Transcript Unit 7_Upper Extremityx

Upper Extremity
• 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…)
Tell me what you know about the
shoulder…
• Great degree of mobility
• Ball and socket joint
• Mobility  instability
• Instability  injury
• Overuse
• Bony
• Clavicle (collar bone)
• S-shaped bone
• Sternum (breast bone)
• 3 parts: manubrium,
body, and xiphoid process
• Scapula (shoulder blade)
• Humerus (upper arm)
• Sternoclavicular joint (SC)
• Joint between sternum and clavicle
• Acromioclavicular (AC) joint
• Joint between acromion and clavicle
• Glenohumeral (GH) joint
• Joint between glenoid
(of scapula) and humerus
• SC 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
• 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
• 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
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Clavicular fractures
SC sprain
AC sprain
Dislocations
Impingement
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.
• 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
• 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
• 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
• 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
• 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
• 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
• Bone
• Humerus (upper arm)
• Forearm:
• Radius
• Ulna
• Articulations
• Humeroulnar
• Humeroradial
• Proximal radioulnar
• 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
• Elbow muscles
• Flexors
• Biceps brachii
• Brachialis
• Brachioradialis
• Extensors
• Triceps brachii
• Anconeus
• Pronation
• Pronator teres
• Pronator quadratus
• Supination
• Supinator
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Lateral epicondylitis
Medial epicondylitis
Little league elbow
UCL sprain
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.
• 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
• 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
• 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
• 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
• 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.
• Forearm
• Radius
• Ulna
• Wrist
• Region that connects the
forearm to the hand
• Radiocarpal joint
• Radius and ulna connects with
proximal row of carpals
• Flexors and pronators 
on anterior side
• Flexor carpi radialis
• Flexor carpi ulnaris
• Flexor digitorum
superficialis
• Flexor pollicis longus
• Pronator quadratus
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• 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
• Colles’ Fracture
• TFCC injury
• 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
• 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
• Bones
• 8 carpal bones
• Scaphoid, lunate,
triquetrium, pisiform
• Trapezium,
Trapezoid, Capitate,
Hamate
• Metacarpals
• Phalanges
• 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
• 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
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Carpal Tunnel Syndrome
De Quervian’s disease
Lunate dislocation
Scaphoid fracture
• 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
• 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
• 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
• 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
• Small groups
• Pick a body part
• Make a project to demonstrate your knowledge about the body
part…
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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!!!
• 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