This is the presentation we have presented as our assessments. The presentation includes brief anatomy and injuries that may occur in the joints of upper limbs and vertebral column.

1. UPPER EXTRIMITES JOINTS
INJURIES AND DISORDERS
Presented by:
Pranish Pradhan
Pragya Dhungel
Pratibha Dhakal
Ashmita Karki
1

2. Table of contents
• Introduction to Joint
• Types of joints
• Joints of Upper Extremities
• Shoulder Joint
• Elbow Joint
• Wrist Joint
• Spine Joint
2

3. Introduction to joint
A joint is a site at which any two or more bones
articulate or come together.
3

4. Types of joints
• Fibrous or fixed joints
• Cartilaginous or slightly movable joints
• Synovial or freely movable joints
 Ball and socket joint
Hinge joint
Gliding joint
Pivot joint
Condyloid and saddle joint
4

5. SHOULDER
5

6. General anatomy
• Muscles of the shoulder
Deltoid
Perctoralis major
Coracobranchialis
Latissimus dorsi
Teres major
Biceps brachii
Triceps brachii
6

7. Extracapsular structures
• The coracohumeral ligament, extending from
coracoid process of the scapula to the
humerus
• The glenohumeral ligaments, which blend
with and strengthen the capsule
• The transverse humeral ligament, holding the
biceps tendon in the intertubercular groove
7

8. 8

9. Shoulder joints
• Glenohumeral joint
• Acromioclavicular Joint
• Sternoclavicular joint
• Scapulothoracic joint
• Coracoclavicular joint
9

10. Movements
• Flexion
• Extension
• Abduction
• Adduction
• Circumduction
• Rotation
10

11. SHOULDER INJURIES AND DISORDERS
11

12. Bankart lesion
12

13. Proximal bicep tendon rupture
13

14. Broken collar bone
14

15. Bursitis
15

16. Rotator Cuff tear
16

17. Shoulder Arthritis
17

18. 18

19. Shoulder Dislocation
19

20. Shoulder Impingement Syndrome
20

21. Shoulder Separation
21

22. Elbow Joint
22

23. General anatomy
• The articular surfaces of the elbow joint
Distal humerus
Proximal ulna
Proximal radius
• Elbow is a trochleogingylomoid joint.
23

24. 24

25. coronoid fossa
trochlea
capitulum
lateral epicondyle
medial
epicondyle
Anterior View
Elbow Structures
coronoid process
radial fossa
25

26. > Flexion and Extension
> Pronation and Supination
Movements at the
elbow
26

27. ROM
• flexion/extension
• 145º active, 160º passive
• need 100-140º to perform ADL’s
• (e.g., reach back of head to comb hair need 140º
• only 15º needed to tie a shoe)
• supination/pronation
• 85º supination; 70º pronation
• need 50º supination & 50º pronation to perform
ADL’s
27

28. Flexion and extension
• Elbow flexors - Muscles crossing anterior side
Brachialis
Biceps brachii
Brachioradialis
Elbow extensors – crossing posterior side
Triceps
28

29. biceps brachii
brachioradialis
Elbow Flexors
brachialis
Note: brachialis is the
MOST EFFECTIVE
elbow flexor!
biceps brachii not
effective when pronated
(Used more in rapid mvmts or against resistance)
multi-articular muscle
whose effectiveness
is dependent on
position of shoulder
& radioulnar jts
Flexors are almost
twice as strong as
the extensors making
us better pullers than
pushers
29

30. Elbow Extensors
triceps brachii
anconeus
long head is bi-articular
so its force production
dependent on shoulder
position
medial head is the
‘workhorse’ of this group
active in all positions
lateral head is strongest
yet is relatively inactive
unless acting against
resistance
30

31. Pronation and supination
• Rotation of radius around ulna
• Three radioulnar articulations:
• Proximal, middle and distal articulations
• Proximal and distal- pivot joint
• Middle – syndesmosis
• Associated muscle- pronator and supinator
31

32. Radioulnar Joints
pronator teres
pronator quadratus
supinator
biceps brachii
Supination Pronation
always active
active in rapid mvmts
or against large loads
always active
active in rapid
mvmts or
against
large loads
32

33. Loads on the elbow
• Examples
• 300N- eating and dressing
• 1700-supported by arms when rising from
chair
• 1900-pulling chair across floor
• 45% body weight- push up
33

34. Common injuries of elbow
34

35. 35

36. Mechanism of injury
• Anterior : a direct force strikes the posterior
forearm with the elbow in flexed position
• Posterior: combination of elbow
hyperextension, valgus stress, and forearm
supination
36

37. 37

38. Elbow Injuries: Ligament or Tendon
Injury
• About 50% of the medial and lateral plane of
the elbow is stabilized by ligaments. If the
anterior bundle of the elbow’s MCL is injured,
the elbow becomes extremely unstable except
when fully extended.
• Radiography can assess ligament tears and
joint stability, particularly with valgus or varus
stress applied during a fluoroscopic
examination.
38

39. Heterotopic Bone Formation
• Formation of bone or calcification that is not in the
normal bone growth area is called heterotopic bone
formation. Heterotopic bone growth at the elbow can
be associated with traumatic injury of the elbow, but
heterotopic bone formation of the elbow also can be
caused by central nervous system trauma or excessive
burns.
• The formation of bone at the elbow joint can cause
problems because of decreased full range of motion.
Once elbow motion has been compromised by
heterotopic bone formation, the only treatment for
restoring motion is surgical resection of the bone.
39

40. Fractures
• The proximity of nerves, arteries, tendons, muscle, and bones in the
elbow contributes to the elbow being considered one of the most
complex fracture sites. Clinical examination begins by observing the
patient’s arm. When both arms hang normally at the patient’s sides,
there should be a 5° to 15°separation of the forearms and hands
from the body. This arm-to-body separation is known as “the carrying
angle.” If the patient’s arms and hands are not observed within the
acceptable ranges, it could indicate an elbow fracture. Any variation of
the angle that is more than 15°is known as cubitus valgus. Angles less
than 5°are called cubitus varus.
• All fractures are serious and should be treated as such, although open
fractures are at higher risk for adverse complications.
40

41. Tennis elbow
41

42. 42

43. Wrist joint
• Condyloid joint
• Between the distal end of the radius and the
proximal ends of the scaphoid,lunate and
triquetral
• Disc of white fibrocartilage separates the ulna
from the joint cavity and articulates with the
carpal bones and also separates the inferior
radioulnar joint from the wrist joint
43

44. Muscles and movement
• Flexion-
• Extension-
• Adduction-
• Abduction-
Flexor carpi radialias,flexor carpi ulnaris
Extensor carpi radialis,extensor carpi ulnaris
Flexor carpi radialis,extensor carpi radialis
Flexor carpi ulnaris,extensor carpi ulnaris
44

45. Joints of hands and fingers
• Synovial joint between
-carpal bones
-Carpal and metacarpal bone
-Metacarpal bones and proximal phalanges
-Between the phalanges
45

46. Joints of hands and fingers
• Joints at the base of thumb is a saddle joint
• Corresponding joints of the other fingers-
condyloid
• thumb-more mobile than the fingers and
thumb can
flexed,extended,circumducted,abducted and
adducted
46

47. Movement
• Controlled by muscles in the forearm and
smaller muscles within the hand
• No muscles in the fingers
• Finger movements are produced by tendons
extending from muscles in the forearm and the
hand
47

48. Wrist and hand injuries
• Carpal tunnel
Syndrome
-occurs when the
median nerve is
compressed in the
wrist
-results from repetitive
stress to tissue
-repetitive flexion and
extension of the wrist
joint also causes the
condition
48

49. Dupuytren’s contracture
-Condition that affects the palmar fascia and
connective tissue that lies beneath the skin in the
palm of hand
-This condition causes tightening of tissue in the
hand
-Because of this contractures,the fingers can
become permanently flexed and the function of
the hand is impaired
49

50. Finger dislocation
-Is a joint injury in which the finger bones move
apart or sideways so the ends are no longer
aligned normally
-Usually happen when the finger is bent
backward beyond its normal limit of motion
50

51. Finger fracture
-A fracture finger can result in improper
alignment of the entire hand
-If left untreated,a fractured finger can remain
painful and stiff for a long time
51

52. Finger sprain
-Is stretching or tearing of the ligaments that
support the small joint of finger
-Ligaments are strong bands of tissue that
connect bones to each other
52

53. Ganglion cyst
-Is a tumor or swelling that appears on the top of
joint on the base or front of the wrist or the base
of finger
-They do not spread and they are not cancerous
53

54. Wrist fracture
-There are several different bones about the wrist
that can fracture
-Most commonly fractured bone is radius
54

55. Wrist sprains
• Grade 1:Mild injury,the ligaments are
stretched,but no significant tearing has
occurred
• Grade 2:moderate injury,the ligaments may be
partially torn
• Grade 3:severe wrist sprain,the ligaments are
completely torn,and there may be instability of
the joint
55

56. 56

57. Trigger finger
-Is an inflammation of tissue inside finger or
thumb called tenosynovitis
-Tendons become swollen
57

58. Spine (Vertebral Column)
58

59. General anatomy
33 vertebrae.
Divided into 5 parts.
• Cervical – 7
• Thoracic – 5
• Lumbar – 12
• Sacral – (5)
• Coccygeal – (4)
59

60. Normal curves
Cervical Curve – Concave
Thoracic Curve – Convex
Lumbar Curve – Concave
Sacral Curve – Convex
60

61. Ligaments of spine
• Anterior longitudinal ligament
• Posterior longitudinal ligament
• Supraspinous ligament
– Ligamentum Nuchae
• Interspinous ligament
• Ligamentum flavum
• Intertransverse ligament
61

62. Range of motion
• Flexion
– 90 degrees.
– Limited by ligaments except anterior longitudinal.
• Extension
– 30 degrees.
– Limited by anterior longitudinal ligament.
• Lateral flexion and Rotation
– Both about 30 degrees.
62

63. Loads on Spine
• Forces acting are body weight, tension on
ligament and muscle, intraabdominal
pressure.
• CG of body is anterior to spine, hence forming
a moment arm.
• While lifting a load both compression and
shear force acts on the discs.
• Muscular tension force must be large to
counteract with external weights and weight
of the body.
63

64. Spinal Disorders
64

65. Abnormal Spinal Curves
• Lordosis
– Extreme lumbar curvature.
– May be due to:-
• Weakened abdominal muscles.
• Poor postural habit.
• Excess training which includes
lumbar hyperextension.
65

66. Abnormal spinal curves
• Kyphosis
– Also known as ‘Hunchback’.
– Mainly occurs due to
Scheuermann's disease.
– Also known as ‘swimmer’s back’.
66

67. Abnormal spinal curves
• Scoliosis
– Lateral deviation of spine.
– May be due to
congenital(15%),
idiopathic(65%) or
neuromuscular cause(10%).
– Small lateral deviation is
common.
67

68. Fracture and Dislocation
• Fracture:-
– Breaking of any vertebrae.
• Dislocation :-
– Misplacing of vertebrae.
– Not having correct line up.
68

69. Fracture and Dislocation
• Compression Fracture
69

70. Fracture and Dislocation
burst fracture
70

71. Fracture and Dislocation
• Subluxation
71

72. Fracture and Dislocation
• Fracture-Dislocation
72

73. Low back pain
• Low back refers to
lumbar region.
• 75-80% people
experience it at any time
of their life.
• 2nd most common reason
to cause absence in
work. ( Then 1st ?? It’s up
to you.)
73

74. Low back pain
• Causes :-
– In children, sprain and strain.
– Working in poor posture.
– Repeated loading and vibration.
– Lordosis.
– Degeneration of discs.
– Compression of nerves.
74

75. Low back pain
• Prevention and Treatment:-
– Working in good posture.
– Maintain flexibility.
– Rest.
– Physiotherapy. (Usually curl-up)
– Lumbar surgeries.
– Anti-inflammatory medications.
75

76. Spinal osteoarthritis
• Breakdown of cartilage of joints and discs.
• Called as Spondylosis if hairline fracture
occurs in Pars Interarticularis.
• Spondylolisthesis.
• Causes :-
– Older age.
– Overweight.
– Trauma to joint.
– Repetitive stress on joint.
76

77. Spinal osteoarthritis
• Symptoms :-
– Stiffness and pain of back.
– Discomfort relieved when lied down.
• Treatment :-
– Physiotherapy
– Heat or cold applications.
– TENS( Transcutaneous Electric Nerve Stimulation)
– Pain-killers for reducing pain.
77

78. Disc herniation
• Slipped or prolapsed
disc.
• Bulging out of Nucleus
Pulposus due to torn
Annulus Fibrosus.
• Mainly occurs between
C5-C6, C6-C7 and L4-L5,
L5-Sacrum.
78

79. Disc herniation
• Cause :-
– Age related degeneration of annulus fibrosus.
– Constant sitting and driving.
– Trauma.
• Symptoms :-
– Numbness, tingling, muscular weakness.
– Sometimes symptoms are not seen.
• Treatment :-
– non-steroidal anti-inflammatory pain medication.
– Disectomy – removal of part of the herniated disc.
79

80. Whiplash
• Neck injury involving rapid
extension and flexion.
• Mainly due to rear end
automobile accidents.
• Can cause ligaments and
muscle tear in the neck
region.
80

81. Whiplash
• Symptoms :-
– Neck pain.
– Headache.
– Dizziness, numbness, impaired vision.
• Treatment :-
– Temporary immobilization.
– Rest and ice application.
– Massage.
– Surgery if severe.
81

82. Prevention of spine problems
• Get help to lift heavy objects.
• Never lift at your arms length.
• While lifting bend your knees and hip. Keep
back straight.
• Stand straight and head tall.
• Don’t cradle your phone between ear and
shoulder.
• Hard bed is good for your spine.
82

83. References
• www.rothmaninstitute.com
• www.aclandanatomy.com
• www.webmd.com
• www.healthline.com
• www.wikipedia.org
• www.uiortho.com
• www.slideshare.com
83

84. 84

85. 85