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

5

Assessing Shoulder Injuries

• ROM test for external rotation of the shoulder

• ROM test for internal rotation of the shoulder

6

Assessing Shoulder Injuries

• Specific ROM tests for the shoulder

including abduction, flexion, extension,

horizontal adduction• External muscle tests for the shoulder

7

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

8

Types of Shoulder Injuries

• Fractures– Perform percussion test, compression test

• Dislocations and subluxations• Contusions

9

Types of Shoulder Injuries

• Sprains– Sulcus test, apprehension test for sprain of

the anterior capsule– Acromioclavicular (AC) sprain test– Sternoclavicular (SC) sprain test

10

Types of Shoulder Injuries

• Strains – Drop arm test

• Impingement – Hawkins-Kennedy test, winged scapula

test

11

Types of Shoulder Injuries

• Tendonitis– Speed’s test

• Synovitis and bursitis

12

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

13

Manual Muscle Tests for the Elbow

• Flexion strength test• Extension strength test • Supination strength test • Pronation strength test

14

Injuries to the Elbow and Arm

• Fractures• Dislocations and subluxations• Contusions• Sprains

– Valgus stress test for the elbow– Varus stress test for the elbow

15

Injuries to the Elbow and Arm

• Impingement – Tinel’s sign

• Synovitis and bursitis• Biceps brachii rupture• Epicondylitis• Volkmann’s contracture

16

Physiology of the Wrist and Hand

• Made up of eight bones– Carpals, arranged in two transverse rows

• Five metacarpals and digits make up the hand

17

Assessing Wrist and Hand Injuries

• ROM test for wrist flexion• ROM test for wrist extension• ROM test for finger flexion

18

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

19

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

20

Injuries to the Wrist and Hand

• Fractures• Dislocations and subluxations• Contusions• Sprains

– Gamekeeper’s thumb test• Impingement

21

Injuries to the Wrist and Hand

• Tendonitis• Ganglion cyst of the wrist• Mallet finger• Buttonhold deformity