UPPER EXTREMITY
Finger, Hand, Elbow, Shoulder
HAND & WRIST ANATOMY
PALMAR RIGHT HAND VIEW
GENERAL INJURIES
• Fractures
• Direct blows or falls on outstretched hand
• Pain, swelling, decreased function
• Dislocation/Subluxation
• Direct blow from a ball; fall on hand
• Gross change in anatomy
• Sprains/Strains
• Hyperextension or hyperflexion
• Synovitis & Bursitis
• Overuse & irritation of synvium or bursa
• Contusions
• Direct blow
FINGER INJURIES
• Mallet Finger
• “Baseball Finger”
• Caught in jersey
• Direct blow on
outstretched finger
• Avulsion fracture
• Can’t actively extend
finger
FINGER INJURIES
• Boutonniere Deformity
• Tendon rupture of
middle phalanx
• Forced excessive flexion
• Can’t fully extend finger
• GAMEKEEPER’S THUMB
•
•
•
•
Ulna Collateral Ligament
sprain or tear
Forced abduction
TEST: bend thumb @ 45
degree angle & abduct.
• Pain = sprain
• No end point = tear (3rd
degree sprain)
• FINGER STRAIN
• “JAMMING” FINGER
• Hyperextension or
hyperflexion of finger
• TEST: Valgus/Varus for
stability. Resistance for
strength
DE QUERVAIN’S DISEASE
• Irritated thumb tendons
• Tendons swell or “thicken”
• Tenosynovitis
• Pain in wrist numbness in
fingers
• Finkelstein’s test:
make a fist thumb tucked in,
ulnar deviate wrist.
+ sign:pain in thumb
WRIST IMPINGEMENT
• Compression of median & ulnar nerves
• Repeated stress
• Point tenderness, pain, numbness, loss of strength
• PHALEN’S TEST:Press back of hands together,
elbow’s up. Squeeze hands. + sign:tingling &
numbness
ELBOW INJURIES
• IMPINGEMENT
• Ulnar nerve
compression
• Point tenderness, pain,
numbness, loss of
strenght
• TINEL’S SIGN:Tap on
ulnar goove,
+sign: tingling down
arm.
• BICEPS BRACHI
• Found in upper arm
• Elbow flexion & hand
rotation
• Rupture=complete tear
• Usually @ origin
• Painful bulge may apper
@ belly
ELBOW INJURIES
• Epicondylitis
• Swelling of epicondyles
• Medial affects flexors “little
league elbow”
• Lateral=extensors “tennis
elbow”
• Chronic overuse:
twisting/throwing
• Pain & point tenderness
• VOLKMANN’S
CONTACTURE
• Swelling or muscle spasm or
bone fx putting pressure on
arteries of arm
• Decreases blood supply
• Muscle damage &/or paralysis
• Pain when fingers extend
• Possible loss of pulse
TESTS
WHAT IT TESTS
HOW TO TEST
POSITIVE SIGN
TINEL’S
Ulnar Nerve (Elbow
Imping)
Tap @ ulnar groove
Tingling to the thumb
SPEED’S
Biceps tendon
(tenosynovitis)
Arm flexed @ 60 deg
angle. Resist as flex.
Pain @ bicepital groove
PHALEN’S
Ulnar & Median Nerve
Arms, elbow, wrist,
bent @ 90 deg. Back of
hands touching each
other.
Tingling in fingers
FINKELSTEIN’S
Thumb tendon (de
Quervain’s disease)
Make a fist w/thumb
inside of palm. Resist as
wrist flexes toward ulna
Pain means thumb
tendon tenosynovitis
VALGUS/VARUS
Elbow Sprain
VAL Push on lateral
aspect of elbow
medially
VAR Push on medial
aspect of elbow laterally
VAL=Ulnar Collateral Lig
VAR=Radial Collateral
Lig
WRIST FLEXION
Manual muscle test of
wrist
Resist against flexion
Weaksness/injury of
flexi carpi radialis or
ulnaris
WRIST EXT
Manual muscle test of
wrist
Resist against extension
Weakness/injury of
extensor carpis
RADIAL DEVIATION
Manual muscle test of
wrist
Resist fist on lateral side
Weakness/injury of
flexor/extensor carpi
radialis
ULNAR DEVIATION
Manual muscle test of
Resist fist on medial
Weakness/injury of