Chapter 14

1
Chapter 14 The Elbow and Forearm

• Pages 511 - 516

2
Epicondylitis

• Lateral and medial condyles
• Origin for many muscles acting on wrist and
  fingers
• Inflammation of tendons
• Prolonged stressful loads may result in stress of
  avulsion fractures

3
Lateral Epicondylitis

• Common attachment for wrist extensor group
• Extensor carpi radialis most commonly affected
• Tennis Elbow
• Evaluative Findings
• Table 14-4, page 512

4
Lateral Epicondylitis

• Test for Lateral Epicondylitis (Tennis Elbow
  Test)
• Box 14-6, page 512
• Treatment
• Avoiding aggravating activities
• Anti-inflammatory meds/modalities
• Stretching/strengthening
• tennis elbow straps
• Asses equipment and techniques

5
Medial Epicondylitis

• Powerful snapping of wrist, pronation
• Evaluative Findings
• Table 14-5, page 513
• Little Leaguers Elbow
• Avulsion of common flexor tendon from attachment
  site
• May cause neuropathy of ulnar nerve
• Treatment similar to lateral epicondylitis

6
Distal Biceps Tendon Rupture

• Loss of strength during elbow flexion and
  supination
• MOI eccentric loading when elbow is extended
• Immediate pain, pop
• Evaluative Findings
• Table 14-6, page 514
• Treatment surgical repair

7
Osteochondritis Dessicans of the Capitellum

• Valgus loading compressing redial head and
  capitellum with overhead throwing
• May be result of disrupted blood flow to area
  creating osteochondral defect
• Evaluative Findings
• Table 14-7, page 515
• Treatment
• Surgical vs. non-surgical

8
Nerve Trauma

• Inhibition of radial, ulnar, and median nerves in
  elbow causes symptoms to radiate distally
• Dysfunction characterized by paresthesia,
  decreased grip strength, inability to actively
  extend wrist

9
Ulnar nerve trauma

• Crosses medial aspect of elbow joint line
  superficially, predisposing it to concussive
  forces
• Unstable supporting structures chronic
  subluxation as elbow is flexed inflammation
  decrease in size of cubital fossa compression
  of ulnar nerve

10
Ulnar nerve trauma

• Acute trauma
• Burning sensation in medial forearm, little
  finger, ring finger
• Decreased strength of finger flexors, thumb
  abductors, flexor carpi ulnaris
• Chronic deficit
• Causes hand to deviate radially during flexion
• Clawhand

11
Radial nerve trauma

• Injured by deep laceration or secondary to
  fractures of humerus or radius
• Deep branch
• Dedicated to motor function of thumb, wrist, and
  finger extensors, supinators
• Superficial branch
• Sensory loss on posterior forearm and hand

12
Radial nerve trauma

• Tinels Sign
• Figure 14-20, page 515
• Radial Tunnel Syndrome (RTS)
• Entrapment of radial nerve
• Resembles lateral epicondylitis RTS symptoms
  persist for more than 6 months

13
Median nerve trauma

• Typically compressed or injured on distal portion
  of forearm
• Pressure in cubital fossa may compress nerve
• Carpal tunnel syndrome
• Discussed in Chapter 15
• Pronator teres syndrome
• The anterior interosseous nerve portion of the
  median nerve compressed by pronator teres

14
Forearm Compartment Syndrome

• 3 compartments
• Volar, dorsal, mobile wads
• Increased pressure result of
• Hypertrophic muscles
• Hemorrhage
• Fracture
• Increases risk for compromising circulation and
  neurologic function of hand

15
Forearm Compartment Syndrome

• S S
• Pressure in forearm
• Sensory disruption in hand and fingers
• Decreased muscular strength
• Pain during passive elongation of muscles
• Most commonly affected
• Flexor digitorum profundus, flexor pollicis
  longus
• Volkmanns ischemic contracture
• Surgery used to release pressure