1. UPPER EXTRIMITES JOINTS INJURIES AND DISORDERS Presented by: Pranish Pradhan Pragya Dhungel Pratibha Dhakal Ashmita Karki 1

2. Table of contents Introduction to Joint Types of joints Joints of Upper Extremities Shoulder Joint Elbow Joint Wrist Joint Spine Joint 2 3. Introduction to joint A joint is a site at which any two or more bones articulate or come together. 3 4. Types of joints Fibrous or fixed joints Cartilaginous or slightly movable joints Synovial or freely movable joints Ball and socket joint Hinge joint Gliding joint Pivot joint Condyloid and saddle joint 4 5. SHOULDER 5 6. General anatomy Muscles of the shoulder Deltoid Perctoralis major Coracobranchialis Latissimus dorsi Teres major Biceps brachii Triceps brachii 6 7. Extracapsular structures The coracohumeral ligament, extending from coracoid process of the scapula to the humerus The glenohumeral ligaments, which blend with and strengthen the capsule The transverse humeral ligament, holding the biceps tendon in the intertubercular groove 7 8. 8 9. Shoulder joints Glenohumeral joint Acromioclavicular Joint Sternoclavicular joint Scapulothoracic joint Coracoclavicular joint 9 10. Movements Flexion Extension Abduction Adduction Circumduction Rotation 10 11. SHOULDER INJURIES AND DISORDERS 11 12. Bankart lesion 12 13. Proximal bicep tendon rupture 13 14. Broken collar bone 14 15. Bursitis 15 16. Rotator Cuff tear 16 17. Shoulder Arthritis 17 18. 18 19. Shoulder Dislocation 19 20. Shoulder Impingement Syndrome 20 21. Shoulder Separation 21 22. Elbow Joint 22 23. General anatomy The articular surfaces of the elbow joint Distal humerus Proximal ulna Proximal radius Elbow is a trochleogingylomoid joint. 23 24. 24 25. coronoid fossa trochlea capitulum lateral epicondyle medial epicondyle Anterior View Elbow Structures coronoid process radial fossa 25 26. > Flexion and Extension > Pronation and Supination Movements at the elbow 26 27. ROM flexion/extension 145 active, 160 passive need 100-140 to perform ADLs (e.g., reach back of head to comb hair need 140 only 15 needed to tie a shoe) supination/pronation 85 supination; 70 pronation need 50 supination & 50 pronation to perform ADLs 27 28. Flexion and extension Elbow flexors - Muscles crossing anterior side Brachialis Biceps brachii Brachioradialis Elbow extensors crossing posterior side Triceps 28 29. biceps brachii brachioradialis Elbow Flexors brachialis Note: brachialis is the MOST EFFECTIVE elbow flexor! biceps brachii not effective when pronated (Used more in rapid mvmts or against resistance) multi-articular muscle whose effectiveness is dependent on position of shoulder & radioulnar jts Flexors are almost twice as strong as the extensors making us better pullers than pushers 29 30. Elbow Extensors triceps brachii anconeus long head is bi-articular so its force production dependent on shoulder position medial head is the workhorse of this group active in all positions lateral head is strongest yet is relatively inactive unless acting against resistance 30 31. Pronation and supination Rotation of radius around ulna Three radioulnar articulations: Proximal, middle and distal articulations Proximal and distal- pivot joint Middle syndesmosis Associated muscle- pronator and supinator 31 32. Radioulnar Joints pronator teres pronator quadratus supinator biceps brachii Supination Pronation always active active in rapid mvmts or against large loads always active active in rapid mvmts or against large loads 32 33. Loads on the elbow Examples 300N- eating and dressing 1700-supported by arms when rising from chair 1900-pulling chair across floor 45% body weight- push up 33 34. Common injuries of elbow 34 35. 35 36. Mechanism of injury Anterior : a direct force strikes the posterior forearm with the elbow in flexed position Posterior: combination of elbow hyperextension, valgus stress, and forearm supination 36 37. 37 38. Elbow Injuries: Ligament or Tendon Injury About 50% of the medial and lateral plane of the elbow is stabilized by ligaments. If the anterior bundle of the elbows MCL is injured, the elbow becomes extremely unstable except when fully extended. Radiography can assess ligament tears and joint stability, particularly with valgus or varus stress applied during a fluoroscopic examination. 38 39. Heterotopic Bone Formation Formation of bone or calcification that is not in the normal bone growth area is called heterotopic bone formation. Heterotopic bone growth at the elbow can be associated with traumatic injury of the elbow, but heterotopic bone formation of the elbow also can be caused by central nervous system trauma or excessive burns. The formation of bone at the elbow joint can cause problems because of decreased full range of motion. Once elbow motion has been compromised by heterotopic bone formation, the only treatment for restoring motion is surgical resection of the bone. 39 40. Fractures The proximity of nerves, arteries, tendons, muscle, and bones in the elbow contributes to the elbow being considered one of the most complex fracture sites. Clinical examination begins by observing the patients arm. When both arms hang normally at the patients sides, there should be a 5 to 15separation of the forearms and hands from the body. This arm-to-body separation is known as the carrying angle. If the patients arms and hands are not observed within the acceptable ranges, it could indicate an elbow fracture. Any variation of the angle that is more than 15is known as cubitus valgus. Angles less than 5are called cubitus varus. All fractures are serious and should be treated as such, although open fractures are at higher risk for adverse complications. 40 41. Tennis elbow 41 42. 42 43. Wrist joint Condyloid joint Between the distal end of the radius and the proximal ends of the scaphoid,lunate and triquetral Disc of white fibrocartilage separates the ulna from the joint cavity and articulates with the carpal bones and also separates the inferior radioulnar joint from the wrist joint 43 44. Muscles and movement Flexion- Extension- Adduction- Abduction- Flexor carpi radialias,flexor carpi ulnaris Extensor carpi radialis,extensor carpi ulnaris Flexor carpi radialis,extensor carpi radialis Flexor carpi ulnaris,extensor carpi ulnaris 44 45. Joints of hands and fingers Synovial joint between -carpal bones -Carpal and metacarpal bone -Metacarpal bones and proximal phalanges -Between the phalanges 45 46. Joints of hands and fingers Joints at the base of thumb is a saddle joint Corresponding joints of the other fingers- condyloid thumb-more mobile than the fingers and thumb can flexed,extended,circumducted,abducted and adducted 46 47. Movement Controlled by muscles in the forearm and smaller muscles within the hand No muscles in the fingers Finger movements are produced by tendons extending from muscles in the forearm and the hand 47 48. Wrist and hand injuries Carpal tunnel Syndrome -occurs when the median nerve is compressed in the wrist -results from repetitive stress to tissue -repetitive flexion and extension of the wrist joint also causes the condition 48 49. Dupuytrens contracture -Condition that affects the palmar fascia and connective tissue that lies beneath the skin in the palm of hand -This condition causes tightening of tissue in the hand -Because of this contractures,the fingers can become permanently flexed and the function of the hand is impaired 49 50. Finger dislocation -Is a joint injury in which the finger bones move apart or sideways so the ends are no longer aligned normally -Usually happen when the finger is bent backward beyond its normal limit of motion 50 51. Finger fracture -A fracture finger can result in improper alignment of the entire hand -If left untreated,a fractured finger can remain painful and stiff for a long time 51 52. Finger sprain -Is stretching or tearing of the ligaments that support the small joint of finger -Ligaments are strong bands of tissue that connect bones to each other 52 53. Ganglion cyst -Is a tumor or swelling that appears on the top of joint on the base or front of the wrist or the base of finger -They do not spread and they are not cancerous 53 54. Wrist fracture -There are several different bones about the wrist that can fracture -Most commonly fractured bone is radius 54 55. Wrist sprains Grade 1:Mild injury,the ligaments are stretched,but no significant tearing has occurred Grade 2:moderate injury,the ligaments may be partially torn Grade 3:severe wrist sprain,the ligaments are completely torn,and there may be instability of the joint 55 56. 56 57. Trigger finger -Is an inflammation of tissue inside finger or thumb called tenosynovitis -Tendons become swollen 57 58. Spine (Vertebral Column) 58 59. General anatomy 33 vertebrae. Divided into 5 parts. Cervical 7 Thoracic 5 Lumbar 12 Sacral (5) Coccygeal (4) 59 60. Normal curves Cervical Curve Concave Thoracic Curve Convex Lumbar Curve Concave Sacral Curve Convex 60 61. Ligaments of spine Anterior longitudinal ligament Posterior longitudinal ligament Supraspinous ligament Ligamentum Nuchae Interspinous ligament Ligamentum flavum Intertransverse ligament 61 62. Range of motion Flexion 90 degrees. Limited by ligaments except anterior longitudinal. Extension 30 degrees. Limited by anterior longitudinal ligament. Lateral flexion and Rotation Both about 30 degrees. 62 63. Loads on Spine Forces acting are body weight, tension on ligament and muscle, intraabdominal pressure. CG of body is anterior to spine, hence forming a moment arm. While lifting a load both compression and shear force acts on the discs. Muscular tension force must be large to counteract with external weights and weight of the body. 63 64. Spinal Disorders 64 65. Abnormal Spinal Curves Lordosis Extreme lumbar curvature. May be due to:- Weakened abdominal muscles. Poor postural habit. Excess training which includes lumbar hyperextension. 65 66. Abnormal spinal curves Kyphosis Also known as Hunchback. Mainly occurs due to Scheuermann's disease. Also known as swimmers back. 66 67. Abnormal spinal curves Scoliosis Lateral deviation of spine. May be due to congenital(15%), idiopathic(65%) or neuromuscular cause(10%). Small lateral deviation is common. 67 68. Fracture and Dislocation Fracture:- Breaking of any vertebrae. Dislocation :- Misplacing of vertebrae. Not having correct line up. 68 69. Fracture and Dislocation Compression Fracture 69 70. Fracture and Dislocation burst fracture 70 71. Fracture and Dislocation Subluxation 71 72. Fracture and Dislocation Fracture-Dislocation 72 73. Low back pain Low back refers to lumbar region. 75-80% people experience it at any time of their life. 2nd most common reason to cause absence in work. ( Then 1st ?? Its up to you.) 73 74. Low back pain Causes :- In children, sprain and strain. Working in poor posture. Repeated loading and vibration. Lordosis. Degeneration of discs. Compression of nerves. 74 75. Low back pain Prevention and Treatment:- Working in good posture. Maintain flexibility. Rest. Physiotherapy. (Usually curl-up) Lumbar surgeries. Anti-inflammatory medications. 75 76. Spinal osteoarthritis Breakdown of cartilage of joints and discs. Called as Spondylosis if hairline fracture occurs in Pars Interarticularis. Spondylolisthesis. Causes :- Older age. Overweight. Trauma to joint. Repetitive stress on joint. 76 77. Spinal osteoarthritis Symptoms :- Stiffness and pain of back. Discomfort relieved when lied down. Treatment :- Physiotherapy Heat or cold applications. TENS( Transcutaneous Electric Nerve Stimulation) Pain-killers for reducing pain. 77 78. Disc herniation Slipped or prolapsed disc. Bulging out of Nucleus Pulposus due to torn Annulus Fibrosus. Mainly occurs between C5-C6, C6-C7 and L4-L5, L5-Sacrum. 78 79. Disc herniation Cause :- Age related degeneration of annulus fibrosus. Constant sitting and driving. Trauma. Symptoms :- Numbness, tingling, muscular weakness. Sometimes symptoms are not seen. Treatment :- non-steroidal anti-inflammatory pain medication. Disectomy removal of part of the herniated disc. 79 80. Whiplash Neck injury involving rapid extension and flexion. Mainly due to rear end automobile accidents. Can cause ligaments and muscle tear in the neck region. 80 81. Whiplash Symptoms :- Neck pain. Headache. Dizziness, numbness, impaired vision. Treatment :- Temporary immobilization. Rest and ice application. Massage. Surgery if severe. 81 82. Prevention of spine problems Get help to lift heavy objects. Never lift at your arms length. While lifting bend your knees and hip. Keep back straight. Stand straight and head tall. Dont cradle your phone between ear and shoulder. Hard bed is good for your spine. 82 83. References www.rothmaninstitute.com www.aclandanatomy.com www.webmd.com www.healthline.com www.wikipedia.org www.uiortho.com www.slideshare.com 83 84. 84 85. 85