1 / 95

Upper Extremity Injuries Corinne Gratson, M.S., P.A.-C.

Upper Extremity Injuries Corinne Gratson, M.S., P.A.-C. Shoulder Girdle. Comprised of: - Glenohumeral Joint: Humeral head articulates with glenoid fossa of the scapula - Acromioclavicular Joint: Acromion process of the scapula articulates with distal clavicle

xander
Télécharger la présentation

Upper Extremity Injuries Corinne Gratson, M.S., P.A.-C.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Upper Extremity InjuriesCorinne Gratson, M.S., P.A.-C.

  2. Shoulder Girdle • Comprised of: -Glenohumeral Joint: Humeral head articulates with glenoid fossa of the scapula -Acromioclavicular Joint: Acromion process of the scapula articulates with distal clavicle -Sternoclavicular Joint: Sternum articulates with proximal end of clavicle -Scapulothoracic Joint: Body of the scapula & muscles covering the posterior chest wall

  3. Shoulder • Muscles: -Trapezius, levator, rhomboids, serratus ant. (stabilize scapula, aid motion @ GH joint) -Deltoid (flex/ext, Abduct) -Rotator Cuff -Pec Major (ADDuct) -Coracobrachialis/Biceps (flexors)

  4. Shoulder • Nerves: -Brachial Plexus (passes through axilla, origin of branches C5-T1) -Axillary N. (innervates deltoid; commonly injured in shoulder dislocations) -Musculocutaneous N. (innervates biceps & coracobrachialis)

  5. Shoulder • Rotator Cuff -Muscles: Supraspinatus (ABduct, Ext. Rot.) Infraspinatus (Ext. Rot.) Teres Minor (Ext. Rot.) Subscapularis (Int. Rot., ADDuct) -Injuries: Tear/Rupture, Tendonitis, Impingement

  6. Shoulder • Rotator Cuff (cont.) -Tear: May be partial or full (partial thickness occurs 2x more often; full thickness occurs in pt’s with long standing h/o shoulder injury, rarely under 40 y/o); one or more of the muscle bellies/ tendons; almost always near their insertion on the greater tuberosity; almost always the supraspinatus tendon -Tendonitis: Inflammation of rotator cuff tendon(s); overuse -Impingement: Mechanical compression of soft tissue structures (suprasp.tendon) under the coracoacromial arch during humeral elevation

  7. Shoulder Rotator Cuff Tear (cont.) -S/Sx: Diffuse, dull, aching pain localized over deltoid & upper arm/back; pain with overhead activities; tender to palp. -Dx: Subjective pt. symptoms, PE (+ empty can, + droparm test, MRI -Tx: Depends on severity. Conservative = PT, NSAIDs, Modalities (RICE, e-stim/US); If no improvement = surgery (subacromial decompression)

  8. Empty Can Test Abduct arm 90°, then horizontally ADDuct 30° at shoulder joint Internally rotate shoulder, like emptying a can onto the floor Apply resistance, looking for pain and/or weakness

  9. Shoulder • Adhesive Capsultitis - “Frozen Shoulder” -exact etiology unclear -contracted & thickened joint capsule which is tight around humeral head, little synovial fluid -chronic inflammation, some fibrosis; rotator cuff muscles also contracted & inelastic -constant inflamm. causes pain w/PROM & AROM; pt. progressively resists moving the shoulder joint

  10. Shoulder • Adhesive Capsulitis (cont.) -S/Sx: pain in all directions w/movement, restricted movement in all directions -Dx: PE -Tx: Relieve discomfort, restore motion through aggressive joint mobs, stretching tight muscles; e-stim to decrease pain, US brings heat to area; surgical release

  11. Shoulder • Thoracic Outlet Compression Syndrome -Compression of brachial plexus, subclavian a., subclavian v. in neck & shoulder; usually congenital; 30% result after trauma/accident due to whiplash -Narrowed space b/t 1st rib & clavicle -Ant. & middle scalene muscles -Pectoralis minor (as neurovasc. bundle passes beneath coracoid process, or b/t clavicle & first rib) -Presence of a cervical rib (an abnormal rib, originates from a cervical vertebra & thoracic rib)

  12. Shoulder

  13. Shoulder • Thoracic Outlet Syndrome (cont.) -S/Sx: Paresthesias, pain, sensation of cold, decreased circulation in fingers, muscle weakness, muscle atrophy, radial n. palsy (all due to pressure on subclavian a./v., brachial plexus); worsened by lifting or carrying weights;; -Dx: Subjective s/sx, special testing (Adson’s –ant. scalene,); Roo’s-costoclavicular; Allen – hyperabduction) -Tx: Conservative (early, mild) = correct anatomical condition responsible; stretching (pec minor, scalenes, strengthening (traps, rhomboids, serratus ant., spine erector muscles); if no improvement may consider surgical decompression

  14. Adson’s Test for Thoracic Outlet Anterior Scalenes tested pt breathes deeply, neck extended, chin toward affected side (+) ↓ radial pulse, extremity pain reproduced

  15. Roo’s Test for Thoracic Outlet Costoclavicular Arms Abducted 90°, elbows flexed 90°, open/close hands x3min. (+) unable to maintain position or pain, weakness, numb/tingling on affected side

  16. Allen Test for Thoracic Outlet Elbow flexed to 90°, shoulder externally rotated & horizontally ext. Rotate head away from tested side (+) if radial pulse becomes non-palpable when head is turned away

  17. Shoulder • Biceps -Biceps Brachii Rupture: occurs when powerful concentric or eccentric contraction of muscle is performed; commonly occurs near origin of the muscle in bicipital groove, dominant arm, males >40 y/o – 60 y/o -Causes: tendonitis, impingement, degeneration, aging, nontraumatic -S/Sx: pt. hears/feels “snap”, feels intense pain @ point of injury; may have bulge in midline of upper arm; weakness with elbow flexion & supination; ecchymosis -Dx: Hx (MOI, anabolic steroid use), subjective s/sx., PE, MRI (if full tear is questionable) -Tx: Immediate cold pack (control muscle hemorrhage), sling; eventually surgery. If only partial, can try PT first

  18. Shoulder

  19. Shoulder

  20. Shoulder

  21. Shoulder • Biceps (cont.) -Bicipital Tendonitis: typically long head of biceps; common in pt’s w/repetitive overhead motion; caused by repeated ballistic activities that cause irritation of tendon and/or synovial sheath as it passes under transverse humeral ligament in bicipital groove -S/Sx: tenderness to palp. ant. upper arm over the groove; possible swelling, warmth, crepitus -Dx: Yergason’s test, Speed’s test, Ludington’s test (tendonitis vs. rupture) -Tx: Rest-several days, cold therapy or US to decrease inflamm., NSAIDs; gradual PT w/stretching, strengthening

  22. Yergason’s Test for Biceps Tedonopathy Elbow flexed @ 90°, examiner resists supination while pt. also ext. Rotates arm against resistance (+) pain/tender in bicipital groove

  23. Speed’s Test Arm is supinated, examiner resists shoulder forward flexion; test repeated in pronation (+) pain/tender in bicipital groove; if profound weakness, suspect 2nd/3rd degree strain/rupture

  24. Ludington’s Test Clasp hands on top or behind head, interlock fingers (allows biceps to relax) Alternately contract/relax the biceps muscles; palpate tendon (+) non-palpable biceps tendon = rupture

  25. Shoulder Dislocation • Most common MOI Abduction, Ext. Rotation • Anterior, Inferior dislocations most common • Check ROM, strength& always compare BILATERALLY! • Always check neurovasc. status BEFORE & AFTER relocation (Don’t forget your AXILLARY nerve!)

  26. Normal Shoulder Xray (Axillary View)

  27. Shoulder Dislocation

  28. Shoulder Dislocation

  29. Shoulder Dislocation - anatomy

  30. Shoulder Dislocation - anterior

  31. Shoulder Dislocation - posterior

  32. Shoulder Dislocation - inferior

  33. Shoulder Dislocation

  34. Shoulder Dislocations • MOI: usually a direct impact to posterior or post/lateral shoulder (if ant. disloc.); humeral head forced out of glenoid (FOOSH, grand mal seizure, tear of rotator cuff, etc.) • S/Sx: feeling of the shoulder give way, “pop”, sudden & severe pain, flattened deltoid contour, palpation of axilla reveals prominence of humeral head; pt. unable to touch the opposite shoulder with hand of affected arm, disability; apprehension

  35. Shoulder Dislocations • Tx: Immediate immobilization in a position of comfort using a sling w/small towel placed under the arm • Tx (cont.): Xrays to eval for glenoid fx, then reduction by a doctor or PA, ASAP! Always get post-reduction Xrays as well to make sure you fully reduced; cont. immobliziation (2-4 weeks) • Complications: Nerve damage, tissue damage, recurrent dislocations (~90% after 1st dislocation)

  36. Shoulder Girdle Fractures • Clavicle Fx -Frequent fx in sports, occurs during birth to infant -MOI: FOOSH, fall on tip of shoulder, direct impact -Majority occur middle 3rd (70%), followed by distal 3rd (25%), proximal 3rd (5%)

  37. Shoulder Girdle Fractures • Clavicle Fx S/Sx: pt. presents typically w/protective splinting (holds injured arm, tilts head toward injury); deformity (depends on severity); pain swelling, point tenderness Dx: Hx, PE, XR Tx: Sling/swathe, analgesics, immobilization w/figure 8 brace x 1wk (then begin gentle ROM); limit overhead activity until tenderness resolves; rarely requires surgical repair

  38. Figure ‘8’ Brace

  39. Shoulder Girdle Fractures • Humerus Fx (proximal, shaft, distal) -Proximal: articular surface of shoulder jt. & attachments of rotator cuff to greater/lesser tuberosities ->90% result from low-energy fall directly onto shoulder; other = high energy trauma -Increased risk w/osteoporosis -Classification: articular surface, greater tuberosity, lesser tuberosity, surgical neck; number of fragments

  40. Shoulder Girdle Fractures • Proximal:

  41. Shoulder Girdle Fractures • Mid-Shaft Humerus Fx: -Proximal, Mid, Distal (divided into 3rds) -Fx Pattern (tranverse, oblique, comminuted) -Open vs Closed -Pathologic (2ndary to underlying bone dz) -40% of all humerus fxs -Results from direct force to upper extremity

  42. Shoulder Girdle Fractures • Mid-Shaft Humerus Fx:

  43. Pathologic Humerus Fracture

  44. Shoulder Girdle Fractures • Distal Humerus Fx: -Etiology: FOOSH, auto vs. peds, MVA, direct blow to elbow

  45. Shoulder Girdle Fractures • Tx: stability & early motion (10-14 days immob.), RICE, early surgical repair (if indicated); if limb has diminished/absent pulse, reduction with immobilization or traction should be performed

  46. Orthosis – Sarmiento Brace

More Related