Brace Yourself Physical Exam, Functional Testing and Bracing of Common Upper Extremity Orthopedic Complaints

1. �Brace Yourself� Physical Exam, Functional Testing and Bracing of Common Upper Extremity Orthopedic Complaints

2. Objectives Surface anatomy, muscle testing, special tests, & bracing Cervical spine Shoulder Elbow, wrist, hand Apply these skills to your clinical practice

3. Cervical Spine Exam Surface Anatomy C 3 thru 7

4. Cervical Spine Exam Manual Muscle Tests Special Tests Spurlings Compression

5. Shoulder AnatomySkeletal

6. Shoulder AnatomyMuscular

7. Shoulder Exam Surface Anatomy Sternoclavicular joint Clavicle Acromoclavicular joint Coracoid process Tip of Acromion Proximal Humerus Spine of the Scapula

8. Shoulder Exam Manual Muscle Tests Special Tests AC Spring Test Sulcus Sign Apprehension Test Hawkins-Kennedy Impingement Test Drop Arm Test

9. Shoulder Exam

10. Shoulder Braces Shoulder Stabilizer �SAWA�

11. Elbow, Wrist, and Hand Anatomy Medial Elbow

12. Elbow, Wrist, and Hand Anatomy Lateral Elbow

13. Elbow, Wrist, and Hand AnatomyWrist and Hand

14. Elbow Exam Surface Anatomy Medial Epicondyle Lateral Epicondyle Olecranon Ulnar groove

15. Wrist and Hand Exam Surface Anatomy Scaphoid Pisiform Radial Head Ulnar Styloid

16. Elbow, Wrist, and Hand Exam Manual Muscle Tests Special Tests Valgus Stress Test Tennis Elbow Test (Lateral Epicondylitis) Finkelstein Test

17. Elbow Exam

18. Wrist Exam

19. Hand Exam

20. Upper Extremity Function Mirroring Double/single arm balancing Sport specific skill testing Identify tasks Progress intensity to game-like situation

21. Elbow Braces Hinged Elbow Brace Control ROM Prevent hyperextension

22. Wrist/Hand Bracing Cock-Up Immobilize

23. Wrist/Hand Bracing Wrist/Thumb Spica Brace

24. Orthopedic Exam References Amato, H., Venable-Hawkins, C., Cole, S. 2002. Practical Exam Preparation Guide of Clinical Skills for Athletic Training. Thorofare, NJ: SLACK Incorporated.

25. Orthopedic Exam References Magee, D. 2002. Orthopedic Physical Assessment, 4th Ed. Philadelphia, PA: Saunders. Kendall, F., McCreary, E., Provance, P. 1993. Muscles, Testing and Function. Baltimore, MD: Williams & Wilkins.

26. Injury Scenario # 1 A football player reaches out with his arm to tackle the ball carrier. After the play he walks to the sideline supporting the arm and is in a great deal of pain. Discuss how to evaluate this problem and immediate care procedures.

27. Answer: Injury Scenario # 1 Injury Anterior shoulder dislocation Plan Attempt to reduce Sling the arm (above heart) Assess vascular integrity of the arm Assess neurological integrity of the arm Transport to doctor for immediate reduction

28. Answer: Injury Scenario # 1 Bracing Shoulder stabilizer for stability

29. Injury Scenario # 2 A soccer player running downfield was tripped and fell on her shoulder with the arm extended. She complains of pain over the distal end of the clavicle. On examination she has a lump on the top of the shoulder (not found on bilateral examination) which is tender. Demonstrate what you would do.

30. Answer: Injury Scenario # 2 Injury Acromioclavicular sprain Evaluation Palpable pain at acromion process and AC ligament Piano key sign Positive AC sprain special tests Holds arm in loose packed position Limited shoulder ROM

31. Injury Scenario # 3 During a football game the quarterback makes a throw & just as he releases the ball is struck from his blindside. His head appears to be forced sideways with the shoulder already lowered from his follow-through. The athlete comes to you on the sideline complaining of pain, numbness & tingling in his neck & down his right arm. Evaluate this injury and discuss what return to play criterion should be used.

32. Answer: Injury Scenario # 3 Injury Brachial plexus strain (Burner/Stinger) Plan Light stretch of injured area Perform upper extremity neurological assessment Light cervical traction Brachial plexus tension tests

33. Answer: Injury Scenario # 3 Plan (cont) Assess grip strength Ice over brachial plexus Return to Play Full sensation and full strength demonstrated

34. Injury Scenario # 4 A tennis player reports with a chief complaint of elbow pain. Considering the injury has an insidious onset, the sport the athlete participates in and the joint injured. Demonstrate the key components to the evaluation and list the plan of action for care of the athlete.

35. Findings: Injury Scenario # 4 Evaluation Pain with active and resistive extension of the wrist and forearm Pain and weakness with manual muscle test for the extensor muscle group Palpable pain over lateral epicondyle Positive tennis elbow test Positive Cozens test

36. Answer: Injury Scenario # 4 Injury Lateral Epicondylitis Plan Evaluate biomechanics with coaches assistance Discuss racket tension Discuss grip size Ultrasound (phono if no improvement) for inflammation

37. Answer: Injury Scenario # 4 Plan (cont.) Ice cup after activity Strap to reduce tension on extensor tendons

38. Injury Scenario #5 The quarterback was injured during the first quarter of the contest while carrying the ball. The physician diagnosed the injury as trauma to the abdominal area also known as �getting the wind knocked out� and ruled that he could resume activity. During the fourth quarter, he started to talk about abdominal pain that was radiating up into the left shoulder. Describe your evaluation process and recommended treatment for the athlete.

39. Answer: Injury Scenario # 5 Plan Assess respiratory integrity of athlete for pathology Assess for other signs and symptoms of heart complications Listen to heart sounds with stethoscope Palpate abdomen for areas of rebound tenderness (especially around spleen) Have athlete urinate and look for blood in urine

40. Injury Scenario #6 During an ice hockey game a player catches a slap-shot directly in his chest. The athlete tries to get up but collapses back to the ice and cannot catch his breath. Demonstrate what you would do.

41. Answer: Injury Scenario # 6 Injury Possible heart arrhythmia Treatment Monitor ABC�s Activate emergency action plan X-Ray ribs