Upper extremity injuries and examination

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Upper extremity injuries and examination
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Over the bars head over heels
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CLAVICULAR FRACTURE

• Middle third fracture most common
• Fall on outstretched arm or shoulder
• Visible and palpable deformity
• Greenstick in adolescents
• Check neurovascular status

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CLAVICULAR FRACTURE

• X-rays obvious
• Diff. Dx AC/SC separation, contusion
• Rx figure of eight or sling

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ACROMIOCLAVICULAR JT.

• Sprain, separation, dislocation
• Stretching or partial tearing of AC and/or
• coracoclavicular (CC) ligaments
• Type I AC ligament sprain, CC intact
• Type II AC disrupted, CC sprain, slight
• separation
• Type III AC/CC disrupted, displacement

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TYPE I AC Sprain

• AC joint without deformity (AC/CC intact)
• Tender to palpation
• Pain with motion of shoulder
• Crossover test increases pain

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TYPES II and III

• ?? Type II AC separation (CC intact)
• ?? Type III AC dislocation (CC disrupted)
• ?? Clavicle seen riding above acromion, tender

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AC Sprain/Separation

• X-rays AP lateral Stress views?
• Diff. Dx contusion, arthritis, osteolysis
• Treatment Types I and II
• RICE, NSAIDs, early rehabilitation
• Treatment Type III controversial
• conservative first unless overhead athlete
• Surgical treatment pain, function, cosmesis

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Anterior GlenohumeralDislocation
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Anterior GlenohumeralDislocation

• Diff. Dx subluxation, labral tear, rotator
• cuff tear, AC separation
• Treatment prompt reduction, sling, rehab

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Rotator Cuff

• The rotator cuff muscles are deep in location and
  serve as stabilizers of the GH joint.
• Known by the acronym S.I.T.S.
• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

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Posterior View of Shoulder
Supraspinatus
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Supraspinatus

• Origin supraspinous fossa of scapula
• Insertion greater tubercle of humerus
• Action
• assists deltoid muscle in abducting arm at
  shoulder joint
• Initiates the first 30-60 degrees of abduction at
  which point the deltoid takes over

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Rotator Cuff
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Infraspinatus

• Origin Infraspinous fossa of scapula
• Insertion greater tubercle of humerus
• Action laterally rotates and adducts arm at
  shoulder joint

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Teres Minor

• Origin Inferior lateral border of scapula
• Insertion greater tubercle of humerus
• Action laterally rotates, extends, and adducts
  arm at shoulder joint

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Subscapularis

• Origin subscapular fossa of scapula
• Insertion lesser tubercle of humerus
• Action medially rotates arm at shoulder joint

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Movements of the Shoulder

• Flexion
• Extension
• Abduction
• Adduction
• External Rotation
• Internal Rotation

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Forward Flexion

• 90 degree movement
• Muscles involved
• Deltoid (anterior fibers)
• Pectoralis Major (clavicular fibers)
• Coracobrachialis
• Biceps

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Extension

• 45 degrees
• Muscles involved
• Deltoid (posterior fibers)
• Teres Major
• Teres Minor
• Latissimus Dorsi
• Pectoralis Major (sternocostal fibers)
• Triceps (long head)

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Abduction

• 180 degrees
• Muscles Involved
• Supraspinatus
• Deltoid
• Serratus Anterior
• Infraspinatus

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Adduction

• 45 degrees
• Muscles Involved
• Pectoralis Major
• Latissimus Dorsi
• Teres Major
• Deltod (anterior fibers)
• Subscapularis

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External Rotation

• 80-90 degrees
• Females have greater rotation than males
• ROM can be limited by the Subscapularis
• Muscles Involved
• Infraspinatus
• Teres Minor
• Posterior Deltoid

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Internal Rotation

• 55 degrees
• Muscles Involved
• Subscapularis
• Pectoralis Major
• Latissimus Dorsi
• Teres Major
• Deltoid (anterior fibers)

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Elbow
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Elbow injuries
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Supracondylar fracture
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Mechanism of scaphoid Fractures

• Most frequently fractured carpal bone (60-70 of
  carpal fractures)
• Second only to fractures of the distal radius
• Most common in young men (15-30)
• Results from a fall onto the outstretched hand
  with the wrist
• extended and in radial extension

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Clinical evaluation

• Suspected scaphoid fractures present with wrist
  pain and tenderness at the anatomic snuffbox
• Anatomic snuffbox pain is said to be only 40
  specific for a scaphoid fracture.
• Scaphoid tubercle palpitation is considered more
  specific (57)
• Resisted supination often exacerbates scaphoid
  fracture pain
• and is more reliable than pain from resisted
  pronation
• Range of motion is reduced somewhat, with pain
  usually felt at the extremes of motion
• Swelling or bruising is generally not present
  except in fracture dislocations

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Colles fracture
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Gamekeepers Thumb
Non involved side
Gamekeepers sprain, notice the amount of joint
laxity
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Normal Pediatric Long Bone
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What is a Salter-Harris fracture?

• Fracture through growth plate in a pediatric
  patient
• 35 of skeletal injuries in patients aged 10-15
• involve growth plate
• Often due to trauma, usually sports-related or
• fall
• Complain of point tenderness around fracture
• site
• Soft-tissue swelling on physical exam

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