Elbow And Forearm Regions

Biceps + Triceps brachii Olecrenon Process Medial Epicondyle Cubital Fossa Anterior surface elbow  Contents 

 Median Cubital Vein  Brachial Artery  Median Nerve

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Boundaries  Medial= Pronator teres  Lateral= Brachioradialis  Superior= Line between epicondyles

During pronation, the radius rotates over the ulna, and the bones form an “X” During supination, the radius and ulna are parallel

Bi = 2 Heads Tri = 3 Heads Brevis means there is a Longus Digitorum/Digiti = insertion on fingers Pollicis = insertion on pollex (thumb)

Origin:  Long head: Infraglenoid tubercle of the scapula  Lateral head: inferior to greater tubercle of posterior humerus  Medial head: Posterior surface of humerus Insertion: Olecranon process Action: Elbow extension Innervation: Radial nerve Vascular supply: Deep Brachial artery

Origin:  Long head: Supraglenoid tubercle  Short head: coracoid process Insertion: Radial tuberosity of radius Action: Elbow flexion, forearm supination Innervation: Musculocutaneous nerve Vascular supply: Brachial artery

Origin: Coracoid process Insertion: Medial aspect of humerus Action: Weak adductor Innervation: Musculocutaneous, nerves C6, C7 Vascular: Brachial artery

Origin: Distal ½ of humerus, anterior surface Insertion: Coronoid process and ulnar tuberosity of the ulna Action: Elbow flexion Innervation: Musculocutaneous nerve Vascular: Brachial artery

Origin: Lateral supracondylar ridge of the humerus Insertion: Styloid process of the radius Action: Elbow flexion Innervation: Radial nerve Vascular: Radial artery

Origin: Lateral epicondyle of humerus and adjacent ulna Insertion: Anterior surface of the proximal radius Action: Forearm supination Innervation: Radial nerve Vascular: Recurrent interosseous artery

Origin: Medial epicondyle of humerus and coranoid process of ulna Insertion: Lateral aspect of radius at its midpoint Action: Forearm pronation, assistive in elbow flexion Innervation: Median nerve Vascular: Ulnar artery

Origin: Distal ¼ of ulna Insertion: Distal ¼ of radius Action: Forearm pronation Innervation: Median nerve Vascular: Anterior interosseous artery

Extensor Carpi Ulnaris O- lateral epicondyle of humerus I- medial side of the base of fifth metacarpal A- wrist extension, ulnar deviation N-Radial V- Ulnar artery

Extensor Carpi Radialis Brevis O-lateral epicondyle of humerus I-base of third metacarpal A-wrist extension N-Radial nerve V-Radial artery

Extensor Carpi Radialis Longus O-supracondylar ridge of humerus I-base of second metacarpal A-wrist deviation, radial deviation N-Radial V-Radial artery

Extensor Digiti Minimi O-lateral epicondyle of humerus I-base of distal phalanx of fifth finger A-extends all joints of fifth finger N-Radial V-Recurrent interosseous artery

Extensor Digitorum O-lateral epicondyle of humerus I-base of distal phalanx of second-fifth fingers A-extends all three jts of fingers N-Radial V-Recurrent interosseous artery

Extensor Pollicis Longus O-middle posterior ulna and interosseous membrane I-base of distal phalanx of pollex (thumb) A-extends MP and IP jts of thumb N-Radial V-Posterior Interosseous artery

Extensor Pollicis Brevis O-posterior distal radius I-base of proximal phalanx of pollex (thumb) A-extends MP jt of thumb N-Radial V-Posterier Interosseous artery

Abductor Pollicis Longus O-posterior radius, interosseous membrane, middle ulna I-base of first metacarpal A-abducts pollex (thumb) N-Radial V-Posterior interosseous artery

Palmaris Longus O-medial epicondyle of humerus I-palmar fascia A-assistive in wrist flexion N-Median V-Ulnar artery

Flexor Carpi Radialis O-medial epicondyle of humerus I-base of second and third metacarpals A-wrist flexion, radial deviation N-Median V-Radial and Ulnar arteries

Flexor Carpi Ulnaris O-medial epicondyle of humerus I-pisiform, and base of fifth metacarpal A-wrist flexion and ulnar deviation N-Ulnar V-Ulnar artery

Flexor Digitorum Profundus O-upper ¾ of ulna I-distal phalanx of the four fingers A-flexes all three jts of fingers N-Median and Ulnar V-Ulnar artery

Flexor Digitorum Superficialis O-common flexor tendon, coronoid process and radius -sides of the middle phalanx of four fingers A-flexes MP and PIP jts of fingers N-Median V-Ulnar artery

Flexor Pollicis Longus O-anterior surface of radius I-distal phalanx of pollex (thumb) A-flexes all jt of thumb N-Median V-Radial artery

Clinical Concerns Carpal Tunnel Syndrome Compression of carpal tunnel where the median nerve lies Leads to sensory changes over lateral side of hand and muscle weakness in the thenar eminence Creates pain, tingling, and numbness of the fingers Causes:    

Inflammation of digital tendon sheaths Excessive exercise Infection and fluid retention Repetitive activities (keyboarding, plating piano)

Tx: Use of non steroidal anti inflammatory drugs (Ibuprofen, Aspirin) Wear a wrist splint or get cortico steroid injections

Clinical Concerns Cont. Nursemaids Elbow (AKA Tennis Elbow) Painful musculoskeletal condition developed from repetitive use of the superficial extensor muscles of the forearm Pain radiates over the lateral epicondyle down the posterior surface of the forearm

History Observation Visually inspect, including wrsit and elbow  If no deformity present, observe while they supinate and pronate 

Palpation Special Tests

Contusion 

Etiology:direct blow  Why more common to ulna?

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Signs and Symptoms Management

Forearm Splints    

Etiology: repeated severe static contraction Signs and Symptoms:dull ache between extensors, interosseous membrane Management: early season vs late in season? Note: Acute / Chronic exertional compartment syndrome: deep compartment most common and associated with avulsions, distal radius fracture, or crushing injuries; management same as in lower leg

Colles’ fracture    

Etiology: FOA, forces radius and ulna back and up = hyperextension Signs and Symptoms (posterior displacement) Management Reverse Colles’ = fall on back of hand

Forearm Fractures   

Etiology Signs and Symptoms: more common for radius and ulna to fracture simultaneously Management