1. Injuries to the Upper Extremities
Chapter 16
Injuries to the Upper Extremities

2. Upper Extremity Injuries
Upper extremities are vulnerable to a variety of injuries depending on the sport, including:
Sprains
Strains
Dislocations
Fractures

3. 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

4. Shoulder Complex Physiology
Bones
Muscles
Ligaments
Tendons
Articulations
Shoulder Bones | Shoulder Anatomy
The shoulder is a ball & socket joint
Radius is the lateral bone of the forearm
Radial and ulnar arteries supply the elbow

5. Shoulder Complex Physiology
The glenohumeral joint is the point of articulation for the scapula and the head of the humerus – most commonly dislocated
The rotator cuff is composed of the subscapularis, infraspinatus, teres minor & supraspinatus.

6. Assessing Shoulder Injuries
ROM test for external rotation of the shoulder
ROM test for internal rotation of the shoulder

7. Assessing Shoulder Injuries
Specific ROM tests for the shoulder
including abduction, flexion, extension,
horizontal adduction
External muscle tests for the shoulder

8. 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 (used for rotator cuff)

9. Types of Shoulder Injuries
Fractures
Perform percussion test, compression test
Dislocations and subluxations
Do not attempt to maneuver the joint back into position
Decreased circulation in arm can be detected by paleness, coolness, loss of sensation in lower part of arm, pulse, capillary refill.
Contusions (PRICE technique) should be immobilized

10. PRICE Technique
P- protect
R- rest
I – ice
C- compress
E - elevate

11. Groups for Shoulder Special Tests

12. Types of Shoulder Injuries
Sprains
Sulcus test, apprehension test for sprain of the anterior capsule
Acromioclavicular (AC) sprain test
Sternoclavicular (SC) sprain test
Usual occurs from hyperextension

13. Types of Shoulder Injuries
Strains (rotator cuff)
Drop arm test
Impingement pinching of soft tissue, such as bursa, tendon, or a nerve
Hawkins-Kennedy test, winged scapula test
PRICE technique

14. Types of Shoulder Injuries
Tendonitis repeated stress to the tendons
Speed’s test
Synovitis and bursitis
If no swelling is present, use moist heat packs
If swelling, use PRICE technique

15. 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
The olecranon process makes up the tip of the elbow

16. Manual Muscle Tests for the Elbow
Flexion strength test
Extension strength test
Supination strength test
Pronation strength test

17. Injuries to the Elbow and Arm
Fractures
Dislocations and subluxations most commonly occur from outstretched arms and severe twisting of the arm
Contusions immobilization
Sprains usually result from hyperextension
Valgus stress test for the elbow
Varus stress test for the elbow

18. Injuries to the Elbow and Arm
Impingement
Tinel’s sign
Synovitis and bursitis
Biceps brachii rupture pain, bulging muscle & decreased mobility treat with ICE tech and immobilize upper arm & refer to MD
Epicondylitis
Volkmann’s contracture

19. Physiology of the Wrist and Hand
Made up of eight carpal bones
Carpals, arranged in two transverse rows
Five metacarpals and digits make up the hand
Controlled by the median, radial, & ulnar nerves
The thumb only has 2 phalanx

20. Assessing Wrist and Hand Injuries
ROM test for wrist flexion
ROM test for wrist extension
ROM test for finger flexion

21. 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

22. 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

23. Injuries to the Wrist and Hand
Fractures
Dislocations and subluxations
Contusions
Sprains
Gamekeeper’s thumb test YouTube - Gamekeeper's Thumb
Impingement

24. Injuries to the Wrist and Hand
Tendonitis
Ganglion cyst of the wrist
Mallet finger
Buttonhold deformity rupture of the tendon in the middle finger phalanx
Colles’ fracture