1. UPPER EXTREMITY Finger, Hand, Elbow, Shoulder

2. HAND & WRIST ANATOMY

3. 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

4. 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

5. FINGER INJURIES  GAMEKEEPER’S THUMB –Ulna Collateral Ligament –sprain or tear –Forced abduction –TEST: bend thumb @ 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

6. 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

7. 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

8. 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 –Usually @ origin –Painful bulge may apper @ belly

9. 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

10. TESTSWHAT IT TESTSHOW TO TESTPOSITIVE SIGN TINEL’S Ulnar NerveTap @ ulnar grooveTingling to the thumb SPEED’S Biceps tendon (tenosynovitis) Arm flexed @ 60 deg angle. Resist as flex. Pain @ bicepital groove PHALEN’S Ulnar & Median NerveArms, elbow, wrist, bent @ 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