indirect trauma with the arm:

abducted

extended

externally rotated

Indirect trauma with the arm:

abducted

flexed

internally rotated

Most common dislocated joint in the body

Men > woman

Ant. dislocation more frequent than Post.

Various Dimensions and occur with relative frequency

small= < 1cm

medium= < 3cm

large= > 5cm

Avulsion of capsule and glenoid labrum off rim

traumatic anterior dislocation

part of rim ripped away

results in anterior shoulder instability

injury to head of humerus (posterior lateral aspect)

compression or impaction fracture

frozen shoulder

Decreased ROM

capsular inflammation

fibrous synovial adhesions

reduction of joint cavity

>females 40-60yrs

idiopathic

spontaneous

self limiting

frozen shoulder

trauma

limited immobilization as soon as 1-2 days

frozen shoulder

Acromioclaviular Sprain

(A-C joint)

falls on acromion (direct force)

falls on outstretched arm (indirect force)

ligamentous sprain

graded in degrees by severity

First-degree, grade I

A-C joint sprain

partial tearing of the A-C ligaments

joint tenderness

NO jt. instability or laxity of lig.

Min. loss of fnx

Second-degree, Grade II

A-C Sprain

Complete rupture of the A-C lig.

partial tearing coracoacromial lig.

moderate pain

some dysfunction

palpable gap between acromion and clavicle

Third-degree, Grade III

A-C ligament injury

Dislocation between acromion and clavicle

A-C and Coracoclavicular lig ruptured

distal clavicle becomes displaced superiorly

Marked pain

severe limitation of shoulder motion

direct or severe trauma

body is most common site

ice and immobilization w/ sling (2-3 weeks)

Tx = WB tolerated or no WB

Direct or indirect trauma

men under age 25

immobilization of glenohumeral jt

figure-of-eight bandage

healing 4-6 weeks or longer

risk for avascular necrosis (avn)

classified by four-parts:

humeral head,

lesser tuberosity,

greater tuberosity

hurmeral shaft

Indicative of severe four-part fractures of:

prox. humerus

acascular necrosis of humeral head

osteoporosis

RA

Advanced OA

partial- replaced head

total- replaced socket and head

Supraspinatus

Infraspinatus

Teres minor

Subscapularis

mechanical wear

friction

supraspinatus tendon most common for impingement

mechanical compression of tendons

primarily suprispinatus tendon

passes under coracoacromial lig.

glenohumeral instability causes problem

reduction of subacromial space

elevated head

Watershed zone

critical zone

area of relative transient hypovascularity occurs with repeated arm motions from abd. to add.

compromises blood supply area

very common

chronic inflammation in bicipital groove

Yergason's test- pt's should in neutral, elbow flexed to 90 degrees:

pt then supinates and externally rotates

+ if pain in groove

tennis elbow

effects wrist extensors

Ext. carpi radialis longus and brevis

extensor digitorum

extensor digiti minimi

Repetitive overuse of this area leads to tendinitis of the origin of the ext. carpe radialis brevis tendon

over use affects origin of:

pronator teres

flexor cari radialis

flexor digitorum

flexor carpi ulnaris

pain when palpating medial epicondyle and with action motion

pn with resisted wrist flexion and full passive

< common than lateral

GOLFER'S ELBOW

medial or ulnar collateral lig

overload or repetitive actions

sprain injury

Pain at medial epi. and olecranon

problem with supracondylar fx

can occur anywhere

brachial artery

displaced fx can cause hemorrhage or vascular obstruction

severe pn with pt in cast

fall on outstretched arm

Can change entire carrying angle

increased valgus deformity

varus elbo malalignment "gunstock deformity"

Fracture to radial head, --> heals with a larger carrying angle

Ulnar nerve is stretcheds

pain and agitation

Late onset

relocation of ulnar

Fall on the point of the elbow

indirectly- forcefull contraction of the triceps

Second most common fracture

fracture and dislocation in same area

entrapment Compression Neuropathy

median nerve

most common

transverse carpal lig and carpal bones

mononeuropathy

thenar muscle atrophy

Swelling occurs and more compression to median nerve

causes pain and dysfunction

HALL MARK- symptoms worse at night

Start off with numbness or tingling (new clumisiness)

pregnant women at high risk

wrist in cock- up position

De Quervain’s Tenosynovitis

cumulative trauma ds

ulnar deviations

affected tendons:

abductor pollicis longus and extensor pollicis brevis

pass w/ in 1st dorsal compartment

pn an swelling at radial styloid

massage therapist

intracapsular ligaments provide stability

results from fall on wrist hyperextended

most common distal radius fracture

w/ in 2.5 cm of the wrist

distal radius displaced in dorsal direction

DINNER FORK DEFORMITY

Middle age to elderly women

"reverse colle's"

distal radial fracture in palmar direction

is a chronic pain condition

Exageration of pain

injury to the nerve

occurs most often in the arms or legs after a minor injury

Stage 1 (lasts 1 - 3 months):

Complex regional pain syndrome

Stage 2 (lasts 3 - 6 months)

Complex regional pain syndrome

Scaphoid Fractures

proximal pole

most common of carpal bones

due to direction of blood flow fracture can cause non union and avascular necrosis

acute sprain of ulnar collateral ligament of the thumb

valgus stress with hyperextension

Boxer's fracture

fighter fracture

Neck of metacarpal bones 2, 3, 4, and 5

fracture

Fracture subluxation

proximal first metacarpal

proliferative fibrodysplasia

palmar connective tis.

ulnar digits

Normal collagen type I is replaced by type III

painless w/ palpable nodules

tendon rupture or avulsion fracture

extensor tendon

DIP joint flexion contracture

trauma to area

direct trauma to terminal phalanx

rupture or stretch of central extensor tendon

PIP jt

PIP flexion with DIP extension

Vasomotor Dysfunction

reflex response to chronic sensory stimulus

pain, hyperestesia, edema, discoloration, and loss of motion and fnx