Download Unit 8 notes - Wando High School

The Upper Extremity- Unit 8
The shoulder
The shoulder has a great deal of mobility. It is under a lot
of stress by throwing, lifting, hitting volleyballs and so on.
Overuse injuries are very common.
Anatomy- Bones
-Clavicle- (collar bone)- "S" shaped, weakest at the curve
- Scapula- (shoulder blade)- glenoid is the cup shape of
the scapula, that receives the ball of the humerus
- Humerus- upper arm bone- proximal head is the rounded
end of the bone
- Sternum- breast bone.
Joints
Glenohumeral- humerus and scapula
Acromioclavicular- AC joint- clavicle and scapula- weak
joint because the ligaments are weak, bony arrangement
is bad and not much muscular protection
Sternoclavicular- sternum and clavicle
Soft tissue
Rotator Cuff- a group of muscles on the back of the
shoulder that assist the shoulder with a wide ROM. Very
important muscle group.
S- Supraspinatus- assist mostly with abduction
I- Infraspinatus- Assist with internal rotation
T- Teres Minor- assist with internal rotation
Other muscles
Deltoid- tip of shoulder- assist with : abduction, flexion and
extension
Pectoralis Major- chest- assist with adduction
Latissimus Dorsi- lats- large back muscle- external rotation
Biceps- shoulder and elbow flexion
Triceps- shoulder and elbow extension
Glenoid Fossa or Labrum- thick tissue in the
glenohumeral joint that cushions and helps hold the joint
together.
Preventing Shoulder Injuries
1. Proper conditioning- strength and flexibility is important
2. Proper warm up- increase body temp and sport specific
skills
3. Protective equipment
4. Proper throwing technique
5. Proper falling technique
Shoulder injuries
Shoulder impingement
-overuse injury/ overhead activity- throwing/hitting
volleyball-tennis,swim
-the space between the head of humerus and acromion
becomes narrowed by swelling. These bones will then
squeeze, put pressure on the soft tissue that is located in
this space. Usually the rotator cuff.
Signs- localized pain
-pain/weakness with abduction
-limited internal rotation
Care- RICE
- stop overhead activity
-slow ROM exercises and strength
- see Dr. possible for injection or surgery
Rotator cuff tears- unfortunately becoming more common
in younger athletes- overuse injury
- supraspinatus is the most common to tear
Cause- as you get older, the muscles become less flexible
and more likely to tear. repetitive throwing, putting hand
out to break a fall
Signs- pain on back of shoulder
-loss of abduction ROM and strength
care- surgery possible- about 1 year+ to recover
Shoulder dislocation/subluxation
-the head of the humerus is forced out of the socket
(glenoid)
- anterior dislocations are most common
- each time, the chance to happen again increases,
3rd/4th episode requires surgery
Signs- very painful
-loss of ROM, arm locked in position
-deformity- flattened deltoid muscle
Care- visit ER to be reduced
- Several weeks of rehab, brace to return
- dislocation could injure bones, soft tissue
Labrum tears-deepest soft tissue of the shoulder
-cartilage ring that keeps the head of humerus in place
Cause- shoulder dislocations, tissue degeneration
(overuse)
Signs- shoulder pain
- catching/popping sensation
- can limit ROM
care- try conservative rehab program of strengthening
- surgery to repair or trim off tears
AC Separation- occurs at Acromioclavicular joint
-usually caused by putting your hand out to break fall or
impact to tip of shoulder
- Grade I, II and III (separation)
Signs- pain, swelling, deformity (clavicle tip pointing up)
Care- RICE, sling
- may need to be re-attached surgically
Clavicle Fx- very common injury
- blow to shoulder or putting hand out to break fall
-signs- pain- deformity, loss of ROM
care- splint,RICE, X-ray, 4-6 weeks
*Greenstick fx- common in adolescents- Splintering of
bone that produces jagged edges.
Elbow- 3 bones- humerus, radius, ulna
Soft tissue- Ligaments
- ulna collateral- (medial)- humerus+ulna
- radial collateral- (Lateral)- humerus+radius
- Annular- Radius+Ulna (Wraps around the head of
radius)
Muscles- Biceps- elbow flexion
- triceps -elbow flexion
Injuries
Elbow sprains/tears/ - injury to the ulna collateral Lig.
usually caused by hand out to break fall- elbow
buckles inward or excessive throwing (tommy john injury/
surgery)
Signs- pain, unable to throw grab an object
- joint is loose (Valgus motion- stress test)
Care- RICE, surgery possible
Lateral epicondylitis- tennis elbow
repetitive forceful wrist extension (hitting tennis balls)
Signs- aching pain over lateral elbow
-pain/weakness with wrist extension
Care- RICE
- anti-inflammatory meds.
- stretch/strength
-elbow-tennis strap
-possible local injection
How to correct the problem
- Proper hitting technique
-Check racket grip size
- Check size of racket head
-String strength
Elbow dislocations- not common, but very serious injury
- putting your hand out to break fall- posterior dislocations
common
-gross deformity
- ER to have doc reduce
Ulna Nerve Injuries- "Funny bone"
-Common Causes- 1. hitting funny bone 2. Nerve friction
3. dislocates 4. trapped or impinged
- Signs- numbness/tingling weakness up to 4th/5th fingers
Care- Rest until back to normal- couple of minutes
Forearm fracture- very common injury- usually the radius
- check the growth plate 4-6 weeks to recover
Wrist- Anatomy
10 bones- Radius (thumb side), ulna (pinky side) 8- small
carpal bones (scaphoid is at base of thumb)
Injuries
Carpal Tunnel syndrome- the wrist has 6 "tunnels" that
pass through to the hand. Inside these tunnels are small
tendons, blood vessels and nerves. Constant finger/wrist
flexion-extension causes these tendons to produce friction
which leads to swelling in these tunnels and puts pressure
on the nerves and blood vessels.
Signs- numbness in hand-palm and fingers
- aching type of pain- muscle weakness
- Care - Rest- brace- meds.
-Stretch- check key board- seat
-surgery possible
Scaphoid Fracture- common injury- putting hand out to
break fall
- aching pain at base of thumb (Anatomical snuffbox)
-grip weakness
Care - X-ray, re-x-ray to be sure
- splint/case for several weeks and then determine if
surgery needed
*Asceptic Necrosis- bone death due to poor blood supplypossible
Wrist Ganglion- swollen fluid pocket on back of the wrist
- no pain or redness
- hit it with a book or see doc to drain
Hand and Fingers
Anatomy
Bones- Hand 5 bones called metacarpals
Fingers- 14 bones called phalanges (thumb has one less)
Joints- Metacarpalphalangeal joint -metacarpal+phalanges
(knuckles)
- Proximal interphalangeal joint- PIP
-distal interphalangeal joint- DIP
Injuries
- 5th/ 4th metacarpal fracture (Boxers Fracture)- usually
the 5th
Caused by punching or hitting something hard
Signs- pain and deformity
- crepetus (bone grinding)
Care- cast/splint for several weeks
- Surgery possible
Mallet finger- tear of extensor tendon at DIP joint
- usually from hitting the finger tip
Signs- cannot fully extend finger
Care -usually splint finger in hyperextension for 6 weeks
straight
Boutonniere deformity- tear extensor tendon at PIP joint
-same as above
Jersey finger- tear finger flexor tendon
caused by grabbing something and they pull away
Signs- cannot flex finger
Care- Surgery
Gamekeeper's thumb- tear of the ulna collateral ligament
in thumb
caused by forceful thumb abduction- put hand out to break
fall
common in soccer goalies/ snow skiers
Signs- pain, no grip strength, unstable
Care- Splint for 2 weeks and re-evaluate to see if it is
healing
- surgery to re-attach could occur
Finger dislocation- most common dislocation of the body
- usually not serious, but Fx/ ligament tear could occur