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Chapter 14 – The Elbow and Forearm

Chapter 14 – The Elbow and Forearm. Pages 511 - 516. Epicondylitis. Lateral and medial condyles Origin for many muscles acting on wrist and fingers Inflammation of tendons Prolonged stressful loads may result in stress of avulsion fractures. Lateral Epicondylitis.

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Chapter 14 – The Elbow and Forearm

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  1. Chapter 14 – The Elbow and Forearm Pages 511 - 516

  2. Epicondylitis • Lateral and medial condyles • Origin for many muscles acting on wrist and fingers • Inflammation of tendons • Prolonged stressful loads may result in stress of avulsion fractures

  3. Lateral Epicondylitis • Common attachment for wrist extensor group • Extensor carpi radialis – most commonly affected • “Tennis Elbow” • Evaluative Findings • Table 14-4, page 512

  4. Lateral Epicondylitis • Test for Lateral Epicondylitis (Tennis Elbow Test) • Box 14-6, page 512 • Treatment • Avoiding aggravating activities • Anti-inflammatory meds/modalities • Stretching/strengthening • “tennis elbow” straps • Asses equipment and techniques

  5. Medial Epicondylitis • Powerful snapping of wrist, pronation • Evaluative Findings • Table 14-5, page 513 • “Little Leaguers Elbow” • Avulsion of common flexor tendon from attachment site • May cause neuropathy of ulnar nerve • Treatment similar to lateral epicondylitis

  6. Distal Biceps Tendon Rupture • Loss of strength during elbow flexion and supination • MOI – eccentric loading when elbow is extended • Immediate pain, “pop” • Evaluative Findings • Table 14-6, page 514 • Treatment – surgical repair

  7. Osteochondritis Dessicans of the Capitellum • Valgus loading compressing redial head and capitellum with overhead throwing • May be result of disrupted blood flow to area creating osteochondral defect • Evaluative Findings • Table 14-7, page 515 • Treatment • Surgical vs. non-surgical

  8. Nerve Trauma • Inhibition of radial, ulnar, and median nerves in elbow causes symptoms to radiate distally • Dysfunction characterized by paresthesia, decreased grip strength, inability to actively extend wrist

  9. Ulnar nerve trauma • Crosses medial aspect of elbow joint line superficially, predisposing it to concussive forces • Unstable supporting structures = chronic subluxation as elbow is flexed = inflammation = decrease in size of cubital fossa = compression of ulnar nerve

  10. Ulnar nerve trauma • Acute trauma • Burning sensation in medial forearm, little finger, ring finger • Decreased strength of finger flexors, thumb abductors, flexor carpi ulnaris • Chronic deficit • Causes hand to deviate radially during flexion • Clawhand

  11. Radial nerve trauma • Injured by deep laceration or secondary to fractures of humerus or radius • Deep branch • Dedicated to motor function of thumb, wrist, and finger extensors, supinators • Superficial branch • Sensory loss on posterior forearm and hand

  12. Radial nerve trauma • Tinel’s Sign • Figure 14-20, page 515 • Radial Tunnel Syndrome (RTS) • Entrapment of radial nerve • Resembles lateral epicondylitis; RTS symptoms persist for more than 6 months

  13. Median nerve trauma • Typically compressed or injured on distal portion of forearm • Pressure in cubital fossa may compress nerve • Carpal tunnel syndrome • Discussed in Chapter 15 • Pronator teres syndrome • The anterior interosseous nerve portion of the median nerve compressed by pronator teres

  14. Forearm Compartment Syndrome • 3 compartments • Volar, dorsal, mobile wads • Increased pressure result of: • Hypertrophic muscles • Hemorrhage • Fracture • Increases risk for compromising circulation and neurologic function of hand

  15. Forearm Compartment Syndrome • S & S • Pressure in forearm • Sensory disruption in hand and fingers • Decreased muscular strength • Pain during passive elongation of muscles • Most commonly affected • Flexor digitorum profundus, flexor pollicis longus • Volkmann’s ischemic contracture • Surgery used to release pressure

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