6/23/16
Common Upper
Extremity Sports
Injuries
Kristin Ernest, MD
Sports Medicine
Objectives:
•Recognize common upper extremity sports injuries
•Discuss prevention strategies
1
Introduction
• Sports injuries are injuries that occur in athletic
activities or exercising.
Exercising is good for you, but sometimes you can
• injure yourself when you play sports or exercise.
Accidents, poor training practices, or improper gear can
cause them. Some people get hurt because they are
• not in shape. Not warming up or stretching enough can
also lead to injuries.
The most common sports injuries
• Sprains and strains
• Knee injuries
• Swollen muscles
• Achilles tendon
• injuries Pain along
• the shin bone
• Rotator cuff injuries
• Fractures
Dislocations
Treatment plan for sports injuries
• Rest Ice
• Compressi
• on
• Elevation
• Rest:
Immediately stop using the injured area. Sometimes 24 to 48
hours of rest will make a big difference in overall recovery. It could
be that the area you injured will need to rest for a longer period of
time. For injuries affecting legs, knees, or ankles, this means using
crutches so that you are not putting weight on the injured body
part.
• Ice:
Putting ice on your injury will help with pain and swelling. You
should apply ice to the affected area for 15 to 20 minutes every
four hours. Crushed ice is best for ice packs because you can
manipulate it easier to cover the injury.
• Compression:
Keeping pressure on the injury will also help with swelling
and will provide additional support. An elastic medical-
grade bandage works best. Wrap the bandage tight, but
not so tight that it cuts
off circulation to the area.
• Elevation:
Propping up the affected area offers a few benefits.
First, it will ensure you are resting your injury
properly. Second, it will help reduce swelling.
6/23/16
Background
•Increase in youth sport participation
– 2 million high school injuries annually
•Risk factors for injury
– Intrinsic
– Extrinsic
Shoulder: Acute Injuries
7
6/23/16
Clavicle Fracture
• Mechanism of injury
– Fall on point of shoulder
– Fall on outstretched hand
– Direct force
• Presentation
– Severe pain
Picture courtesy of Royal
– Guarding Children’s Hospital Melbourne
– Difficulty carrying affected arm
• Evaluation
– Deformity
– Neurovascular examination
– Imaging?
Picture courtesy of Kids Health
8
6/23/16
• Management
– Sling
– Sleep
– Pain medication
– Rehabilitation
• Range of motion
• ADLs
Picture courtesy of HubPages
• Orthopedic surgery referral
– Significantly angulated fracture
• Severe tenting of skin
• Neurovascular compromise
• Persistent pain
• Failure to form callus
• Fracture location Picture courtesy of FRPMED
9
6/23/16
Acromioclavicular (AC) Sprain
•Mechanism of Injury
– Blow to top of shoulder
– Fall on lateral or posterior shoulder
•Presentation
– Pain on top of shoulder
Picture courtesy of Axon Physio
& Acupuncture
• Evaluation
– Swelling
– Tenderness
– Step-off
– Range of motion
– Scarf test Picture courtesy of Osce Skills
– Imaging
– Rockwood classification
1
0
6/23/16
Rockwood Classification
Table courtesy of Journal of Medicine and Life
• Management
– Sling
• Grade I: 2-3 days
• Grade II: 1-2 weeks
– Ice
– Rehabilitation exercises
• Range of motion
Picture courtesy of Dr. David Geier and
• Strengthening Sports Medicine Simplified
1
1
6/23/16
• Orthopedic surgery referral
– Grade III or higher injury
Picture courtesy of AC
separation forum
Glenohumeral Dislocation
• Mechanism of Injury
– Shoulder abducted and forcefully externally rotated and
extended
– Fall on outstretched arm
– Blow to posterior shoulder
• Presentation
– Severe discomfort
– Generalized weakness
1
2
6/23/16
• Evaluation
– Gross deformity
– Crepitus?
– Neurologic evaluation
• Axillary nerve
Picture courtesy of PhysioPedia
– Imaging
• Management
– Shoulder reduction
• Hippocratic method
https://www.youtube.com/watch?v=cvCHi7pzNSs
• Sitting method
• Prone method
– Imaging
– Sling
– Rehabilitation
1
3
6/23/16
• Orthopedic surgery referral
– Fracture of clavicle or humerus
– Bankart lesion
– Persistent pain
Picture courtesy of The Radiology Assistant
Brachial Plexus Injury
(“Burner” or “Stinger”)
•Mechanism of Injury
– Traction most common
– Compression
• Presentation
– Immediate burning pain down arm Picture courtesy of AAFP
• Dysesthesia
• Numbness
• Weakness
1
4
6/23/16
• Evaluation
– Rule out C-spine injury
– Neurological exam
– Imaging
• Plain films
• MRI
– Consider nerve conduction study
• Management
– Rest
– Observation
– NO physical therapy
Picture courtesy of Happy News
10
6/23/16
Shoulder: Overuse Injuries
Recurrent Subluxation or Dislocation
•Mechanism of Injury
– Position of abduction and external rotation
•Presentation
– Describe shoulder “popping” or “popping out”
16
6/23/16
• Evaluation
– Atrophy of deltoid and trapezius
– Weak rotator cuff
– Load and shift test:
https://www.youtube.com/watch?v=0edignSiNGs
– Apprehension test:
https://www.youtube.com/watch?v=IfPLBFgYbCg
– Radiographs
• Management
– Rotator cuff strengthening
– Physical therapy
– Remove offending agents
– Shoulder brace
• Orthopedic surgery referral
– Operative stabilization as treatment option
17
6/23/16
Impingement Syndrome
•Mechanism of Injury
– Supraspinatus tendon pinched between humeral head and
acromion with abduction
•Presentation
– Pain
– Similar to rotator cuff tendonitis
• Evaluation
– Demonstrate multidirectional instability
• Load and shift test
• Impingement tests
• Kennedy-Hawkins
• Neer impingement test
– MRI?
18
6/23/16
• Management
– Similar to rotator cuff tendonitis
– Relative rest
– Pain medication
– Strengthening
Picture courtesy of JTS Strength and The Shoulder Health Essentials
Physiolysis of the proximal humerus
(Little League Shoulder)
•Mechanism of Injury
– Repetitive throwing
•Presentation
– Pain worsening with throwing
– Insidious onset
Picture courtesy of Cincinnati
Childrens
19
6/23/16
• Evaluation
– Tender to deep palpation proximal upper arm
– Slightly decreased ROM
– Mild weakness
– Radiographs
Picture courtesy of OrthoInfo
• Management
– Conservative
– Throwing cessation
– Radiographs
– Rotator cuff strengthening
20
6/23/16
Elbow: Acute Injuries
Elbow Fracture
•Presentation
– Diffuse swelling
– Limited range of motion
•Evaluation
– Diffuse swelling
– Limited range of motion
– Imaging Picture courtesy of Medscape
21
6/23/16
• Management
– Splint
– Sling
• Orthopedic surgery referral
– Neurovascular compromise
– Significant deformity Picture courtesy of Kids Fractures
– Supracondylar fracture
Elbow Dislocation
•Mechanism of Injury
– Fall on outstretched hand
•Presentation
– Pain
– Gross deformity
Picture courtesy of Christifurrr
22
6/23/16
• Evaluation
– Neurologic exam
– Vascular exam
– Sensory exam
• Ulnar nerve most commonly affected
• Management
– Reduction
• May worsen injury
• Parvin technique
– Repeat exam
• Median nerve injury
– Imaging Picture courtesy of Emergency Medicine News
– Splint and Sling
– Hospitalization
23
6/23/16
Elbow: Overuse Injuries
Medial Epicondylitis
(Little League Elbow)
•Mechanism of Injury
– Throwing with valgus stress on elbow
•Presentation
– Insidious onset
– Medial elbow pain
Picture courtesy of
BaseballChiro.com
24
6/23/16
• Evaluation
– Mild soft tissue swelling
– Tender to palpation
– Normal range of motion
– Valgus stress testing
– Tinel test
– Imaging
Picture courtesy of HandLab
• Management
– REST
– Ice
– Education
• Pitch counts
20
6/23/16
Wrist Injuries
Carpal Bone Fractures
•Mechanism of Injury
– Fall on outstretched hand
• Presentation
– Swelling
Picture courtesy of AAFP
– Tender to palpation
• Scaphoid: anatomic snuffbox
26
6/23/16
• Evaluation
– Swelling and tenderness
– Imaging
• Management
– Thumb spica cast
Prevention
• Modify risk factors
– Intrinsic
• Strengthening to correct deficiencies
• Optimize mechanics
– Extrinsic
• Activity modification
• Education
27
6/23/16
In Summary
•Most upper extremity injuries are due to overuse
•Rest and activity modification are crucial for recovery
•Education is critical to help prevent injury
28
