UPPER EXTREMITY Finger, Hand, Elbow, Shoulder

HAND & WRIST ANATOMY

GENERAL INJURIES  Fractures –Direct blows or falls on outstretched hand –Pain, swelling, decreased function  Dislocation/Subluxation –Direct blow from a ball; fall on hand –Gross change in anatomy  Sprains/Strains –Hyperextension or hyperflexion  Synovitis & Bursitis –Overuse & irritation of synvium or bursa  Contusions –Direct blow

FINGER INJUIRIES  Buttonhole Deformity –“Boutonniere” –Tendon rupture of middle phalanx –Forced excessive flexion –Can’t fully extend finger  Mallet Finger –“Baseball Finger” –Caught in jersey –Direct blow on outstretched finger –Avulsion fracture –Can’t actively extend finger

FINGER INJURIES  GAMEKEEPER’S THUMB –Ulna Collateral Ligament –sprain or tear –Forced abduction –TEST: bend 45 degree angle & abduct. –Pain = sprain –No end point = tear (3 rd degree sprain)  FINGER STRAIN –“JAMMING” FINGER –Hyperextension or hyperflexion of finger –TEST: Valgus/Varus for stability. Resistance for strength

DE QUERVAIN’S DISEASE  Irritated thumb tendons  Tendons swell or “thicken”  Tenosynovitis  Pain in wrist numbness in fingers  Finkelstein’s test: make a fist thumb tucked in, ulnar deviate wrist. make a fist thumb tucked in, ulnar deviate wrist. + sign:pain in thumb + sign:pain in thumb

WRIST IMPINGEMENT  Compression of median & ulnar nerves  Repeated stress  Point tenderness, pain, numbness, loss of strength  PHALEN’S TEST:Press back of hands together, elbow’s up. Squeeze hands. + sign:tingling & numbness

ELBOW INJURIES  IMPINGEMENT –Ulnar nerve compression –Point tenderness, pain, numbness, loss of strenght –TINEL’S SIGN:Tap on ulnar goove, +sign: tingling down arm.  BICEPS BRACHI –Found in upper arm –Elbow flexion & hand rotation –Rupture=complete tear origin –Painful bulge may belly

ELBOW INJURIES  Epicondylitis –Swelling of epicondyles –Medial affects flexors “little league elbow” –Lateral=extensors “tennis elbow” –Chronic overuse: twisting/throwing –Pain & point tenderness  VOLKMANN’S CONTACTURE –Swelling or muscle spasm or bone fx putting pressure on arteries of arm –Decreases blood supply –Muscle damage &/or paralysis –Pain when fingers extend –Possible loss of pulse

TESTSWHAT IT TESTSHOW TO TESTPOSITIVE SIGN TINEL’S Ulnar ulnar grooveTingling to the thumb SPEED’S Biceps tendon (tenosynovitis) Arm 60 deg angle. Resist as flex. bicepital groove PHALEN’S Ulnar & Median NerveArms, elbow, wrist, 90 deg. Back of hands touching each other. Tingling in fingers FINKELSTEIN’S Thumb tendon (de Quervain’s disease) Make a fist w/thumb inside of palm. Resist as wrist flexes toward ulna Pain means thumb tendon tenosynovitis VALGUS/VARUS Elbow SprainVAL Push on lateral aspect of elbow medially VAR Push on medial aspect of elbow laterally VAL=Ulnar Collateral Lig VAR=Radial Collateral Lig WRIST FLEXION Manual muscle test of wristResist against flexionWeaksness/injury of flexi carpi radialis or ulnaris WRIST EXT Manual muscle test of wristResist against extensionWeakness/injury of extensor carpis RADIAL DEVIATION Manual muscle test of wristResist fist on lateral sideWeakness/injury of flexor/extensor carpi radialis ULNAR DEVIATION Manual muscle test of wristResist fist on medial sideWeakness/injury of flexor/extensor carpi ulnaris FINGER STRENGTH Ability to moveManual resistanceWeakness in movement