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Chapter 14 – The Elbow and Forearm

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

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Chapter 14 – The Elbow and Forearm

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  1. Chapter 14 – The Elbow and Forearm Pages 507 - 511

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

  3. 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

  4. 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

  5. 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

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

  7. 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

  8. 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

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

  10. 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

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