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Chapter 7 - Upper Extremity Injuries. Impair peoples’ ability to manipulate the environment. Upper extremity design for motion not for the support of large loads. Shoulder Anatomy. Shoulder complex: Shoulder girdle: scapula and clavicle Shoulder joint joint Sternoclavicular joint:

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chapter 7 upper extremity injuries

Chapter 7 - Upper Extremity Injuries

Impair peoples’ ability to manipulate the environment. Upper extremity design for motion not for the support of large loads

shoulder anatomy
Shoulder Anatomy
  • Shoulder complex:
    • Shoulder girdle: scapula and clavicle
    • Shoulder joint joint
  • Sternoclavicular joint:
    • Modified Ball & Socket
    • disk
  • Acromioclavicular joint
    • AC ligaments
  • Coracoclavicular joint
  • Glenohumeral joint:
  • Scapulothoracic joint
shoulder anatomy1
Shoulder Anatomy
  • Glenohumeral Joint
    • Most mobile joint
    • Shallow joint cavity
    • Glenoid labrum
    • Glenohumeral ligaments
    • Coracohumeral ligament
  • Muscular support
    • Rotator cuff muscles
shoulder anatomy2
Shoulder Anatomy
  • Rotator cuff
    • subscapularis
    • infraspinatus
    • supraspinatus
    • teres minor
  • Primary source of stability to the shoulder
shoulder injuries
Shoulder Injuries
  • AC sprain or separated shoulder
  • Indirect or direct forces
    • direct force to acromion with shoulder in adducted position
    • fall on a outstretched arm
    • traction to arm
  • Classification
    • Type I-III
    • Type IV > rare
      • severe forces
shoulder injuries1
Shoulder Injuries
  • Shoulder instability
    • poor joint cavity
    • poor ligament
    • musculature
    • Intracapsular pressure
    • Concavity compression
    • scapulohumeral balance
shoulder injuries2
Shoulder Injuries
  • Anterior Luxation
    • mostly anterior when arm is abducted, extended and ext. rotated
    • posterior forces
  • Posterior luxation
    • same mechanism reverse
  • Inferior luxation
shoulder injuries3
Shoulder Injuries
  • Impingement
    • glenohumeral joint: abduction
    • supraspinatus and bursae
  • Categories
    • Under 35 year: sports or jobs with overhead movement
    • Older: degeneration
  • Microtrauma-instability-subluxation-aggravation
shoulder injuries4
Shoulder Injuries
  • Rotator cuff impingements
    • Extrinsic: structural factors
      • hook acromion
      • hypertrophy of supraspinatus
    • Intrinsic
      • inflammation of the tissue
  • Mechanism
    • work of sports requiring overhead movements
    • Wheelchair (abductor dominance)
shoulder injuries5
Shoulder Injuries
  • Rupture Rotator cuff
    • Chain of events:
      • inflammation
      • microtears
      • partial or total rupture
      • movement adaptations
    • Supraspinatus rupture most common
    • Eccentric actions
      • acceleration phase
      • decceleratiom phase
shoulder injuries6
Shoulder Injuries
  • Upper arm
    • two compartments
      • anterior
      • posterior
  • Humeral fractures
    • 7% of fractures
    • Direct or indirect
    • Low & high energy
    • falls, car crashes, direct loading, violent muscle contraction (throwing)
shoulder injuries7
Shoulder Injuries
  • Biceps tendon injuries
    • tenosynovitis (repetition)
    • dislocation (medial)
      • abduction/ext. rotation
      • falls outstretched arm
      • lateral impact
      • hyperextension
      • anterior GH dislocation
      • bicipital grove angulation
    • rupture: tissue degeneration
    • SLAP
elbow anatomy
Elbow Anatomy
  • Hinge joint
  • Ligament support
    • MCL:valgus loading
    • LCL: varus loading
    • Annular ligament
  • Muscles
    • Flexors: biceps, brachialis and brachioradialis
    • Extensor: Triceps & anconeus
elbow injuries
Elbow Injuries
  • Epicondylitis: repeated loading causing microtrauma and tissue degeneration leading to inflammation and tissue weakness
  • Lateral epicondylitis
    • tennis players 30-50 years old, poor stroke mechanics, excessive muscle contraction
    • Overuse of extensor mechanics, pinching and grasping
elbow injuries1
Elbow Injuries
  • Medial epicondylitis
    • excessive loading forehand and serve
    • Advanced players
    • Wrist motions
elbow injuries2
Elbow Injuries
  • Valgus Extension Loading
    • large varus torque
  • Mechanism
    • elbow extension
    • huge internal rotation torque transmitted to elbow
elbow injuries3
Elbow Injuries
  • Dislocations
    • more stable, less incidence of dislocation
    • Axial force to extended or hyper
    • Avulsion of collateral ligaments
elbow injuries4
Elbow Injuries
  • Fractures
    • humeral
    • Ulnar
      • olecranon:impact or hyperextension
    • Radial
      • axial loading of radius from a fall or dislocation
forearm anatomy
Forearm Anatomy
  • Two bones
    • radius & ulna
  • Two compartments of muscles
    • anterior: flexor-pronator
    • posterior:extensor-supinator
  • Proximal radioulnar joint
  • Distal radioulnar joint
forearm injuries
Forearm injuries
  • Diaphyseal fractures of ulna & Radius
  • Galeazi: distal 1/3 radius, outstretched arm, blow to dorsum of wrist
  • Nightstick
  • Montegia lesion: classification for ulnar fractures
  • Distal radius: Colles etc.
forearm injuries1
Forearm injuries
  • Ulnar variance: relative length of ulna and radius
  • Determined
    • genetics
    • elbow pathology
    • mechanical loading
  • Ulnar variance in gymnast-premature closure of radial growth plate
  • Gymnastic: huge loads to the wrist- cartilage degeneration/fractures
wrist hand anatomy
Wrist & Hand Anatomy
  • Wrist joints
    • distal radio ulnar
    • radiocarpal
    • intercarpal
  • Hand joints
    • CM:
    • MP: condyloid
    • IP: hinge
wrist hand anatomy1
Wrist & Hand Anatomy
  • Strong ligaments
  • Muscles
    • control wrist & finger motion
    • carpal tunnels
    • Flexor & extensor retinacula
wrist hand injuries
Wrist & Hand Injuries
  • Carpal tunnel (CTS)
    • result from repetitive stress to tissue
    • 64% of work injuries
    • Compressive neuropathy
    • Wrist flexion/ext and finger movements
    • Risk factors
      • exertion
      • repetitive stress
      • posture
      • localized contact
      • cold
wrist hand injuries1
Wrist & Hand Injuries
  • Carpal fractures
    • compressive loads to hyperextended wrist
    • hyper flexion
    • rotation loading against a fixed wrist
    • Scaphoid
      • 60-70%
    • Lunate
wrist hand injuries2
Wrist & Hand Injuries
  • Thumb: essential to prehension
  • Sprain: skiers thumb
    • fall with thumb in abducted position
    • tensile loads on MCL
  • Hyperextension
  • Bennets fracture (fighting)
  • Bowler’s thumb: ulnar digital nerve trauma
    • tingling, sensitivity
wrist hand injuries3
Wrist & Hand Injuries
  • Metacarpal & phalangeal injuries
  • Fractures
    • Boxers
  • Dislocations