Chapter 14 – The Elbow and Forearm Pages 507 - 511

Ligamentous Testing Single-plane instability tested in frontal plane with elbow not fully extended Full extension – olecranon is securely locked within fossa

Test for Medial Ligament Laxity Anterior oblique portion of UCL Primary restraint of medial elbow against valgus stress Trauma = laxity throughout ROM Injury to other ligaments unlikely without first damaging this structure Valgus Stress Test – Box 14-3, page 508

Test for Lateral Ligament Laxity Radial collateral ligament Primary restraint against varus stress Other involved ligaments that allow radius to separate from ulna Annular L. Accessory lateral collateral L. (ALCL) Lateral ulnar collateral L. (LUCL) Varus Stress Test, Box 14-4, page 509

Neurologic Testing Nerve impingement occurring in shoulder or cervical region can result in disruption of motor and/or sensory function in elbow, forearm, hand Nerve trauma at elbow refers symptoms to wrist, hand, fingers Figure 14-18, page 507 Upper quarter screen, Box 1-6, page 17

Elbow Sprains Valgus or varus stress Rotational component Blow or forceful motion to flexed elbow Rotational component Hyperextension mechanism May stress anterior capsule or compress posterior structures

Ulnar Collateral Ligament Valgus loading Overhead pitching motion Assistance from triceps, wrist flexor-pronator muscles, anconeus LUCL may also be injured if force if sufficient Evaluative Findings Table 14-3, page 510

Ulnar Collateral Ligament Posterolateral Rotational instability Tears of LUCL permit rotatory subluxation of humeroulnar joint and subluxation of radiohumeral joint Posterolateral Rotatory Instability Test Box 14-5, page 510

Ulnar Collateral Ligament Treatment Alleviate repetitive forces Reduce pain and inflammation ROM Strengthening Assess ROM at shoulder Excessive external rotation Cocking and acceleration phases

Radial Collateral Ligament Rare due to protection from body Varus forces Trauma to RCL, and possibly annular L. May also disrupt articulation between radial head and capitellum S & S similar to UCL sprain Pain, laxity, weakness-pronation/supination Treatment also similar to UCL sprain