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

2. ANATOMY
BONES
Ulna
Radius
Carpals
Metacarpals
Phalanges

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

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

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

7. 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

10. 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

11. Bones and Joints Scavenger Human Hunt
Homework Assignment

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

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

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

17. 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

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

21. Supraspinatus: abducts, external rotation, stability

22. Infraspinatus: externally rotates, stabilizes the shoulder

23. Teres Minor: externally rotates, stabilizes the shoulder

25. Subscapularis: internally rotates and stabilizes the shoulder

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

30. Deltoid: abducts the arm

31. Biceps Brachii: shoulder flexion, elbow flexion

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

34. Triceps Brachii: shoulder extension, elbow extension

35. How to stretch the triceps brachii?

36. 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

38. Upper Extremity Injuries

39. FOOSH: Fallen on Outstretched Hand (Mechanism of Injury)

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

42. 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.

43. IS

44. 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

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

46. 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

50. 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!!!

51. Video

52. RCT

54. 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

58. Empty Can Test - Supraspinatus

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

63. 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.

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

69. ACS

71. 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.

73. AC Joint Separations

74. 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.

75. *Think backhand*

76. 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.

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

80. This guy is having a bad day!

81. 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?

82. 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!

83. Handouts for Upper Extremity