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Elbow and Forearm Pathologies
Chapter 16 Elbow and Forearm Pathologies
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Clinical Anatomy Bony anatomy Medial epicondyle Trochlea Capitellum
Lateral epicondyle Radial fossa
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Clinical Anatomy Bony anatomy Ulna Semilunar notch Olecranon process
Olecranon fossa Coronoid process Coronoid fossa Radial notch Proximal radioulnar joint Radial head Bicipital tuberosity Radial shaft Radial styloid process Lister tubercle
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Clinical Anatomy Articulation and ligamentous anatomy
Humeroulnar joint Flexion and extension Modified hinge joint Humeroradial joint Pronation and supination Proximal and distal radioulnar joints Syndesmotic joint
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Clinical Anatomy Articulation and ligamentous anatomy
Ligamentous support Ulnar collateral ligament (UCL) Anterior, transverse, and posterior bundle Lateral collateral ligament Radial collateral ligament (RCL) Annular ligament Accessory lateral collateral ligament Interosseous membrane
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Clinical Anatomy Elbow extensor and pronator group
Elbow flexor and supinator group Elbow extensor and pronator group
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Clinical Anatomy Nerves Bursa Median nerve Anterior interosseous nerve
Ulnar nerve Arcade of Struthers Tunnel of Guyon Radial nerve Superficial branch Deep branch Subcutaneous olecranon bursa Subtendinous olecranon bursa
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Clinical Evaluation of the Elbow and Forearm
Past medical history History of the present condition Previous history Seasonal pain Cervical injury General medical health Vascular, neurological, or systemic conditions Location of the symptoms Onset of the symptoms MOI Technique Associated sounds and sensations
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Clinical Examination of the Elbow and Forearm
Inspection Functional observation Anterior structures Carrying angle Cubitus valgus Cubitus varus Cubital fossa Medial structures Medial epicondyle Flexor muscle mass
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Cubital Fossa The cubital fossa is a triangular area demarcated by the brachioradialis muscle laterally and the pronator teres medially. The brachial artery and its two subdivisions (the radial and ulnar arteries), the median nerve, and the musculocutaneous nerve pass through this fossa.
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Clinical Examination of the Elbow and Forearm
Inspection Lateral structures Alignment of the wrist and forearm Cubital recurvatum Extensor muscle mass
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Clinical Examination of the Elbow and Forearm
Inspection Posterior structures Bony alignment Olecranon process and bursa
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Clinical Examination of the Elbow and Forearm
Palpation of the anterior structures Biceps brachii Cubital fossa Brachioradialis Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Pronator quadratus
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Clinical Examination of the Elbow and Forearm
Method of approximating the superficial muscles of the flexor forearm.
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Clinical Examination of the Elbow and Forearm
Palpation of the medial structures Medial epicondyle Ulna Anterior band UCL Posterior band UCL Transverse band UCL
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Clinical Examination of the Elbow and Forearm
Palpation of the lateral structures Lateral epicondyle Radial head Radial collateral ligament Capitellum Annular ligament Lateral ulnar collateral ligament
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Clinical Examination of the Elbow and Forearm
Palpation of the posterior structures Olecranon process Olecranon fossa Triceps brachii Anconeus Ulnar nerve Extensor carpi ulnaris Extensor carpi radialis brevis Extensor carpi radialis longus Extensor digitorum Extensor digiti minimi Extensor pollicis brevis Abductor pollicis longus Radial tunnel
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Clinical Examination of the Elbow and Forearm
Joint and muscle function assessment Active range of motion (AROM) Flexion and extension Pronation and supination Manual muscle tests (MMT) Passive range of motion (PROM)
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Clinical Examination of the Elbow and Forearm
Passive range of motion
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Passive Range of Motion
Elbow: Ulnohumeral and radiohumeral joint capsular patterns and end-feels Capsular pattern: Flexion, extension Extension: Hard Flexion: Soft Elbow: Superior radioulnar joints Capsular pattern: Supination and pronation equally Radioulnar supination: Firm Radioulnar pronation: Hard or firm
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Passive Range of Motion
Forearm: Distal radioulnar joint Capsular pattern: Supination and pronation equally Radioulnar supination: Firm Radioulnar pronation: Firm
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Clinical Examination of the Elbow and Forearm
Joint stability tests Stress testing Medial ligament laxity Lateral ligament laxity Joint play
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Valgus Stress Test
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Varus Stress Test
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Clinical Examination of the Elbow and Forearm
Neurological testing Innervated by the brachial plexus Injury may disturb sensory or motor function in elbow, forearm, and hand Upper quarter screen
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Pathologies and Related Special Tests
Elbow dislocations MOI: Axial force through the forearm with the elbow flexed Extremely painful Obvious deformity “Terrible triad of the elbow” Swelling can be rapid, masking deformity
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Pathologies and Related Special Tests
Fracture about the elbow Supracondylar fracture MOI: Hyperextension or fall on flexed elbow Olecranon process fracture MOI: Falling on flexed elbow Radial head fracture MOI: Longitudinal compression (FOOSH) Forearm fracture Open or closed, simple or complex, degree of angulation, rotation or displacement
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Pathologies and Related Special Tests
Elbow sprains Ulnar collateral ligament Valgus extension overload Elbow posterolateral rotatory instability Radial collateral ligament MOI: Varus force
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Selective Tissue Test: Moving Valgus Stress Test
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Selective Tissue Test: Posterolateral Rotatory Instability Test (Pivot Shift)
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Pathologies and Related Special Tests
Epicondylalgia Lateral epicondylalgia Inflammation or repetitive stress at the lateral epicondyle Swelling TTP Pain with active wrist extension “Tennis elbow” Medial epicondylalgia TTP on medial epicondyle “Little Leaguer’s elbow” Neuropathy of the ulnar nerve
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Selective Tissue Test: Lateral Epicondylalgia (“Tennis Elbow” Test)
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Pathologies and Related Special Tests
Distal biceps tendon rupture Most common in males over 40 years of age MOI: Eccentric loading of the biceps brachii when the elbow is flexed to 90 Complete or partial Signs and symptoms Pain “Pop” within elbow Palpable defect Usually treated with a surgical repair
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Selective Tissue Test: Hook Test for Distal Biceps Tendon Rupture
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Pathologies and Related Special Tests
Nerve pathology Ulnar nerve pathology Radial nerve pathology Median nerve pathology Forearm compartment syndrome
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On-Field Evaluation of Elbow and Forearm Injuries
On-field history On-field inspection Position of the arm Type of force involved Alignment of forearm and wrist Posterior triangle of the elbow
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On-Field Evaluation of Elbow and Forearm Injuries
On-field palpation On-field joint and muscle function tests Alignment of the elbow Collateral ligaments Radius and ulna On-field neurological tests Assessment of forearm and hand AROM MMT PROM
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On-Field Management of Elbow and Forearm Injuries
Elbow dislocations Management Activate EMS Immobilize in the position found in Monitor distal pulse Rule out injury to GH joint, proximal humerus, and wrist Immediately transport athlete to medical facility for further evaluation and treatment
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On-Field Management of Elbow and Forearm Injuries
Fractures about the elbow Management Monitor distal pulse Immobilize elbow, forearm, and wrist Treat for shock Immediately transport athlete to medical facility for further evaluation and treatment
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