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Chapter 16 Injuries to the Upper Extremities Upper Extremity Injuries • Upper extremities are vulnerable to a variety of injuries depending on the sport, including: – Sprains – Strains – Dislocations – Fractures 2 Upper Extremity Injuries • Upper extremities are vulnerable to a variety of injuries depending on the sport, including: – Separations to the thoracic cage, shoulder, arm, and hand – Repetitive motion injuries such as arthritis, bursitis, tendonitis 3 Shoulder Complex Physiology • • • • • Bones Muscles Ligaments Tendons Articulations 4 Assessing Shoulder Injuries • ROM test for external rotation of the shoulder • ROM test for internal rotation of the shoulder 5 Assessing Shoulder Injuries • Specific ROM tests for the shoulder including abduction, flexion, extension, horizontal adduction • External muscle tests for the shoulder 6 Assessing Shoulder Injuries • Internal rotation strength test for the shoulder • Extension strength test for the shoulder • Flexion strength test for the shoulder • Abduction and adduction strength tests for the shoulder • Empty can test 7 Types of Shoulder Injuries • Fractures – Perform percussion test, compression test • Dislocations and subluxations • Contusions 8 Types of Shoulder Injuries • Sprains – Sulcus test, apprehension test for sprain of the anterior capsule – Acromioclavicular (AC) sprain test – Sternoclavicular (SC) sprain test 9 Types of Shoulder Injuries • Strains – Drop arm test • Impingement – Hawkins-Kennedy test, winged scapula test 10 Types of Shoulder Injuries • Tendonitis – Speed’s test • Synovitis and bursitis 11 Assessing Elbow and Forearm Injuries • Methods to assess elbow and forearm injuries include: – ROM test for elbow flexion – ROM test for elbow extension – ROM test for elbow supination – ROM test for elbow pronation 12 Manual Muscle Tests for the Elbow • • • • Flexion strength test Extension strength test Supination strength test Pronation strength test 13 Injuries to the Elbow and Arm • • • • Fractures Dislocations and subluxations Contusions Sprains – Valgus stress test for the elbow – Varus stress test for the elbow 14 Injuries to the Elbow and Arm • Impingement – Tinel’s sign • • • • Synovitis and bursitis Biceps brachii rupture Epicondylitis Volkmann’s contracture 15 Physiology of the Wrist and Hand • Made up of eight bones – Carpals, arranged in two transverse rows • Five metacarpals and digits make up the hand 16 Assessing Wrist and Hand Injuries • ROM test for wrist flexion • ROM test for wrist extension • ROM test for finger flexion 17 Assessing Wrist and Hand Injuries • ROM test for finger extension manual muscle tests: – Extension strength test – Flexion strength test for the wrist – Radial deviation strength test for the wrist – Ulnar deviation strength test for the wrist – Extension strength test for the fingers 18 Assessing Wrist and Hand Injuries • ROM test for finger extension manual muscle tests: – Flexion strength test for the fingers – Abduction strength test for the fingers – Adduction strength test for the fingers 19 Injuries to the Wrist and Hand • • • • Fractures Dislocations and subluxations Contusions Sprains – Gamekeeper’s thumb test • Impingement 20 Injuries to the Wrist and Hand • • • • Tendonitis Ganglion cyst of the wrist Mallet finger Buttonhold deformity 21