Chapter 14 – The Elbow and Forearm

Pages 511 - 516

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

Lateral Epicondylitis

Common attachment for wrist extensor group Extensor carpi radialis – most commonly

affected “Tennis Elbow” Evaluative Findings

Table 14-4, page 512

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

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

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

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

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

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

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

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

Radial nerve trauma

Tinel’s 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

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

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

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 Volkmann’s ischemic contracture Surgery used to release pressure