1. ICAK Certification Courses
Elbow Conditions
Pronator Teres syndrome
Supinator syndrome
Ulnar sulcus syndrome
SEE LEAF and WALTHER MANUALS
FOR IN DEPTH DISCUSSION
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2. Pronator Teres Syndrome
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Pronator Teres Syndrome
Entrapment of Median nerve between ulnar and radial heads of Pronator Teres muscle
most common site of compression caused by muscle hypertrophy or thickening of aponeurotic fascia between two heads of pronator teres
Median nerve enters forearm passing between the two heads of pronator teres and then deep to flexor digitorum superficialis arch, continuing between flexor digitorum superficialis and flexor digitorum profundus in forearm
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3. Pronator Teres Syndrome…
There are four reported sites of median nerve compression
pronator teres: most common
flexor digitorum superficialis arch: second most common, fibrosis of flexor digitorum superficialis arch
supracondylar process/ligament of struthers
lacertus fibrosis (bicipital aponeurosis)

4. Lacertus Fibrosis
The lacertus fibrosis, an aponeurotic expansion, originates at the musculotendinous junction of biceps brachii medially and blends distally with fascia of superficial flexor mass and inserts on proximal ulna

5. Pronator Teres Syndrome…
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Pronator Teres Syndrome…
Symptoms of decreased hand strength, problems with writing, numbness/tingling in hand and especially palm, pain in proximal forearm, fatigue with exercise
Signs and symptoms usually worse with activity
Nocturnal symptoms seen with carpal tunnel syndrome are typically absent
Negative Phalen's test
Weakness of median innervated muscles may only appear after provocative tests (resisted pronation)
Weakness of finger flexors (ie: flexor digitorum profundus)
Strengthens with approximation of proximal radius and ulna
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6. Pronator Teres Syndrome…
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ICAK BASIC CERTIFICATION COURSE*
Pronator Teres Syndrome…
Weakness of finger flexors (ie: flexor digitorum profundus)
Strengthens with approximation of proximal radius and ulna
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7. Pronator Teres Syndrome…
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ICAK BASIC CERTIFICATION COURSE*
Pronator Teres Syndrome…
Challenge radial head and adjust
Often superior or lateral
Test Pronator teres for proper function
Weakness
Shortened : SCS/RSCS, FF, etc
Test for core muscle dysfunction
Esp transverse abdominis
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8. Median Nerve Provocative tests
Resisted forearm pronation for 30 to 60 seconds demonstrates compression at pronator teres when symptoms are reproduced
Resisted elbow flexion and supination of the forearm can localize compression to lacertus fibrosis
Resisted long-finger flexion localizes lesion at level of flexor digitorum superficialis (FDS) arch
Supracondylar process can be palpated on medial humeral surface and confirmed with radiographs
EMG/NCV is inconsistent and diagnosis should be made clinically

9. Lacertus Fibrosis
The lacertus fibrosis can be deformed by trauma, repetitive stress, or imbalance of triceps and biceps brachii
Biceps brachii is elbow flexor and most powerful forearm supinator
can be inhibited by over-facilitated triceps due to pancreatic hyperfunction
Hyperinsulinism very common!

10. ICAK Certification Courses
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Supinator Syndrome
Entrapment of Radial nerve beneath Supinator muscle
Symptoms with repetitive forearm motions
esp. throwing
Decreased hand strength, pain deep in posterior forearm
Weakness of extensor carpi ulnaris
Strengthens with approximation of proximal radius and ulna or with lower arm in full supination
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11. ICAK Certification Courses
ICAK BASIC CERTIFICATION COURSE*
Supinator Syndrome…
Test Supinator for normal function
especially fascial involvement
Test for core muscle dysfunction
Esp transverse abdominis
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12. ICAK Certification Courses
ICAK BASIC CERTIFICATION COURSE*
Ulnar Sulcus Syndrome
Entrapment of ulnar nerve in ulnar sulcus of medial epicondyle of humerus
due to laxity or enlargement of epicondylo-olecranon ligament
Symptoms of numbness/tingling and/or pain in ulnar nerve distribution
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13. Ulnar Sulcus Syndrome…
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ICAK BASIC CERTIFICATION COURSE*
Ulnar Sulcus Syndrome…
Weakness of flexor carpi ulnaris in elbow flexion but usually not in extension
Challenge humerus and ulna and adjust
Test ligament for fascial shortening and raw bone supplementation
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