UPPER EXTREMITY INJURIES Recognizing common injuries to the upper extremity…

ANATOMY BONES Clavicle Scapula Humerus Spine of the scapula Acromion process Glenoid fossa/cavity Humerus Epicondyles Video Clavicle- collarbone Scapula- Shoulder blade Spine of the scapula- The spine of the scapula or scapular spine is a prominent plate of bone, which crosses obliquely the medial four-fifths of the scapula at its upper part, and separates the supra- from the infraspinatous fossa. Acromion process- In human anatomy, the acromion (from Greek: akros, "highest", ōmos, "shoulder", plural: acromia) is a bony process on the scapula (shoulder blade). Together with the coracoid process it extends laterally over the shoulder joint. Glenoid fossa/cavity- The glenoid cavity or glenoid fossa of scapula [help 1] is a part of the shoulder. It is a shallow pyriform, articular surface, which is located on the lateral angle of the scapula. Humerus - the bone of the upper arm or forelimb, forming joints at the shoulder and the elbow. Epicondyles- a protuberance above or on the condyle of a long bone, especially either of the two at the elbow end of the humerus.

ANATOMY BONES Ulna Radius Carpals Metacarpals Phalanges Ulna- the thinner and longer of the two bones in the human forearm, on the side opposite to the thumb Radius- the thicker and shorter of the two bones in the human forearm. Carpals- Anatomical terms of bone. [edit on Wikidata] The carpal bones are the eight small bones that make up the wrist (or carpus) that connects the hand to the forearm. Metacarpals- any of the five bones of the hand. Phalanges- form the skeleton of the fingers and toes, or digits.

JOINTS OF THE SHOULDER GIRLDLE Acromioclavicular Glenohumeral Elbow Wrist Metacarpal Phalengeal (MCP) Interphalengeal (PIP & DIP) Shoulder- the upper joint of the human arm and the part of the body between this and the neck. Acromioclavicular- The acromioclavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. Glenohumeral- relating to the shoulder joint. "elite tennis players were at risk of developing glenohumeral osteoarthritis" Elbow- . the joint between the forearm and the upper arm. Wrist- . the joint connecting the hand with the forearm. Metacarpal Phalengeal (MCP)- The metacarpophalangeal joints (MCP) refer to the joints between the metacarpal bones and the phalanges of the fingers. That means the MCP joint is the knuckle between the hand and the finger. Interphalengeal (PIP & DIP)- There are two sets (except in the thumb): "proximal interphalangeal joints" (PIJ or PIP), those between the first (also called proximal) and second (intermediate) phalanges. "distal interphalangeal joints" (DIJ or DIP), those between the second and third (distal) phalanges.

SOFT TISSUES Subacromial bursa – below the acromion process Acromioclavicular (AC) Ligament – connects acromion and clavicle Glenoid Labrum- cartilage ring around socket of shoulder *The bursa (sac) between the rotator cuff and acromion that allows the muscles to glide freely when moving. When rotator cuff tendons are injured or damaged, this bursa often becomes inflamed and painful. Subacromial bursa-The subacromial bursa is a sac of fluid that separates the acromion from the rotator cuff. The bursa is underneath the coracoacromial ligament, acromion bone, and the deltoid muscle as shown in the illustration. Acromioclavicular (AC) Ligament - The acromioclavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. It is a plane synovial joint. Glenoid Labrum- The glenoid labrum (glenoid ligament) is a fibrocartilaginous rim attached around the margin of the glenoid cavity in the shoulder blade. The shoulder joint is considered a ball and socket joint.

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 *The rotator cuff is a group of four muscles that surround the humeral head (ball of joint). The muscles are referred to as the "SITS" muscles-Supraspinatus, Infraspinatus, Teres minor and Subcapularis. The muscles function to provide rotation and elevate the arm and give stability to the shoulder joint (glenohumeral joint). *The supraspinatus is most frequently involved in degenerative tears of the rotator cuff.

Prevention Strategies Common Injuries 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.

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Prevention Strategies Common Injuries 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 What causes impingement syndrome? Repeated movement of the arm overhead can cause the rotator cuff to contact the outer end of the shoulder blade where the collarbone is attached, called the acromion. When this happens, the rotator cuff becomes inflamed and swollen, a condition called tendonitis. The swollen rotator cuff can get trapped and pinched under the acromion. All these conditions can inflame the bursa in the shoulder area. A bursa is a fluid-filled sac that provides a cushion between a bone and tissues such as skin, ligaments, tendons, and muscles. An inflammation of the bursa is called bursitis

Prevention Strategies Common Injuries 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 Hand out article

Prevention Strategies Common Injuries 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. Video What are the signs and symptoms of a dislocation? If the shoulder is dislocated, it is usually very apparent: The shoulder is quite painful. Motion is severely restricted. The shoulder appears to hang down and forward, with a large dimple evident under the acromion (in the area of the collar bone). The humeral head may be visible as a bump on the front of the shoulder, or in the armpit. To return the dislocated arm to its socket (called a reduction) usually requires a visit to the emergency department, where expert assistance can be found. Some individuals with recurrent dislocations eventually become experienced at reducing the arm themselves.

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Prevention Strategies Common Injuries 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. A shoulder separation is not truly an injury to the shoulder joint. The injury actually involves the acromioclavicular joint (also called the AC joint). The AC joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion).

Video AC Joint Separations

Prevention Strategies Common Injuries 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. Inflammation of the tendons of the elbow (epicondylitis) caused by overuse of the muscles of the forearm

Prevention Strategies Common Injuries Medial epicondylitis – “Little Leaguer’s or Golfer’s Elbow” 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. *Medial epicondylitis is commonly known as golfer's elbow. This does not mean that only golfers have this condition. But the golf swing is a common cause of medial epicondylitis. Many other repetitive activities can also lead to golfer's elbow--throwing, chopping wood with an ax, running a chain saw, and using many types of hand tools. Any activities that stress the same forearm muscles can cause symptoms of golfer's elbow.   Commonly involves the wrist and finger flexors –common flexor tendon. Same issues as in lateral epicondylitis with repetitive tendon injuries leading to angiofibroblastic degeneration or tendinosis.

Common Injuries 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. *Dislocation occurs when trauma causes the bones in the middle joint of a finger to dislodge. *This usually results in a very painful, swollen and bruised joint that does not move properly, if at all. *A sprain occurs when ligaments in a joint are torn or pulled and may occur without joint dislocation. *Suspected sprains and dislocations must be evaluated and treated as soon as possible. It is important not to move the affected area to avoid further injury.