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Musculares Ligamentosas Oseas Capsulares Bursitis Periostitis ¿? • Después del hombro, es la articulación que más se luxa. Especialmente en niños • PLRI Posterolateral rotacional (ulna en rotación, radio posterior) Regan-Morrey classification of coronoid fractures • Compromiso a nivel de la diáfisis radial en conjunto a una luxación en la articulación distal radio-ulnar. La lesión produce una disrupción a nivel de la articulación de la muñeca • Ocurren alrrededor del codo por tracción o compresiones repetidas, en especial en deportes • Inflamaciones • Hipertrofia • Tumores • Fracturas • Conflictos de espacio en general • Atrapado por el musculo pronador redondo, o por bandas tensas • Levantamiento de pesas, remo, tenis, glof (pronación+prensión) • The anterior interosseous nerve is a motor branch off the median nerve that runs along the interosseous membrane, passing between the flexor digitorum profundus and flexor pol licis longus on its way to the pronator quadratus. Occasionally this nerve is compressed by the forearm muscles or overlying fibrous bands, secondary to forceful muscle contractions. Anterior interosseous nerve compression causes pain and motor weak ness in the proximal forearm. The prevailing sign is loss of pinch strength between the tips of the thumb and index finger. • Radial nerve compression, or radial tunnel syndrome, can occur within the radial tunnel, which extends anteriorly from the radial head to the supinator muscle. Radial tunnel syndrome is typically caused by repetitive or vigorous wrist extension and forearm pronation and supination. It is often incorrectly identified as lateral epicondylitis but careful examination can differentiate the two conditions. With radial tunnel syndrome, tenderness is present several centimeters distal to the lateral epicondyle, within the supinator– extensor muscle mass of the proximal forearm • También sensible a traumatismos directos Imagenología Pruebas ROM Palpación Inspección • Evalúa indemnidad de colaterales laterales • The milking maneuver. The patient grabs the thumb on the arm with the affected elbow by passing the other hand beneath the affected elbow. This locks the shoulder, thereby reducing the effect of shoulder rotation and motion, which may confuse the examination. The examiner palpates the medial joint as the patient pulls on the thumb, exerting a valgus force on the elbow. Note that the elbow is in a high degree of flexion, greater than the angle at which a person throws; it also is flexed to the point that bony anatomy contributes to valgus stability of the elbow. • El paciente con el brazo en supinación máxima, se le pide que resista en la posición, mientras se le prona el antebrazo. Sin la ayuda mecánica del bíceps resistir el movimiento es virtualmente imposible. Activa Pasiva Activa Pasiva • Se busca palpar el nervio ulnar en su recorrido. • El test es +, si se genera la sensación de “disparo” en el antebrazo, mano y quinto dedo • Se realiza una flexión, para observar si existen atrapamientos del nuervio. • En la flexión se tensa el nervio • Para provocar la compresión del nervio mediano • 1) Lower lateral cutaneous nerve of arm (radial). (2) Medial cutaneous nerve of arm. (3) Medial cutaneous nerve of forearm. (4) Lateral cutaneous nerve of forearm (musculocutaneous nerve). (5) Posterior cutaneous nerve of forearm (radial nerve). Coronoid process fracture with hemarthrosis. The posterior fat pad (arrows) is shown clearly on this lateral view with the arm flexed to 90°, indicating joint effusion. The anterior fat pad (open arrow) is clearly visible. There is a fracture of the coronoid process (curved arrow) and a loose body (arrowhead) Cubital tunnel. The ulnar nerve (asterisk) lies in a tunnel bridged by the arcuate ligament (dashed line), which extends from the medial epicondyle to the olecranon process. LAT = lateral. A-P P-A PLRI surgical repair and reconstruction. A, Schematic representation of PLRI reconstruction using a free graft. The graft is woven through bony tunnels bony avulsion of the origin of the lateral collateral ligament (LCL) has been reattached with suture anchors Radial head fracture treated with internal fixation using two screws Radiograph of a patient who had a comminuted radial head fracture; treatment required prosthetic replacement of the radial head Radiograph of a patient treated with tension band wiring for a simple olecranon fracture Radiograph of a patient with a comminuted olecranon fracture treated with plates and screws. Radiograph of a patient who had open reduction and internal fixation for a comminuted distal humeral fracture