpal Phalengeal (MCP) Metacarpals and Phalanges Interphalengeal (PIP & DIP) Inbetween phalangeal bones

Joint Activity: Partner Up! Palpate each of the following joints: Acromioclavicular Humeroradial and humeroulnar Proximal radioulnar Distal radioulnar Metacarpal Phalangeal Proximal Interphalangeal Distal Interphalangeal Palpate: examine by touch for medicinal purposes

Bones and Joints Scavenger Human Hunt Homework Assignment

SOFT TISSUES Subacromial bursa – below the acromion process Sub: means below Acromial: acromion Bursa: fluid filled sac

Soft Tissues Continued Acromioclavicular (AC) Ligament – connects acromion and clavicle It says it in the name

Soft Tissue Continued Glenoid Labrum- cartilage ring around socket of shoulder

MUSCLES Muscle Location Function Deltoid Covers the shoulder Abducts the arm Supraspinatus (rotator cuff muscle) Posterior scapula Abducts the arm, some external rotation of shoulder; stabilizes the head of the humerus. Infraspinatus (rotator cuff muscle) Externally rotates the shoulder; stabilizes the head of the humerus. Teres minor (rotator cuff muscle) Subscapularis (rotator cuff muscle) Anterior scapula Internally rotates the shoulder; stabilizes the head of the humerus. Biceps Brachii Anterior aspect of the upper arm Flexes the elbow Triceps Brachii Posterior aspect of the upper arm Extends the elbow

Rotator Cuff (SITS): externally rotates, abducts, stabilizes Rotator Cuff (SITS): externally rotates, abducts, stabilizes and internally rotates

Supraspinatus: abducts, external rotation, stability

Infraspinatus: externally rotates, stabilizes the shoulder

Teres Minor: externally rotates, stabilizes the shoulder

Subscapularis: internally rotates and stabilizes the shoulder

Rotator Cuff Functions It is all about stabilization!!!! Perform the following: Shoulder abduction Shoulder external rotation Shoulder internal rotation

Deltoid: abducts the arm

Biceps Brachii: shoulder flexion, elbow flexion

How to stretch the biceps brachii? Thumb Down!!!!

Triceps Brachii: shoulder extension, elbow extension

How to stretch the triceps brachii?

Joint Activity: Partner Up! Palpate each of the following Muscles: Rotator Cuff Muscles What are they?? Name them Deltoid Biceps Triceps Palpate: examine by touch for medicinal purposes

Upper Extremity Injuries

FOOSH: Fallen on Outstretched Hand (Mechanism of Injury)

Photos of Graphic Nature Coming Up Try and guess which injury it is from the pictures show before

Prevention Strategies Clavicle Fracture Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies 1. Fall on outstretched arm. 2. Fall on tip of shoulder. 3. Direct impact Pain, deformity, swelling. Immobilize shoulder. Refer to physician. Don' t fall.

IS

Poor Posture Activity Stand up Roll shoulders forward, protract scapula Try and pull shoulders into flexion Try and pull shoulders into abduction Now pull shoulders back, retracting scapula

How many students are sitting like this or tend to stand in this position?

Prevention Strategies Impingement Syndrome Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies Mechanical compression of the supraspinatus tendon, subacromial bursa, and long head of biceps tendon. Pain around acromion with overhead arm position. Weak external rotators. Positive empty can and impingement tests. Restore normal biomechanics. Strengthen shoulder complex muscles, stretch posterior joint capsule, modify activity until asymptomatic. Decrease overhead activity, shoulder complex strengthening, improve technique

Impingement Rehabilitation Fix the postural defects Look at improper mechanics or techniques Evaluate for muscle imbalances Strong Pectoralis Major/Biceps Brachii with weak Trapezius/Rhomboids Tight anterior musculature EDUCATE!!! EDUCATE!!! EDUCATE!!!

Video

RCT

Prevention Strategies Rotator Cuff Strain Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies Mechanical compression of the supraspinatus tendon, subacromial bursa, and long head of biceps tendon. Pain around acromion with overhead arm position. Weak external rotators. Positive empty can and impingement tests. Restore normal biomechanics. Strengthen shoulder complex muscles, stretch posterior joint capsule, modify activity until asymptomatic. Decrease overhead activity, shoulder complex strengthening, improve technique Remember: Grade I, Grade II and Grade III Strains

Empty Can Test - Supraspinatus

Rotator Cuff Strengthening Shoulder Flexion Shoulder Abduction Scaption Thumbs up Thumbs down Internal Rotation External Rotation With small weights or a theraband.

Glenohumeral Dislocation Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies Forced abduction, external rotation of shoulder. Flattened deltoid contour, pain, disability. Splint in position found, immediate transport to physician. Shoulder complex strengthening.

Shoulder Dislocation NEVER, EVER, EVER ,EVER REDUCE A DISLOCATION!!!!!

ACS

Prevention Strategies AC Joint Separation Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies 1. Falling on an outstretched arm. 2. Direct impact to the tip of the shoulder. Grade I:point tender, painful ROM, no deformity. Grade II: elevation of the end of the clavicle, decreased ROM. Grade III: dislocation of the clavicle, severe pain, loss of ROM. Ice, immobilization of the shoulder, refer to physician. Return to play at return of full strength and ROM. Proper fitting pads Strengthening of deltoid muscle.

AC Joint Separations

Lateral Epicondylitis – “Tennis Elbow Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies Repetitive extension of the wrist. Aching pain in lateral elbow during and after activity. RICE, anti-inflammatory medications, strengthening exercises. Proper technique, progressive increase in frequency/intensity of training.

*Think backhand*

Medial Epicondylitis – “Little Leaguer’s or Golfer’s Elbow” Can lead to “Tommy-John” surgery Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies Repetitive flexion of the wrist. Pain in medial elbow, could radiate down arm; point tenderness, mild swelling. RICE, anti-inflammatory medications, strengthening exercises Proper technique, progressive increase in frequency/intensity of training.

Forearm Stretches to Prevent Epicondylitis Palm supinated Palm pronated Cross arms, pull up

This guy is having a bad day!

Interphalangeal Dislocation Mechanism of Injury Signs and Symptoms Treatment Blow to the tip of the finger. Pain, deformity, no ROM. Splint in position found, immediate referral to a physician. NEVER, EVER REDUCE YOURSELF! WHY?

THE END!!! GET YOUR STUDY ON!!!! Test on Tuesday! We will review as a class on Friday, but start studying now. If there is something you don’t understand, you won’t learn it in one night! Come to any of the games this week and get extra help. Just come sit by me and I will go over anything you need!

Handouts for Upper Extremity