Unit 7 Upper Extremity

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…)

Shoulder complex

Tell me what you know about the shoulder…

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

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

Bones of shoulder

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

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

Ligaments

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

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

Muscles

Muscles

Shoulder injuries Clavicular fractures SC sprain AC sprain Dislocations Impingement

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.

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

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

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

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

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

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

Elbow

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

Elbow

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

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

Muscles

Elbow injuries Lateral epicondylitis Medial epicondylitis Little league elbow UCL sprain

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.

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

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

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

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

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.

Forearm and Wrist

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

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

Muscles of the forearm

Forearm Injuries Colles’ Fracture TFCC injury

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

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

Hand

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

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

Muscles

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

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

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

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

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

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

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!!!

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