Chapter 14 – The Elbow and Forearm Pages

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