chapter 14. Upper limb injuries
MH Vioreanu and JH Mullett
INTRODUCTION
Upper limb injuries are very common in collision sports (e.g. rugby, ice-hockey) and in sports that use large ranges of motion of the arm (e.g. gymnastics, cricket). They occur mainly after falls on to an outstretched hand or a direct blow to the arm.
Injuries can range anywhere from a dislocation (shoulder, elbow) to a simple sprain or ligament damage.
We have divided the arm into three areas (Fig. 14.1):
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| Fig. 14.1 |
• Shoulder area
• Elbow area
• Wrist and hand area
What should I check for?
Speak to the player
• Reassure the player
• Ask the player what happened. Get details of injury
• ‘How did you land?’
• ‘Did you feel/hear a crack?’ (?Broken bone)
• ‘Did you feel a snap or feel like you pulled a muscle?’
• ‘Where is the pain?’
• ‘Point to the sore area.’
• ‘Does the pain go anywhere or is it in the same place?’
• ‘Can you move your arm?’
• ‘Do you have pins and needles?’
Problem identification
• A player in a lot of pain generally has a serious injury
• Most injuries of the arm are obvious enough
• A player will point to the area of soreness and complain of pulling a muscle or receiving a blow
• Asking how the injury happened will give clues as to what the injury is – for example, severe shoulder pain after direct impact
Observe
• Look at the arm in question and compare it to the other side
• Focus on where it is sore!
• Does the arm look different? Is it funny looking? (?Broken bone)
• Is the player holding their arm in a particular way?
• Is there any swelling of the arm? Look at the normal side
• Check for obvious bruising, grazes or bleeding
Rule out serious injury
Remember – pain in the arm can come from a neck injury.
• ‘Can you move your arms?’ (If not, this indicates a potential neck injury: see Ch. 13)
• Any pins and needles/numbness in the arms? (If yes, treat as a neck injury)
• Can you see bone sticking out through the skin? (Red Zone Injury)
• Can you see blood spurting out from a wound? (Red Zone Injury)
Touch for tenderness
• Feel the area that was injured
• Is it swollen? Is it very sore to touch? (Does the player wince?)
• Can you feel anything broken or unusual?
• Ask the player to move the joint
• Move the joint for the player. Is it very painful?
Skills assessment
• If the player is unable to fully move shoulder, elbow, wrist and fingers without pain (Amber Zone Injury), remove from field immediately and continue assessment on sideline
• Sometimes, the pain resolves rapidly and the player can perform sports-specific skills without discomfort
• Test joints above and below the injured area
• Do specific tests to assess each joint/muscle
• If the player can stand and demonstrate basic game skills, this is a good sign. This is a Green Zone Injury and the player may play on
What should I do?
Talk to the player
• Reassure the athlete, explain what is happening
Remove the player safely from the field of play
• If a neck injury is suspected, the player should have spine and back stabilization prior to transfer
• Any other injuries to the arm – ask the player to walk off the field with support
• If there are other injuries to the legs, etc., a stretcher is advised
Emergency transfer to hospital
• Any neck or spine injuries – ambulance
• Broken bones/dislocated – quickest possible means
Avoid further injury
• Immobilization of the injured arm
• Ensure no neck injury or other injury
• Any player who cannot perform basic skills runs the risk of doing more damage and should not continue (Amber Zone Injury)
Treatment
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| Fig. 14.2 |
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| Fig. 14.3 |
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| Fig. 14.4 |
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| Fig. 14.5 |
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| Fig. 14.7 |
• Application of ice
• Application of compressive bandage, if necessary
• Administration of painkillers (trained personnel only)
SHOULDER AREA
Red Zone
• Broken collar bone
• Dislocated shoulder
• Broken upper arm
Amber Zone
• Acromioclavicular joint injury
• Stinger
Broken collar bone (Fig. 14.8)
What should I check for?
Speak to the player
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| Fig. 14.8 |
• Reassure the player
Problem identification
• Ask the player to point to the sore area
• ‘Where is the pain?’
• ‘Did you hear a crack?’
• ‘Can you move your shoulder?’
Observe
• Deformity of the collar bone
• Whether the player is anxious not to move the arm
Rule out serious injury
• Neck injury
• Extreme pain on light touch
• You may be able to feel the broken bone
Skills assessment
• The player is unable to move the shoulder
What should I do?
Talk to the player
• Reassure them
Remove safely from the field of play
• Support the injured arm
• Apply a broad arm sling
Emergency transfer to hospital
• Send player to hospital (by ambulance) in a seated position
Dislocated shoulder (Fig. 14.9)
What should I check for?
Speak to the player
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| Fig. 14.9 |
• Reassure the player
• ‘Where is the pain?’
• ‘Did you hear a crack?’
• ‘Did you feel a pop?’
Problem identification
• How did it happen?
• The player will describe a feeling of the shoulder popping out
• The player will point to the pain
Observe
• Deformity of the injured shoulder
• Normally there is a fullness in the front of the shoulder
• You may notice a ‘step’ at the shoulder joint
• The player is anxious not to move the arm
Rule out serious injury
• Neck injuries
Touch for tenderness
• Extreme pain on light touch
• Feel for a ‘step’. Follow the collar bone along to the edge. You will notice a step. Compare with the opposite side
Skills assessment
• The player is unable to move the shoulder
What should I do?
• Safely remove athlete from the pitch
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