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

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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

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Shoulder Exam
10
Shoulder Braces

• Shoulder Stabilizer
• SAWA

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Elbow, Wrist, and Hand Anatomy Medial Elbow
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Elbow, Wrist, and Hand Anatomy Lateral Elbow
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Elbow, Wrist, and Hand AnatomyWrist and Hand
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Elbow Exam

• Surface Anatomy
• Medial Epicondyle
• Lateral Epicondyle
• Olecranon
• Ulnar groove

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Wrist and Hand Exam

• Surface Anatomy
• Scaphoid
• Pisiform
• Radial Head
• Ulnar Styloid

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Elbow, Wrist, and Hand Exam

• Manual Muscle Tests
• Special Tests
• Valgus Stress Test
• Tennis Elbow Test (Lateral Epicondylitis)
• Finkelstein Test

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Elbow Exam
18
Wrist Exam
19
Hand Exam
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Upper Extremity Function

• Mirroring
• Double/single arm balancing
• Sport specific skill testing
• Identify tasks
• Progress intensity to game-like situation

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Elbow Braces

• Hinged Elbow Brace
• Control ROM
• Prevent hyperextension

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Wrist/Hand Bracing

• Cock-Up
• Immobilize

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Wrist/Hand Bracing

• Wrist/Thumb Spica Brace

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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.

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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.

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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.

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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

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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

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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.

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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

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Answer Injury Scenario 3

• Plan (cont)
• Assess grip strength
• Ice over brachial plexus
• Return to Play
• Full sensation and full strength demonstrated

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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.

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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

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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

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Answer Injury Scenario 4

• Plan (cont.)
• Ice cup after activity
• Strap to reduce tension on extensor tendons

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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.

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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

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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.

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Answer Injury Scenario 6

• Injury
• Possible heart arrhythmia
• Treatment
• Monitor ABCs
• Activate emergency action plan
• X-Ray ribs