Upper Extremity Upper Extremity Injury EvaluationInjury Evaluation

AnatomyAnatomyShoulderShoulderElbowElbowWrist/HandWrist/HandAbdomen/ThoraxAbdomen/Thorax

Shoulder AnatomyShoulder Anatomy SternumSternum

– Manubrium, Manubrium, – BodyBody– Xiphoid processXiphoid process

ClavicleClavicle– AC JointAC Joint– SC JointSC Joint– S-CurveS-Curve

HumerusHumerus– Bicipital groove/Biceps Tendon Bicipital groove/Biceps Tendon

ScapulaScapula– Acromion processAcromion process

Anatomy: ScapulaAnatomy: Scapula SpineSpine Rotator cuffRotator cuff Superior AngleSuperior Angle Medial BorderMedial Border Acromion ProcessAcromion Process

Anatomy: GH JointAnatomy: GH Joint Glenohumeral Joint Glenohumeral Joint

– ““Shoulder Joint”Shoulder Joint”– Shallow for extra Shallow for extra

mobility, mobility, – Susceptible to Susceptible to

dislocations & labral dislocations & labral tearstears

Anatomy: ElbowAnatomy: Elbow HumerusHumerus

– Medial/lateral epicondylesMedial/lateral epicondyles UlnaUlna

– Olecranon ProcessOlecranon Process RadiusRadius

– HeadHead

Anatomy: Hand/WristAnatomy: Hand/Wrist Carpal bones (8 bones)Carpal bones (8 bones) MetacarpalsMetacarpals

– 1-5 (one = thumb, five = little finger)1-5 (one = thumb, five = little finger) PhalangesPhalanges

– 14 total14 total Radius/Ulna Radius/Ulna

– Styloid ProcessStyloid Process

Abdomen & Thorax Abdomen & Thorax AnatomyAnatomy

AbdomenAbdomen– VertebraeVertebrae– Lower ribsLower ribs

ThoraxThorax– SternumSternum– RibsRibs– VertebraeVertebrae

9 Abdominal Regions &9 Abdominal Regions &4 Abdominal Quadrants4 Abdominal Quadrants

Abdominal MusclesAbdominal Muscles Rectus AbdominisRectus Abdominis Internal/External ObliquesInternal/External Obliques TranverseAbdominisTranverseAbdominis

Muscles of Chest and BackMuscles of Chest and Back

DeformitiesDeformities

Swan Neck:Swan Neck: Boutonniere:Boutonniere: Mallet:Mallet:

-Flex tendon-Flex tendon -Ext tendon -Ext -Ext tendon -Ext tendontendon

from middlefrom middle from middle from middle from from distaldistal

phalanxphalanx phalanx phalanx phalanx phalanx

DeformitiesDeformities

Cubitus Valgus: “carrying angle”Should be present, normal is ~11-16 degrees)

Cubitus Varus: “gunstock deformity”

Cubitus Recurvatum: “hyperextension”

Range of MotionRange of Motion Shoulder:Shoulder: Flexion, Abduction, Flexion, Abduction,

Adduction, Extension, Int. & Ext. Adduction, Extension, Int. & Ext. RotationRotation

Elbow:Elbow: Flexion, Extension, Pronation, Flexion, Extension, Pronation, SupinationSupination

Wrist & Hand:Wrist & Hand: Flexion, Extension, Ab- Flexion, Extension, Ab- & Ad-duction (fingers & thumb), & Ad-duction (fingers & thumb), Ulnar & Radial DeviationUlnar & Radial Deviation

Trunk:Trunk: Flexion, Extension, Lateral Flexion, Extension, Lateral Flexion/BendingFlexion/Bending

UE Injury EvaluationUE Injury Evaluation

Clavicle FractureClavicle Fracture– ““Broken Collarbone”Broken Collarbone”– Direct blow to front or side of shoulderDirect blow to front or side of shoulder– Point tendernessPoint tenderness– Pain moving armPain moving arm– Grating/grinding sensationGrating/grinding sensation– DeformityDeformity– SwellingSwelling

Treatment:Treatment:– Immobilize arm w/ slingImmobilize arm w/ sling– Shock? Call 911Shock? Call 911– IceIce– ReferRefer

RTP:RTP:– 4-6 weeks minimum4-6 weeks minimum– Released by a physicianReleased by a physician– Full ROM & StrengthFull ROM & Strength

Prevention:Prevention:– Proper fitting shoulder padsProper fitting shoulder pads– Proper landing techniqueProper landing technique

AC SprainAC Sprain““Separated Shoulder”Separated Shoulder” Direct blow to top or side of shoulderDirect blow to top or side of shoulder FOOSH: Fall on outstretched handFOOSH: Fall on outstretched hand– Point tenderness over ACPoint tenderness over AC– Mild to severe pain raising arm or reaching across bodyMild to severe pain raising arm or reaching across body– Deformity: elevation of the clavicleDeformity: elevation of the clavicle

Treatment:Treatment:– Rest, IceRest, Ice– Shock? 911Shock? 911– Refer if Grade II or III (deformity present)Refer if Grade II or III (deformity present)

Immobilize arm to body with elastic wrapImmobilize arm to body with elastic wrap RTP:RTP:

– Full strength & ROMFull strength & ROM– Released by physician (if seen by doctor)Released by physician (if seen by doctor)

Prevention:Prevention:– Proper fitting equipmentProper fitting equipment– Proper landing techniqueProper landing technique

SC SprainSC Sprain““Shoulder Separation”Shoulder Separation” FOOSHFOOSH Direct anterior blow (take caution!)Direct anterior blow (take caution!)

– Point tendernessPoint tenderness– Mild to severe pain moving arm across chest & shrugging Mild to severe pain moving arm across chest & shrugging

shouldersshoulders– Dizziness (potential blood vessels damage going to brain)Dizziness (potential blood vessels damage going to brain)– DeformityDeformity– Possible unconsciousness; respiratory or cardiac arrestPossible unconsciousness; respiratory or cardiac arrest

Treatment:Treatment:– Rest, ice, immobilizeRest, ice, immobilize– Refer (maybe for anterior, but definitely for even mild Refer (maybe for anterior, but definitely for even mild

posterior)posterior)– Monitor for shockMonitor for shock– 911 for grade II or III posterior separation911 for grade II or III posterior separation

RTP:RTP:– Released by physicianReleased by physician– Full ROM & StrengthFull ROM & Strength– Pain freePain free

Prevention:Prevention:– Wear appropriate equipmentWear appropriate equipment

GH Disloc/SubluxationGH Disloc/Subluxation– FOOSHFOOSH– Direct blow to anterior or posterior shoulderDirect blow to anterior or posterior shoulder– Intense painIntense pain– Carrying angle/DeformityCarrying angle/Deformity– InstabilityInstability– Tingling in arm or handTingling in arm or hand– Felt or heard popFelt or heard pop– Inability to move arm or handInability to move arm or hand

Treatment:Treatment:– Immobilize, monitor, ice, 911?Immobilize, monitor, ice, 911?

RTP:RTP:– Released by MD, Full strength & ROMReleased by MD, Full strength & ROM

Prevention:Prevention:– Shoulder strengthening exercisesShoulder strengthening exercises

RC Strain/TearRC Strain/Tear– Supraspinatus most commonSupraspinatus most common– Poor mechanicsPoor mechanics– Weak/tight RCWeak/tight RC– Pain w/ raising or using armPain w/ raising or using arm– WeaknessWeakness

Treatment:Treatment:– Rest, ice, refer if symptoms persist, immobilize?, Rest, ice, refer if symptoms persist, immobilize?,

monitor?monitor? RTP:RTP:

– Pain free, full strength & ROM, Cleared by MDPain free, full strength & ROM, Cleared by MD Prevention:Prevention:

– Shoulder strengthening, teach proper mechanicsShoulder strengthening, teach proper mechanics

Rib Fracture/ContusionRib Fracture/Contusion– Direct blow to rib cageDirect blow to rib cage– Mild to severe pain with breathing, coughing, Mild to severe pain with breathing, coughing,

sneezing, or laughingsneezing, or laughing– Swelling, bruisingSwelling, bruising– Point tendernessPoint tenderness– DeformityDeformity– Pain w/ compression of rib cagePain w/ compression of rib cage– Breathing difficultiesBreathing difficulties

Treatment:Treatment:– Ice, Rest, Compression, 911?Ice, Rest, Compression, 911?

RTP:RTP:– Released by MD, PaddingReleased by MD, Padding

Prevention:Prevention:– Wear appropriate paddingWear appropriate padding

Humerous FractureHumerous Fracture– Direct blow, torsion injury, compression injuryDirect blow, torsion injury, compression injury– Severe painSevere pain– Deformity, swellingDeformity, swelling– Severe point tendernessSevere point tenderness– Inability to move armInability to move arm– Bluish skin on forearm down to fingers Bluish skin on forearm down to fingers – Tingling & loss of sensationTingling & loss of sensation

Treatment:Treatment:– 911, Monitor, Immobilize, Ice911, Monitor, Immobilize, Ice

RTP:RTP:– Released by MD, Full Strength & ROMReleased by MD, Full Strength & ROM

Prevention:Prevention:– Teach proper landing/falling techniqueTeach proper landing/falling technique

Forearm/Wrist/Hand Forearm/Wrist/Hand FractureFracture– Direct Blow/FOOSHDirect Blow/FOOSH

– Numbness, tinglingNumbness, tingling– Severe painSevere pain– Deformity, swellingDeformity, swelling– Point tendernessPoint tenderness– Inability to bend or straighten elbow Inability to bend or straighten elbow

Treatment:Treatment:– Ice, Immobilize, monitor, 911?Ice, Immobilize, monitor, 911?

RTP:RTP:– Cleared by MD, pain free, full strength & Cleared by MD, pain free, full strength &

ROMROM Prevention:Prevention:

– Wear padding, teach proper falling techniqueWear padding, teach proper falling technique

Bicipital TendonitisBicipital Tendonitis– Common in overhead athletesCommon in overhead athletes– Repeated forceful contraction or stretchRepeated forceful contraction or stretch– Weak/inflexible bicepsWeak/inflexible biceps– Mild to severe pain on upper armMild to severe pain on upper arm– Pain w/ moving armPain w/ moving arm– Point tenderness over proximal bicipital tendonPoint tenderness over proximal bicipital tendon

Treatment:Treatment:– Rest, Ice, Change MechanicsRest, Ice, Change Mechanics

RTP:RTP:– Pain free/to tolerance, full strength/ROMPain free/to tolerance, full strength/ROM

Prevention:Prevention:– Teach proper mechanics, preseason Teach proper mechanics, preseason

strengthening/stretching, limit amount of strengthening/stretching, limit amount of throwingthrowing

Elbow Disloc/SubluxationElbow Disloc/Subluxation– Direct blow, FOOSH, Forced Ext.Direct blow, FOOSH, Forced Ext.– Tingling/numbnessTingling/numbness– Felt/heard a popFelt/heard a pop– Sense of looseness/giving outSense of looseness/giving out– Swelling/DeformitySwelling/Deformity– Inability to bend elbowInability to bend elbow

Treatment:Treatment:– Rest, Ice, Immobilize, Monitor, 911?Rest, Ice, Immobilize, Monitor, 911?

RTP:RTP:– Cleared by MD, Pain free, Full ROM/StrengthCleared by MD, Pain free, Full ROM/Strength

Prevention:Prevention:– Preseason strengthening/stretching biceps, Preseason strengthening/stretching biceps,

triceps, forearm musclestriceps, forearm muscles

Ulnar Nerve ContusionUlnar Nerve Contusion– ““Funny Bone”Funny Bone”– Direct blowDirect blow– Tingling down arm/handTingling down arm/hand– Mild to severe painMild to severe pain– Point tendernessPoint tenderness– Loss of grip strengthLoss of grip strength

Treatment:Treatment:– RestRest

RTP:RTP:– Full strength, no tingling or numbnessFull strength, no tingling or numbness

Prevention:Prevention:– Wear protective paddingWear protective padding

Tennis ElbowTennis Elbow– Lateral EpicondylitisLateral Epicondylitis– Inflammation where the wrist extensors Inflammation where the wrist extensors

attach to the elbowattach to the elbow– Mild to severe painMild to severe pain– Point tenderness over lat. epicondylePoint tenderness over lat. epicondyle– Pain with wrist extension/backhand strokesPain with wrist extension/backhand strokes

Treatment:Treatment:– Ice, rest, NSAID’sIce, rest, NSAID’s

RTP:RTP:– Pain free, full strengthPain free, full strength

Prevention:Prevention:– Pre-season strengthening, proper Pre-season strengthening, proper

mechanicsmechanics

Golfer’s ElbowGolfer’s Elbow– Common in Baseball/SoftballCommon in Baseball/Softball– Medial EpicondylitisMedial Epicondylitis– Inflammation where the wrist flexors attach to Inflammation where the wrist flexors attach to

the elbowthe elbow– Mild to severe painMild to severe pain– Point tenderness over medial epicondylePoint tenderness over medial epicondyle– Pain with wrist flexion/overhead motionsPain with wrist flexion/overhead motions

Treatment:Treatment:– Ice, rest, NSAID’sIce, rest, NSAID’s

RTP:RTP:– Pain free, full strengthPain free, full strength

Prevention:Prevention:– Pre-season strengthening, proper mechanicsPre-season strengthening, proper mechanics

Epiphyseal Stress FractureEpiphyseal Stress Fracture– Growth Plate FractureGrowth Plate Fracture– Caution should be taken in young athletes with Caution should be taken in young athletes with

open growth platesopen growth plates– Repetitive & forceful throwingRepetitive & forceful throwing– Pain on med. elbow that worsens w/ activityPain on med. elbow that worsens w/ activity– SwellingSwelling– Point tenderness above med. epicondylePoint tenderness above med. epicondyle

Treatment:Treatment:– Rest, ice, immobilize, monitor, refer to MDRest, ice, immobilize, monitor, refer to MD

RTP:RTP:– Cleared by MD, Full strength/ROM, Pain freeCleared by MD, Full strength/ROM, Pain free

Prevention:Prevention:– Preseason strengthening, Preseason strengthening, Limited pitch countLimited pitch count

Elbow BursitisElbow Bursitis– Acute blow or repetitive blowsAcute blow or repetitive blows– InfectionInfection– Pain over posterior elbowPain over posterior elbow– SwellingSwelling– Warmth? Warmth?

Treatment:Treatment:– Rest, Ice, Refer to MD?Rest, Ice, Refer to MD?

RTP:RTP:– Released by MD, Pain freeReleased by MD, Pain free

Prevention:Prevention:– Wear protective paddingWear protective padding

Wrist SprainWrist Sprain– Stretch or tear of lig.’s in wristStretch or tear of lig.’s in wrist– FOOSH or torsion injuryFOOSH or torsion injury– Mild to severe painMild to severe pain– Pain with certain wrist movementsPain with certain wrist movements– Instability (Grade II & III)Instability (Grade II & III)– Point tendernessPoint tenderness– Swelling/DeformitySwelling/Deformity– Decreased grip strengthDecreased grip strength

Treatment:Treatment:– Ice, rest, wrap or splint, monitor, refer?Ice, rest, wrap or splint, monitor, refer?

RTP:RTP:– Pain free, full strength/ROMPain free, full strength/ROM

Prevention:Prevention:– Pre-season strengthening, proper landing Pre-season strengthening, proper landing

techniquestechniques

Finger SprainFinger Sprain– ““Jammed finger/thumb”Jammed finger/thumb”– Lig. stretch/tearLig. stretch/tear– Direct blow to finger/twisting of fingerDirect blow to finger/twisting of finger– Mild to severe painMild to severe pain– Pain w/ ext. and flex.Pain w/ ext. and flex.– Instability (Grade II/III)Instability (Grade II/III)– Point tenderness/swelling/decreased strengthPoint tenderness/swelling/decreased strength

Treatment:Treatment:– Ice, Rest, Monitor, Splint?, Refer?Ice, Rest, Monitor, Splint?, Refer?

RTP:RTP:– Pain free, Full strength/ROM, TapePain free, Full strength/ROM, Tape

Prevention:Prevention:– Strengthening of hand musclesStrengthening of hand muscles

Finger DislocationFinger Dislocation– Direct blow to end of fingerDirect blow to end of finger– Crush injuryCrush injury– Intense painIntense pain– Tingling?Tingling?– Felt or heard a popFelt or heard a pop– Feels out of placeFeels out of place– Deformity/Swelling/Inability to bend or move Deformity/Swelling/Inability to bend or move

fingerfinger Treatment:Treatment:

– Ice, Immobilize, Monitor, 911?Ice, Immobilize, Monitor, 911? RTP:RTP:

– Cleared by MD, Pain free, Full strength/ROMCleared by MD, Pain free, Full strength/ROM Prevention:Prevention:

– Strengthen muscles of handStrengthen muscles of hand