Download The Elbow and Forearm - Acupuncture and Massage College

The Elbow and Forearm
The Elbow
 A hinge joint performing
flexion, extension,
pronation, and
supination
 Anatomy

Humerus
 Lateral/Medial
Epicondyle
 Olecranon Fossa
The Elbow
 Anatomy
 Radius
 lateral bone of the
forearm
 Radial Tuberosity
 Radial Styloid
process
 Ulna
 Medial border of the
forearm
 Semilunar notch
 Olecranon process
The Elbow
 Articulations

Flexion and Extension



Humeroulnar joint
Humeroradial joint
Supination and Pronation


Humeroradial joint
Superior and inferior Radioulnar joints
The Elbow
 Ligamentous
support

Ulnar collateral Lig.
(UCL)
 Divided into
sections
 Anterior Oblique
band
 Transverse
Oblique band
 Posterior oblique
band
The Elbow
 Ligamentous
Support




Lateral Ulnar
collateral Lig.
(LUCL)
Radial Collateral
Lig. (RCL)
Annular Ligament
Interosseus
Membrane
The Elbow
 Supporting Structures
 Types
Static Structure
 Dynamic Structure

Static Structures
 Includes




Fibrous Capsule
Collateral Ligaments
Synovial membrane
Fat pads


At the Olecranon Fossa (largest)
Over the radial and coronoid fossae (2 small fat
pads)
Dynamic Structures
 Supinator muscle - supports lateral joint
and serves as false ligament
 Other muscle around elbow joint
Cubital Fossa
 Passing within the fossa
is the




Brachial artery
Median Nerve
Biceps Tendon
Musculocutaneous
Nerve
This is called the
Triangular Space
Carrying Angle
 The way the forearm goes
outward when at ones side.
 Caused by the size of the
trochlea.
 Valgus (outward angulation)
of 5-15 degrees is normal
 being greater in females.
 Cubitus Valgus/Varus
 Gunstock deformity

A deformity of the elbow,
resulting from condylar fracture
at the elbow in which the
forearm deviates toward the
midline of the body when
extended.
Isoceles Triangle
 Medial and lateral
epicondyles, Olecranon
process. Forms a
triangle in flexion and
lines up in extension
 Boarded laterally by the
Brachioradialis and
medially by the pronator
teres
Eating Angle
 Due to the carrying angle hand
goes straight to the mouth when
elbow is flexed.
Observation
 Note the carrying angle
 Note Cubitus valgus
and/varus
 excessive swelling
 Look for normal bony
and soft tissue contours
 Functional position

90 degrees of flexion
with hand in neutral
Range of Motion
 AROM
 Flexion - 135-145
degrees
 Extension - 0-10
degrees
 Supination - 90
degrees
 Pronation - 80-90
degrees
Circulation
 Brachial Artery

The pulse of the
brachial artery can
be felt directly
medial to the
biceps tendon
insertion
Peripheral Nerve Injuries
 Median Nerve (C6-C8,T1)
innervates wrist & finger
flexors & pronates forearm
 Pinched or compressed
as it passes under the
Lig. of Struther
 Weakness of the
pronator teres, and motor
and sensory loss
 Referred as Humerus
Supracondylar Process
Syndrome
Peripheral Nerve Injuries
 Pronator Teres Syndrome
 As the median nerve passes through the two heads of
the pronator teres it can be compressed
 In this case the pronator teres remains normal and the
other muscles supplied by the median nerve become
involved down the median nerve’s motor distribution.
 The motion of pronation is possible but weak
 Tested with Pronator Teres Syndrome Test: + sign is
tingling or paresthesia in the median nerve distribution
of the forearm and hand
Pronator Teres Syndrome Test
 The patient stands with the elbow in 90 degrees of




flexion.
The practitioner then places one hand on the client's
elbow for stabilization and the other hand grasps the
client's hand in a handshake position.
The client holds this position as the practitioner
attempts to supinate the client's forearm (forcing the
client to contract the pronator muscles).
While holding the resistance against pronation, the
practitioner extends the client's elbow
If the client's pain or discomfort is reproduced, there
is a good chance of median nerve compression by
the pronator teres
Pronator Teres Syndrome
 Pronator Teres
Syndrome Test: In 90
degrees of elbow
flexion the pronator
teres muscle is weaker:
a positive test is
indicated by tingling or
parenthesis in the
median nerve
distribution
Peripheral Nerve Injuries
 Anterior Interosseus NervePinch Deformity

Sometimes pinched or
entrapped as it passes the
pronator teres, leading to
impairment of



Flexor pollicis longus
Flexor digitorum
profundus (lateral half)
Pronator Quadratus
 Anterior Interosseous Nerve
Syndrome or Kiloh-Nerin
Syndrome- exhibited by pinch
deformity: + sign is touching
finger pulp-to-pulp instead of
finger tip to finger tip
 AIS causes no sensory loss
because the AIN is a motor
nerve
Peripheral Nerve Injuries
 Ulnar Nerve (C7-C8,
T1)- innervates flexors
of wrist & finger,
intrinsics of the fingers
and thumb


Likely to be
compressed or stretch
in the Cubital tunnel
Compressed by
 The Cubital Tunnel
 Between the two
heads of the flexor
carpi ulnaris muscle
Peripheral Nerve Injuries
 Radial Nerve (C5-C8, T1) innervates triceps,
brachiolis, brachioradialis, supinator ,&
extensor muscles of wrist and fingers



May be injured as it winds around behind the
Humerus in the Radial Groove.
Damage can occur at time of injury or later
when the nerve gets caught in the callus of
fracture healing
The extensor muscle of the arm are supplied
by the radial nerve and only the triceps get
spared with this injury
Peripheral Nerve Injuries
 Posterior Interosseous
Nerve
 Radial Tunnel
Syndrome
 The PIN can be
compressed as it passes
b/t the two head of the
Supinator in the Arcade
or Canal of Frohse.
 Compression leads to
functional involvement
of forearm extensor
muscles and drop wrist
 No sensory deficit and
may mimic tennis elbow
Elbow Pathology
 Lateral Epicondylities/Radiohumeral Bursitis
 Location: extensor carpi radialis brevis
tendon or the extensor commounis tendon
 Signs & Symptoms:




Pain & tenderness on the outer side of elbow
Pain or weakness with gripping activities
Pain with twisting motions of the wrist ( playing
tennis, using a screwdriver, opening a door or
jar)
Pain with lifting objects
Lateral Epicondylitis
 Causes:






Chronic repetitive stress and
strain to the muscles and
tendons that attach the forearm
muscles to the elbow
Sudden change in activity level
or intensity
Incorrect grip
Incorrect grip size of racquet
(often to large)
Incorrect hitting position or
technique ( usually backhand;
leading with the elbow
Using a racket that is too heavy
Radial Head Fractures
 MOI:
 FOOSH injury
 Elbow Dislocation
 Direct Blow to the area
Radial Head Fractures
 Three Types or
Classifications:
 Type I: Nondisplaced
 Type II Marginal radial
fractures that are
displaced
 Type III: Comminuted
Fractures involving the
entire radial head
Elbow Dislocation
 Very common in children and athletes
 MOI: FOOSH injury
Direct blow or twisting injury to the elbow
 Posterior Dislocations are most common(98%)
 Seldom occur in isolation – are associated with
fracture of the radial head (occur in 10%),
Neurovascular involvement including brachial artery
and median nerve

Elbow Dislocations
 Signs and Symptoms:
 Extreme pain, swelling, and inability to bend the elbow
 Deformity with olecranon protruding posteriorly and
inferiorly
 Loss of elbow function
 Severe pain when attempting to move the elbow
 Numbness or paralysis in the forearm or hand below
the dislocation from pinching , stretching, or pressure
on the blood vessels or nerves
 Decrease or absent pulse at the wrist
Olecranon Bursitis
 Inflammation of the bursa located b/t the skin
and tip of the ulna
 Common in contact sports such as wrestling,
football, volleyball
Olecranon Bursitis
 Signs and Symptoms
 Pain, tenderness, swelling, warmth, or redness over
the olecranon process
 Crepitaiton ( a crackling sound) on movement or touch
 Fever when infected
 Often painless swelling of the bursa