Forearm

1) Elbow tendinitis/ Lateral Epicondylitis tennis elbow think tennis backhand

a. Painful musculoskeletal condition
b. Clinical presentation:
i. Pain over lateral epicondyle radiates down to posterior surf of forearm
ii. Pain when opening door/ lifting glass
c. Cause:
i. Repetitive use of superficial extensor muscles E.g. ECRL, ECRB, ED, EDM,
ECU
ii. Repeated forceful flexion and extension of wrist common extensor
tendon attachment strained
d. Result:
i. Inflammation of periosteum of lateral epicondyle (lateral epicondylitis)
2) Mallet/ Baseball Finger
a. Long extensor tendon avulsed(torn away) from part of phalanx
b. Cause:
i. Sudden severe tension on long extensor
tendon
1. Eg baseball miscaught
2. Eg finger jammed into mouse base
pad (AHAH ELLEN :D)
c. Result:
i. Distal interphalangeal joint (DIP) forced in to hyperflexion (extreme
flexion)
ii. Unable to extend distal phalangeal joint
1. Attachment of tendon to base of distal phalanx avulsed
3) Olecranon Fracture fractured elbow
a. FUNFACTS:D
i. Olecranon is subcutaneous and protrusive thus common to fracture
b. Cause:
i. Fall on elbow combined w sudden contraction of
ticeps brachii
c. Result: Avulsion Fracture
i. Fractured olecranon pulled away by active and
tonic contraction of triceps
d. Treatment:
i. Pinning(usually required)
1. Traction produced by tonus of triceps on olecranon fragment
ii. Slow (often cast worn for extended time)
4) Median Nerve Injury - Hand of Benediction (when try to close fist)
a. Median nerve severed at elbow
b. Results:
i. Flexion affected @ MC joint, PIP joint and DIP joints
1. Metacarpophalangeal (MC) Joints- Hand of Benediction (when person
tries to make fist)
a. 2nd and 3rd affected (median nerve supplied 1st and 2nd
lumbricals)
2. Proximal interphalangeal (PIP) joints
a. 1st (Lost)
b. 2nd (Lost)
c. 3rd (Lost)
d. 4th (weakened)
e. 5th (weakened)
3. Distal interphalangeal (DIP) joints
a. 2nd (Lost)
b. 3rd (Lost)

c. 4th (Not affected because medial part of FDP innervated by

ulnar nerve)
d. 5th (Not affected because medial part of FDP innervated by
ulnar nerve)
ii. Thenar Muscles
1. Function lost (same in Carpal tunnel syndrome)
2. Function not lost but Paresis (partial paralysis) of FDP and FPLAnterior interosseous syndrome if only anterior interosseous nerve
is affected
a. Injury of anterior interosseous nerve (branch of median nerve
supplying deep muscles of forearm except ulnar half of FDP
and FCU)
iii. Anterior Interosseous Syndrome
1. Clinical test signs:
a. Pinch posture results when attempt to make
OK sign
i. X flexion at IP joint of thumb
ii. X flexion at DIP joint of index finger
5) Pronator Syndrome (Median nerve compression)
a. Nerve entrapment syndrome
b. Cause:
i. Compression of median nerve near elbow (nerve compressed btwn heads
of pronator teres)
1. Trauma
2. Muscular hypertrophy (large growth steroids)
3. Fibrous bands (some fibre)
c. Clinical presentation:
i. Pain and tenderness in proximal anterior forearm
ii. Hypesthesia ( loss of sensation) of palmar aspects of radial three and a
half digits (including adjacent palm)
iii. Symptoms follow activities that require repeated pronation
6) Injury of Ulnar nerve at Elbow and in forearm (4) Medial epicondyle funny bone
fracture, Cubital fossa syndrome, Ulnar canal syndrome/ Guyon Tunnel syndrome, Claw
hand Refer to Ulnar Canal syndrome and handlebar neuropathy in HAND
section
a. > 27% of nerve lesions of UL affect ulnar nerve
b. Results:
i. Numbness and tingling (paresthesia)
1. medial part of palm
2. medial one and a half fingers
3. Claw hand
ii. Severe: Elbow pain that radiates distally
c. Possible locations of Ulnar nerve injuries (4):
i. Posterior to medial epicondyle (most common)- medial epicondyle funny
bone fracture
1. Medial elbow hits hard surface
ii. Lesion superior to medial epicondyle Paresthesia of median part of
dorsum of hand
iii. Compression at elbow affects cubital tunnel Cubital tunnel syndrome
(Cubital tunnel formed by tendinous arch connecting humeral and ulnar
heads of FCU)
1. Compression of ulnar nerve at elbow
2. Severe compression pain tt radiates distally
iv. Wrist- Ulnar canal syndrome = Guyon Tunnel syndrome (uncommon)
1. Compression of ulnar nerve at ulnar canal
v. Hand-Claw hand (main en griffe)- hyperextension of MCP joints and
flexion of PIP of 4th and 5th digits)

1. Cause:
a. Injury to nerve at distal part of forearm
b. Atrophy of interosseous muscles of hand supplied by ulnar
nerve
c. Claw produced by: unopposed action of extensors and FDP
2. Result: most intrinsic muscles of hand denervated
a. Adduction of wrist impaired
b. Hand drawn to lateral side (outwards towards radial side)
when wrist joint flexed
i. inbalance of FCU (absent) and FCR (supplied by
median nerve)
c. Unable to make fist
d. Metacarpophalangeal joints hyper extended
i. Opposition absent
e. Cannot flex 4th and 5th digits at DIP when making fist
f. Cannot extend IP joints when trying to straighten fingers
d. Ulnar paradox
i. Ulnar nerve innervates medial half of FDP. If lesion of nerve occurs
proximally, the FDP may be denervated, resulting in weakened IP joints,
reducing the claw hand appearance (4 th and 5th fingers are simply
paralyzed in fully extended position)
ii. Paradox because one would expect a more deformed appearance if lesion
is proximal than distal.
iii. As Reinnervation occurs after proximal lesion, deformity will get worse
(FDP is reinnervated). Close to the paw, the worse the claw
7) Injury of Radial Nerve- Wrist Drop
a. Cause:
i. Fracture of humeral shaft
b. Types:
i. Injury of radial nerve is proximal to motor branches to long and short
extensors of wrist Wrist Drop (See injury to radial nerve in arm, in
Arm and Cubital fossa)
ii. Deep injury penetrating posterior side of forearm
1. Result
a. Inability to extend thumb
b. Inability to extend MC joints of other digits
c. NO loss of sensation
i. Deep branch of radial nerve entirely muscular and
articular
2. Test: For deep branch integrity
a. Ask person to extend MP joints while examiner provides
resistance (unclench fist with resistance)
b. Long extensor tendons appear prominently on dorsum of
hand if nerve is intact (confirms tt extension is occurring at
MP joints instead of IP joints)
iii. Superficial Branch (cutaneous nerve) of Radial nerve injured
1. Result:
a. Coin-shaped area of anaesthesia at distal base of 1 st and 2nd
metacarpals (sensory loss minimal)
i. High overlap from cutaneous branches of medial and
ulnar nerve
8) Synovial Cyst of Wrist Carpal tunnel Syndrome
a. Cause : Unknown
b. Clinical Presentation:
i. Non- tender cystic swelling (Type of swelling: Ganglion (swelling/knot))
1. Cyst contains clear mucinous fluid
ii. Varies in size ( grape size- plum size)

iii. Flexion of wrist Cyst enlarge, may be painful

c. Commonly occurs on
i. Dorsum of hand
ii. Distal attachment of the ECRB tendon to the base of the 3 rd metacarpal
iii. Large cystic swelling on common flexor synovial sheath on anterior aspect
of wrist CTS (compression of median nerve)
1. Pain in sensory distribution of median nerve
2. Paresthesia in sensory distribution of median nerve
3. Clumsiness of finger movements
d. FUNFACTS :D
i. Synovial cyst communicate with synovial sheaths on dorsum of hand
9) Cubital Tunnel Syndrome
a. Ulnar nerve entrapment
i. Ulnar nerve compressed in cubital tunnel by tendinous arch connecting
ulnar and humeral head of FCU attachment
b. Symptoms:
i. Same as if ulnar nerve lesion occurs at ulnar groove on posterior medial
epicondyle of humerus
10)
Measuring pulse rate
a. Location:
i. Anterior distal radius, lateral to FCR
1. Artery only covered by fascia and skin at this position
2. Can be compressed btwn FCR and APL tendons
ii. Press lightly over anatomical snuff box
b. * Clin skills
i. X use thumb to take pulse because pulp of thumb has its own pulse
ii. If pulse cant be felt, try other wrist
1. Aberrant artery (artery with unusual origin or course) on one side
may make pulse difficult to palpate
11)
High Division of Brachial Artery
a. Brachial artery divides at more proximal level than usual ulnar and radial
arteries begin in superior/middle arm ( Median nerve still passes between unlar
and radial artery)
12)
Superficial Ulnar artery
a. Ulnar nerve descends superficial to flexor muscles
b. 3% of ppl
c. Pulsations felt and visible
d. Clinical significance:
i. Keep variation in mind when doing
1. Venessections for drawing blood
a. Aberrant artery mistaken for vein damage and bleeding
2. IV injections
a. If certain drugs injected into aberrant artery, result could be
FATAL (DUN DUN DUNNNNN)
13)
Variations in Origin of Radial Artery
a. Origin of radial artery more proximal than usual (branch or axillary artery or
brachial artery)
b. Radial artery may be superficial to deep fascia instead of deep to it
i. Clinical significance:
1. Vulnerable to laceration
14)
Communications between median and ulnar nerves
a. Occurs in forearm
b. Branches- slender nerves
c. Clinical Significance:
i. Erroneous conclusion that median nerve not damage although it has been
damaged

1. Due to communications, some muscles may not be paralysed

although there is complete lesion of median nerves