Osteopathic Approach to Upper Extremity
OSTEOPATHIC APPROACH TO UPPER EXTREMITY
ANATOMY, INJURIES, TREATMENTS & OMT DR. SAUNDRA HOLSETH FM/NMM FOMA SEPT. 2018
DISCLOSURES
? I HAVE NO COMMERCIAL, FINANCIAL OR LEGAL DISCLOSURES
OBJECTIVES
o BASIC ANATOMY REVIEW OF THE UPPER EXTREMITY, WITH KEY AREAS OF THE SHOULDER, ELBOW, WRIST AND HAND
o COMMON INJURIES- SHOULDER, ELBOW, WRIST AND HAND
o MECHANISM OF INJURY o DIAGNOSIS o TREATMENTS
o UPPER EXTREMITY OSTEOPATHIC MANIPULATIVE TREATMENTS
SHOULDER ANATOMY
o SHOULDER IS THE PROXIMAL SEGMENT OF THE UPPER EXTREMITY AND CONNECTS IT TO THE AXIAL SKELETON
o IT INCLUDES THE PECTORAL, SCAPULAR AND DELTOID REGIONS
o LIGAMENTS- TRANSVERSE HUMERAL LIG, SUPERIOR ACROMIOCLAVICULAR LIG, CORACOACROMIAL LIG, CORACOCLAVICULAR LIG, INTERCLAVICULAR LIG, ANTERIOR STERNOCLAVICULAR LIG, COSTOCLAVICULAR LIG
o JOINT CAPSULE- GLENOID LABRUM
o TENDONS- BICEPS TENDON, SITS MUSCLES, TRICEPS TENDON
o BURSAE- SEMITENDINOUS BURSAE OF SUBSCAPULARIS, SUBDELTOID BURSAE, SUBACROMIAL BURSAE, SUBCORACOID BURSAE
o THE BONES THAT MAKE UP THE SHOULDER CONSIST OF
o STERNUM o CLAVICLE o SCAPULA o HUMERUS
SHOULDER ANATOMY- JOINTS
THERE ARE 5 TOTAL JOINTS-
o ACROMIOCLAVICULAR JOINT- ACROMION OF THE SCAPULA AND THE DISTAL CLAVICLE. A DIARTHRODIAL JOINT THAT ALLOWS MOTION IN ALL 3 PLANES. ENCLOSED BY A CAPSULE.
o STERNOCLAVICULAR JOINT- MANUBRIUM OF THE STERNUM AND THE CLAVICLE. HAS A JOINT CAPSULE THICKENED BY 4 LIGAMENTS. ALLOWS MOVEMENT OF DISTAL CLAVICLE IN SUPERIOR, INFERIOR, ANTERIOR AND POSTERIOR DIRECTION.
o CORACOCLAVICULAR JOINT- SYNDESMOSIS JOINT OF THE CORACOID PROCESS OF THE SCAPULA AND THE INFERIOR DISTAL CLAVICLE. ATTACHED BY THE CORACOCLAVICULAR LIGAMENT. VERY LITTLE MOVEMENT IS PERMITTED HERE.
o SCAPULOTHORACIC JOINT- PERMITS THE SCAPULA TO GLIDE ALONG THE THORAX ON A CURVED SURFACE OF LOOSE CONNECTIVE TISSUE
o GLENOHUMERAL JOINT- BALL AND SOCKET (GLENOID FOSSA OF THE SCAPULA AND THE HUMERUS) SYNOVIAL JOINT THAT PERMITS WIDE RANGES OF MOTION. HOWEVER, THIS MAKES THE JOINT RELATIVELY UNSTABLE. SURROUNDED BY A JOINT CAPSULE THAT IS REINFORCED BY THE SITS MUSCLES TO ADD STABILITY.
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