1. Unit 7
Upper Extremity

2. Bell Ringer Tell me 3 things you know about the shoulder…
Try to think of 3 different kinds of things (For example…a bone, a muscle, and something else…)

3. Shoulder complex

4. Tell me what you know about the shoulder…

5. Shoulder Great degree of mobility Mobility  instability
Ball and socket joint
Mobility  instability
Instability  injury
Overuse

6. Anatomy Bony Clavicle (collar bone) S-shaped bone
Sternum (breast bone)
3 parts: manubrium,
body, and xiphoid process
Scapula (shoulder blade)
Humerus (upper arm)

7. Bones of shoulder

8. Articulations Sternoclavicular joint (SC) Acromioclavicular (AC) joint
Joint between sternum and clavicle
Acromioclavicular (AC) joint
Joint between acromion and clavicle
Glenohumeral (GH) joint
Joint between glenoid
(of scapula) and humerus

9. Ligaments SC joint AC joint GH joint SC joint ligaments
Anterior and posterior SC ligaments
Prevent upward displacement of clavicle
Interclavicular
Prevents lateral displacement of clavicle
Costoclavicular
Prevents lateral and upward displacement of clavicle
AC joint
Acromioclavicular
Coracoclavicular
GH joint
Superior, middle, and inferior GH ligaments

10. Ligaments

11. Muscles of the shoulder
GH joint muscles
Allow for: flexion, extension, abduction, adduction, horizontal adduction/abduction, internal rotation/external rotation, circumduction
Muscles:
Pectoralis major
Latissimus dorsi
Deltoid
Rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, teres minor
Teres major
Coracobrachialis

12. Muscles of the shoulder
Muscles acting on scapula
Help provide dynamic stability of the shoulder
Muscles:
Levator scapulae
Trapezius – upper, middle, lower
Rhomboids- major and minor
Serratus anterior and posterior

13. Muscles

14. Muscles

15. Shoulder injuries Clavicular fractures SC sprain AC sprain
Dislocations
Impingement

16. Search Your mind
Group activity Look up the injury assigned to your group. Identify what causes the injury (MOI), some signs and symptoms, and treatment. Each group will present their injury.

17. Shoulder injuries Clavicular (collar bone) fracture
MOI: fall on outstretched arm, fall on tip of shoulder, or direct impact
Most occur at middle 1/3 of bone
Signs and symptoms:
Swelling
Point tenderness
Mild deformity
Posture: supporting injured arm and tilts head toward that side
Treatment:
Sling
X-ray
Refer to physician

18. Shoulder injuries SC sprain
MOI: indirect force transmitted through the humerus of shoulder joint by direct violence
Blow to shoulder
Twisting or torsion of posteriorly extended arm
3 grades:
Grade 1: little pain and disability
Point tenderness, but no deformity
Grade 2: Visible deformity, pain, swelling, point tenderness
Inability to ABDuct shoulder in full ROM or bring arm across chest
Grade 3: complete dislocation with gross displacement of clavicle at sternal junction
Swelling and disability
Complete rupture of SC and costoclavicular ligaments

19. Shoulder injuries AC sprain
MOI: direct impact to tip of shoulder; upward force exerted against the long axis of the humerus by a fall on an outstretched arm
6 grades:
Grade 1: point tenderness and discomfort during movement; no disruption in AC joint
Grade 2: tearing or rupture of AC ligaments w/ stretching of coracoclavicular ligament; partial displacement
Point tenderness during palpation of injury
Unable to full ABDuct arm or bring arm completely across the chest
Grade 3: complete rupture of AC and coracoclavicular ligaments

20. Shoulder injuries AC joint cont’d
Grade 4: posterior separation of clavicle with complete disruption of AC ligament
Grade 5: complete rupture of AC and coracoclavicular ligaments; tearing of trapezius and deltoid
Gross deformity
Severe pain
Loss of movement
Instability
Grade 6: Clavicle displaced inferior to coracoid behind the coracobrachialis tendon
Treatment: Ice and pressure, stabilization with sling, referral to doctor

21. Shoulder injuries Dislocations Anterior
Direct impact to the posterior or posterolateral aspect of the shoulder
Forced ABDuction, external rotation, and extension
May cause a tear in the glenoid labrum
May have rotator cuff muscle injury
Moderate pain and disability
Posterior
Forced ADDuction and internal rotation of the shoulder or fall on an extended and internally rotated arm
May have glenoid labrum injury
May have fracture of lesser tuberosity
Has severe pain and disability
Position: arm ADDucted and interally rotated

22. Shoulder injuries Impingement
Compression of the supraspinatus tendon, subacromial bursa, and long head of biceps tendon
Seen with repetitive overhead activities
Repetitive motions causing compression and decrease space in the subacromial arch
Poor posture
Signs and symptoms:
Pain around acromion
Pinching sensation
Overhead activities increase pain
ROM may be decrease
Shoulder weakness
Treatment: rehab to fix biomechanics; RICE and modalities

23. Elbow

24. Anatomy Bone Articulations Humerus (upper arm) Forearm: Radius Ulna
Humeroulnar
Humeroradial
Proximal radioulnar

25. Elbow

26. Anatomy Ligaments Ulnar collateral ligament (UCL)- medial
Prevents valgus force
Radial collateral ligament (RCL)- lateral
Prevents varus force
Annular ligament
Keeps radial head
secure to ulna

27. Anatomy Elbow muscles Flexors Biceps brachii Brachialis
Brachioradialis
Extensors
Triceps brachii
Anconeus
Pronation
Pronator teres
Pronator quadratus
Supination
Supinator

28. Muscles

29. Elbow injuries Lateral epicondylitis Medial epicondylitis
Little league elbow
UCL sprain

30. Search your mind
Group activity Look up the injury assigned to your group. Identify what causes the injury (MOI), some signs and symptoms, and treatment. Each group will present their injury.

31. Elbow injuries Lateral epicondylitis
MOI: repetitive overuse of extensor muscles
Repetitive wrist extension, supination, or repetitive heavy lifting
Signs and symptoms:
Aching pain at lateral epicondyle
Point tenderness at lateral epicondyle and extensor muscles
Pain with resisted extension of wrist and full extension of elbow
Decrease ROM
Treatment:
RICE
Rehab – ROM exercises, massage, teach proper technique

32. Elbow injuries Medial epicondylitis
AKA pitcher’s elbow, racquetball elbow, golfer’s elbow, javelin thrower’s elbow
MOI: repetitive flexion motions
Signs and symptoms:
Pain around the epicondyles with forceful wrist flexion and extension
Point tenderness
Mild swelling
Treatment:
RICE
Sling rest
Rehab
modalities

33. Elbow injuries Little league elbow
MOI: repetitive microtrauma that occurs from throwing and not type of pitch thrown
Signs and symptoms:
Onset slow
Starts with patient having flexion contracture
Complaints of locking or catching sensation
Decreased ROM of forearm pronation and supination
Treatment:
RICE and anti-inflammatories
Stop throwing until pain is gone and ROM is better
Gentle stretching
Teaching better throwing technique

34. Elbow injuries UCL sprain (Tommy John’s injury) MOI: valgus stresses
Signs and symptoms:
Pain at medial aspect of elbow
Tenderness over UCL
Paresthesias at ulnar nerve
Increased laxity at ligament
Treatment:
Rest and anti-inflammatories
Rehab
Education and fixing throwing mechanics
Surgery

35. Throwing motion research
With a partner, research the throwing motion
Make a Powerpoint about the throwing motion
Include:
The different phases of the throwing motion
Compare and contrast football and baseball
What is an injury that can occur due to improper throwing motion?
A video about throwing motions – breaking it down.

36. Forearm and Wrist

37. Anatomy Forearm Wrist Radius Ulna
Region that connects the forearm to the hand
Radiocarpal joint
Radius and ulna connects with proximal row of carpals

38. Muscles of the forearm Flexors and pronators  on anterior side
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensors and supinators  on posterior side
Extensor carpi radialis longus and brevis
Extensor digiti minimi
Extensory digitorum communis
Extensor carpi ulnaris
Extensor pollicis longus and brevis
Extensor indicis

39. Muscles of the forearm

40. Forearm Injuries
Colles’ Fracture
TFCC injury

41. Forearm injuries Colle’s Fracture Involve lower end of radius
MOI: Fall on an outstretched hand
Signs and symptoms:
Visible deformity to the wrist
Swelling
Bleeding/bruising
Tendons may be torn
Treatment:
Ice
Splint
X-ray and refer to doctor

42. Forearm injuries TFCC injury
TFCC- cartilagnious structure separating the radiocarpal and inferior radioulnar joints of the wrist
Major ligamentous stabilizer of the wrist
Cushions forces through wrist
MOI: swinging a bat or racquet creating twisting force on wrist
Hyperextension of the wrist from falling on outstretched hand
Signs and symptoms:
Pain along ulnar side of wrist
Wrist extension difficult and painful
Clicking and catching in wrist
Treatment: immobilization, rehab, ROM
Refer to physician

43. Hand

44. Anatomy Bones 8 carpal bones Scaphoid, lunate, triquetrium, pisiform
Trapezium,
Trapezoid, Capitate,
Hamate
Metacarpals
Phalanges

45. Anatomy Muscles Thenar muscles Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis
Hypothenar muscles
Palmaris brevis
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minmi

46. Muscles

47. HAND activity Trace your hand
Draw out the bones of the hand and label all of the bones
Color code the bones by their category
Carpals
Metacarpals
Phalanges

48. Hand Injuries Carpal Tunnel Syndrome De Quervian’s disease
Lunate dislocation
Scaphoid fracture

49. Hand injuries Carpal Tunnel Syndrome
Inflammation of the tendons and synovial sheaths within the space compressing the median nerve
MOI: repeated wrist flexion
Signs and symptoms:
Sensory and motor deficits
Tingling, numbness, and paresthesia
Weakness with thumb movements
Treatment:
Rest
Immobilization
Anti-inflammatory medication
Surgery

50. Hand Injuries De Quervian’s disease
Stenosing tenosynovitis in the thumb
What does that mean?
Tendons affected
Extensor pollicis brevis
Abductor pollicis longus
Signs and symptoms:
Aching pain (may radiate into hand or forearm)
Movements of wrist increase pain
Point tenderness and weakness during thumb extension and abduction
Treatment: immobilization, rest, anti-inflammatories

51. Hand injuries Lunate dislocation
MOI: forceful hyperextension of wrist, fall on an outstretched hand
Signs and symptoms:
Pain
Swelling
Difficulty with wrist and finger flexion
Treatment:
See physician to reduce dislocation

52. Hand injuries Scaphoid fracture MOI: force on an outstretched hand
Commonly mistaken for severe sprain
Signs and symptoms:
Swelling in area of carpal bones
Severe point tenderness at scaphoid bone (in snuff box)
Treatment:
Ice and splint
Refer to doctor for x-ray and casting

53. PROJECT TIME Small groups Pick a body part
Make a project to demonstrate your knowledge about the body part…
Make a model
Make a music video
Make a diagram or picture
If you have another idea, you may ask and I can approve it
NO PowerPoints OR papers
HAVE FUN WITH IT!!!

54. Review with plicker
We will review all body parts and make sure everyone is knowledgeable about the whole lower extremity.
For test…you may pick two body parts and you will be tested on those. OR
Write a paper on an upper extremity injury of a famous athlete
Discuss the anatomy of the injury
Need to have background information, MOI, signs and symptoms, what treatment was given and how they got back to playing
Will need to be 3-4 pages