*mineral deposit in tendon due to local necrosis.

*It irritates undersurface of subacromial bursa and produces a secondary subacromial bursitis with pain.

MSTT- abd and ER will be strong and painful

MLT- pain it able to do test, short/tight

Palp for tenderness-pain while lengthening T

AROM- will be painful during abd

Palpation for Condition- "itis" (warmth and swelling)

• No specific cause- just wake up
• Partial Tendon Tear
• Calcific supraspinatus tendonitis
• Prolonged immobiliation
• DJD
• Cervical Dysfunction
• Posture-increased kyphosis
• Biceps tendonitis

1. Painful stage- initial
2. Frozen Stage- pain has decreased but have restriction
3. Thawing

1. Decreased AROM: ER > Abd> IR
2. Decreased Classical PROM quantity: ER > Abd >IR
3. Decreased Classical PROM quality: tight capsule endfeel
4. Decreased Accessory PROM quantity: Anterior> Inferior> Posterior
5. Decreased Accessory PROM quality: tight capsule endfeel

1. Biceps trapped at fracture site
2. Problem with deltoid due to Axillary Nerve
3. Circumflex A
4. Trauma to arteries, tendon, ligament

• Radial N injury
• Soft tissue injury
• Brachial A injury

Displaced Clavicle

Undisplaced Clavicle

Greenstick fracture

-incomplete fx

-fx of convex but not concave surface (doesn't fx through both cortices)

-requires a sling to provide protection from further damage for 3 weeks

• In young children best treated by snug figure 8
• healing begins with callus formation in 2 weeks and complete healing usually occurs within 3 months
• Over 10 yrs, attempt to realign before applying bandage and possibly a plaster of Paris cast for most stability in active children.

Fx of the clavicle with No displacement. Stays in line.

Tx: mobilize for healing

• In child development, congenital deformity of a high-placed abnormally small acapula (undescended)
• Possible surgery to cut LS and Rhomboids to improve positioning of scapula
• possible neural complications
• If NO neural problems then PT work ROM and strength in available range.

-Secondary to impingement or RTC tear

- Shoulder laxity, instability

- Overuse with overhead activity esp involving shoulder abd and ER, elbow flexion, supination, pronation

Mods, TFM, ROM, Stretching, Strengthening if needed, off loading brace- 6-8 wks

Make sure collagen fibers lay down right

Pt feels pop, with mild-mod pain. Happens in middled aged males more. Hurts initially.

-Contracting biceps rolls into Popeye sign

-Repair in younger or active population b/c at risk for Impingement Syndrome.

• Pain with overhead or forward motions
• Maybe a deceleration/eccentric injury/overuse
• Pain with Horizontal adduction and ER of humerus

1. Painful Arc- any motion that causes the bursa to be compressed by contraction of the Muscle
2. Palp for condition- swelling, warmth over bursa
3. Palp for Tenderness-pain over bursa
4. PROM Classical- decreased with pain at ER
5. PROM Accessory Endfeel- swelling

1. Painful arc- any motion that causes the bursa to be comp by contraction of the m
2. Palp for condition-swelling, warmth over bursa
3. Palp for Tenderness- pain over bursa
4. PROM Classical- decreased with pain at ER
5. PROM Accessory Endfeel- normal

-Repetitive overuse, irritation of surrounding tendons

-Elevation, passive, horizontal adduction, forward fly, IR

Tx: mods, massage, activity modification

• Axillary N injury
• RC tear
• LHB tear
• AC jt dislocation

SC jt dislocation

• Shape of acromion
• calcium deposit
• Ebernation
• OA
• DJD
• RC thickening/swelling
• Increased prominence on greater tuberosity
• Sprengel's deformity
• Decreased ROM

1. Structure
2. Instability/laxity
3. Hypomobility
4. Muscle Imbalance
5. Postural
6. External Factors

• Extensors and flexors of wrist
• ECRB (main T),
• ECRL
• ED
• ECU

• Pain over tendon
• Pain at lateral epi
• Loss of function

MSTT- strong and painful

Palpation for Condition-swelling, warmth, redness

Palpation for Tenderness- pain over tendon

MLT- pain with lengthening

• pronator teres and FCR most common
• occ palmaris longus
• FCU
• FDS

1. Carpal Tunnel (Flexor retinaculum)
2. scalenes
3. cubital fossa- most common
4. Med humeral condyle
5. lig of struthers
6. Biceps aponeurosis
7. pronator teres-most common from hypertrophy

• Abd Pollicis Brevis
• Opponens Pollicis
• FPL
• FPB
• Lumbrical 1 and 2
• Palmaris Longus
• FDS
• FDP 1 and 2

• Supinator
• ECRB
• Direct trauma over radial head
• Fx or radial head
• Fx neck of radius

Only motor

Entrapment M belly of supinator

Functional wrist drop

Sensory only to dorsal aspect of hand

Entrapment of fibrous edge of ECRB

-Pain in anatomical snuff box

-Hypothenar

-Ulnar side of hand

-small deep muscles in hand

• ask pt to make fist
• only able to flex the 4th and 5th digits
• b/c of loss of the Median N have loss of flx of the 2nd and 3rd digits
• ACTIVE- can't flex 1 and 2- weakness of finger flexors

• it is observed
• pt holds hand with 4th and 5th digits flexed
• due to loss of ulnar N and Median 2 lumbricals that assist w/ PIP ext
• pt. unable to fully ext digits

-can't extend 4th and 5th b/c of weakness in extensors

displacement of organ or body part from normal position

ex. grey's

Requires nutrition from an outside source.

ex. needing sunlight and h20 to live

1. Decreased Classical AROM
2. Decreased Classical PROM
3. Normal Accessory PROM- not associated with jt its ST

Severe hyperextension or fall on a hand w/ elbow slightly flexed.

Usually to Brachialis M or capsule.

• Soft tissue injury,
• capsular disruption,
• collateral damage
• stifness
• Median N, ulnar N
• Brachial A
• Minor fractures
• MO, DJD

-Compression of radial head into capitulum

-Severe valgus (abd) force to extended elbow

Fx through epicondyles of humerus

MOI: extension injury

• malunion
• residential deformity
• Brachialis damage
• Median n injury
• brachial A injury
• DJD

• sudden passive flx with a powerful contraction of the triceps

• Delayed union- fx heals but slow from mvt, poor nutrition, drinking, smoking
• Mal union- heals but with deformity. maybe didn't align properly

1. Direct trauma to sympathetic nerves
2. Immobilization causing edema
3. Direct trauma to periperal nerve
4. Immobilization
5. Psychological predisposition

• Sudek's atrophy
• shoulder hand syndrome
• RDS-Reflex Sympathetic Dystrophy

• limb is swollen
• glassy appearance
• atrophy of hair and nails
• UE and hands some LE discoloration

• Direct trauma
• Cast too tight
• Swelling

• injury of the extensor mechanism-tear or ext T
• Result of hyperflx of distal phalanx w/ ext T under tension
• Can have avulsion of base of distal phalanx where T inserts OR
• Extensor T may rupture just prox to the insertion

• 6-8 weeks immob for T
• 10-15 degrees ext to promote healing
• 6 weeks after start moving AROM
• can't extend finger actively

Heberden's- dorsal surface of DIP and associated with OA

Bouchard's- dorsal surface on PIP and associated with OA.

bone spurs with OA. Loss of grip strength. Can be asymptomatic, diminished function in hand.

Flexion of MCP and DIP jts and ext of PIP.

Cause; damage to palmar plate, collateral bands can be damaged and allow to slip.

Extension of MCP and DIP and flexion of PIP jt

Torn extensor hood allows PIP jt to flex

Digital tenovaginitis stenosans

Result of thickening of flexor tendon sheath. Common with 4th and 5th digits. Inflamm response in T sheath

Fracture/dislocation injury at the first CMC jt. Watch for laxity from dislocation

COI: force at thumb ie. catching football. usually partially flexed causes fx/ dislocation. Small fragment stays in place held by strong ligaments.

1. Blood supply enters from the distal pole- so when fx prox piece doesn't get blood supply
2. No M attachments
3. Covered with articular cartilage (little periosteum impeding healing)

• Avascular Necrosis
• Non-Union
• DJD

• Contracture of palmar fascia with a flexion deformity of the MCP and  PIP
• Palmar fascia becomes thickened and adhered to overlying skin
• (feel nodules in palm of hand)
• TX: tons of massage to prevent scarrring or more contractures

• Displaced fx of distal third of radial shaft and
• Dislocation of distal radioulnar jt.
• usually needs surgery. young adults

• Loss of intrinsics- nerve injury
• Overaction of extrinsic extensor muscles on prox phalanx of fingers
• MCP hyperextended
• Prox and DIP flexed

• Distal palmar crease to mid portion of middle phalanx
• Flexor tendons in their tendon sheaths

• An injury to flexor tendons in this area require surgery
• Adhesion typically form here
• Tendons will become ischemic and replaced with scar tissue

• Fracture of distal radius
• MOI: FOOSH in pronated position
• Looks like dinner force b/c of distal fragment
• Dorsal angulation of distal fragment

• Palpation for Condition- feel knot
• AROM- hurts to contract
• PROM- put stretch on tendons. hurts at ER, (Flx abd)
• MSTT- strong and painful
• MLT- pain with lengthening
• Special Test- Finklestein's

• Reverse Colle's fx
• MOI: Fall on flexed wrist
• Distal fragment displaced anterior

APL and EPB

Thickening of 1st tendon sheath

Something repetitive overuse, continuous deviation of wrist

In the volar direction.

MOI: FOOSh

Symptoms: can't push off chair. Possible numbness/tingling (Median N)

Signs: Hypermobility or laxity of lunate, Hypomobility from tight capsule or adhesion, decreased wrist ext with bony block end-feel (PROM classical)

• Osteochondrosis of lunate
• Avascular necrosis

young adults and jobs with vibratory motion in hand (ex: jack hammer, truck driver) Tender over area

1. Abductur Digiti Minimi
2. FCU
3. Flexor retinaculum
4. UCL
5. Piso-hamate metacarpal and L
6. Extensor retinaculum

1. Paresthesia in Median N.
2. M weakness/ motor changes Median N.
3. c/o night pain

1. Trauma
2. Ergonomics
3. Tight Wrist Flexors
4. Displaced Lunate
5. Retinaculum tightness
6. Edema
7. Effusion
8. Pronator Teres Syndrome
9. C5-T1 nerve roots

1. CTS- Carpal Tunnel Syndrome
2. RMI-Repetitive motion injury
3. OOS- Occupational overuse syndrome
4. RSI- Repetitive spring injury
5. RSS- repeititive stress syndrome
6. MNI0 Median Nerve Injury