Upper Extremity Injury Management

Acromioclavicular & Sternoclavicular sprains  Signs & Symptoms  First degree:  Slight swelling, mild pain to palpation  Second degree:  Slight elevation of the clavicle, moderate swelling, moderate pain, unable to abduct the arm or horizontally adduct the arm without pain.  Third degree:  Prominent elevation of clavicle, severe pain, severe swelling, similar movement restrictions as with second degree sprain.

Acromioclavicular & Sternoclavicular sprains  Management  First Degree:  Ice, rest, immobilize, NSAIDs  Second degree:  Ice, rest, figure 8 strap (SC), sling (AC), 1-4 weeks (3-4 for SC)  Third degree:  Immobilize, refer to physician

Glenohumeral Dislocations  95% are anterior, inferior dislocations.  Dislocations require immediate reduction by a physician.  Because dislocations are often accompanied by a fracture, treat the injury as a fracture and splint firmly.

Olecranon Bursitis  AKA Student’s elbow  Caused by a fall on a flexed elbow or constant pressure on the elbow.  Relatively painless in most cases.  Ice, rest, and compressive wrap.

Medial Epicondylitis  AKA Little League Elbow  Caused by repeated or excessive valgus force on the elbow.  Swelling, ecchymosis, and point tenderness directly over the humeroulnar joint. Pain with wrist flexion and pronation.  Ice, NSAIDs, and immobilization in a sling for 2-3 weeks.

Lateral Epicondylitis  AKA Tennis Elbow  Caused by excessive loading of the extensor muscles.  Swelling, pain near the lateral epicondyle, pain with resisted wrist extension.  Ice, NSAIDs, compression, strengthening, stretching.

Wrist Sprains  Most commonly a result from a FOOSH injury.  Point tenderness do radiocarpal joint, pain with wrist extension.  Must rule out a fracture.  Ice, NSAIDs, splinting or taping to prevent hyperextension.

Mallet Finger  Most often occurs when an object hits the end of the finger while the finger is fully extended.  A fracture to the distal phalanx is present in 25% of cases.  Not a serious fracture due to the relatively limited neurovascular supply in the region.  DIP joint is immobilized in full extension for 6-8 weeks  An additional 6-8 weeks of splinting during sports participation.

Ganglion Cysts  Benign masses typically seen about the wrist.  Associated with tissue sheath degeneration, the dorsal cyst contains a jelly-like colorless fluid and is freely mobile and palpable.  Occurring spontaneously, there may be localized tenderness and aggravation with end range wrist motion.  Splinting, NSAIDs, Injection, mobilization, surgical excision may be warranted if symptoms are debilitating and conservative methods fail.

Carpal Tunnel Syndrome  The carpal tunnel is formed by the floor of the volar wrist capsule and the transverse retinacular ligament that attaches to the hamate, pisiform, trapezium, and scaphoid.  Direct trauma or repetitive overuse can cause irritation of the finger flexor tendon sheaths resulting in inflammation and excessive pressure on the median nerve.  Splinting, stretching, ultrasound, E-stim, retinacular release may be warranted if conservative treatments fail.