Chapter 14

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