Upload
ernest-jones
View
235
Download
0
Tags:
Embed Size (px)
Citation preview
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