• Anatomy:Clinical correlation of forearm by

• Dr.liban ahmed ali siad (dr.al-beydhar)

Benadir unuversity

Fracture of the Radial Head and Neck

• Fractures to the proximal radius often involve either the head or the neck of the radius. These fractures can result from a

• fall on an outstretched hand (indirect trauma) or a direct blow to the elbow.

Cont……

• Fracture of the radial head is more commonin adults. whereas fracture of the neck is more common

in children.

Cont….

• There are three types of radial head fructurea. Small chip fracture of radial head.b. Large fracture of radial head with

displacement.c. Comminuted fracture of radial head.

3 types of fructural head

a b c

Fracture of radial neck is more common in children

Fracture of the Ulna Shaft• Usually, a direct blow to

or forced pronation of the forearm is the most common cause of a fracture of the shaft of the ulna.

• Fracture of the ulna with dislocation of the proximal radioulnar joint is termed a Monteggia fracture.

Fracture of the Ulna Shaft

Fracture of the Olecranon

• Fracture of the olecranon, called a fractured elbow by laypersons, is common because the olecranon is subcutaneous and protrusive.

• The typical mechanism of injury is a fall on the elbow combined with sudden powerful contraction of the triceps.

• The fractured olecranon is pulled away by the active and tonic contraction of the triceps.

Fracture of the Olecranon

Normal olecranon Fractured olecranon

Elbow Tendinitis or Lateral Epicondylitis

• Elbow Tendinitis or Lateral Epicondylitis• Elbow tendinitis (tennis elbow) is a painful

musculoskeletal condition that may follow repetitive use of the superficial extensor muscles of the forearm.

• Pain is felt over the lateral epicondyle and radiates down the posterior surface of the forearm

• People with elbow tendinitis often feel pain when they open a door or lift a glass. Repeated forceful flexion and extension of the wrist strain the attachment of the common extensor tendon, producing inflammation of the periosteum of the lateral epicondyle (lateral epicondylitis).

Synovial Cyst of the Wrist

• Sometimes a non-tender cystic swelling appears on the hand, most commonly on the dorsum of the wrist

• The thin-walled cyst contains clear mucinous fluid.

• The cause of the cyst is unknown, but it may result from mucoid degeneration (Salter, 1999).

• Flexion of the wrist makes the cyst enlarge, and it may be painful.

• Anatomically, a ganglion refers to a collection of nerve cells

• Clinically, this type of swelling is called a ganglion

Synovial cyst

Synovial cyst

Synovial cyst

Extensortendons

Synovialsheaths(purple)

High Division of the Brachial Artery

• Sometimes the brachial artery divides at a more proximal level than usual.

• The musculocutaneous and median nerves commonly communicate as shown in this illustration.

Cont…

• In this case, the ulnar and radial arteries begin in the superior or middle part of the arm, and the median nerve passes between them .

Brachialartery

UlnarArtery

MedianNerve

RadialArtery

Medialepicondyle

Variations in the Origin of the Radial Artery

• The origin of the radial artery may be more proximal than usual; it may be a branch of the axillary artery or the brachial artery. Sometimes the radial artery is superficial to the deep fascia instead of deep to it.

Superficial Ulnar Artery

• In approximately 3% of people, the ulnar artery descends superficial to the flexor muscles.

• This variation must be kept in mind when performing venesections for withdrawing blood.

Cont..

• or making intravenous injections.• If an aberrant ulnar artery is mistaken for a

vein, it may be damaged and produce bleeding.

• If certain drugs are injected into the aberrant artery, the result could be fatal

Cont..

• Pulsations of a superficial ulnar artery can be felt and may be visible

Superficialulnar artery

Measuring Pulse Rate

• The common place for measuring the pulse rate is where the radial artery lies on the anterior surface of the distal end of the radius, lateral to the tendon of the FCR.

• Here the artery is covered by only fascia and skin.

• The artery can be compressed against the distal end of the radius, where it lies between the tendons of the FCR and APL.

Count…

When measuring the radial pulse rate, the pulp of the thumb should not be used because it has its own pulse, which could obscure the patient’s pulse.

If a pulse cannot be felt, try the other wrist because an aberrant radial artery on one side may make the pulse difficult to palpate.

A radial pulse may also be felt by pressing lightly in the anatomical snuff box.

Medical procedure of pulse measurment

wrist radial artery pulsation

Median Nerve Injury

• When the median nerve is severed in the elbow region, flexion of the proximal interphalangeal joints of the 1st–3rd digits is lost and flexion of the 4th and 5th digits is weakened.

• Flexion of the distal interphalangeal joints of the 2nd and 3rd digits is also lost.

• Flexion of the distal interphalangeal joints of the 4th and 5th digits is not affected because the medial part of the FDP, which produces these movements, is supplied by the ulnar nerve.

• The ability to flex the metacarpophalangeal joints of the 2nd and 3rd digits is affected because the digital branches of the median nerve supply the 1st and 2nd lumbricals.

• Thenar muscle function (function of the muscles at the base of the thumb) is also lost, as in carpal tunnel syndrome “Carpal Tunnel

• Syndrome”

• Thus, when the person attempts to make a fist, the 2nd and 3rd fingers remain partially extended (“hand of benediction”)

• Inability to flex distalinterphalangeal joint ofindex finger.

Injury of ulnar nerve at elbow and in forearm

• More than 27% of nerve lesions of the upper limb affect the ulnar nerve (Rowland, 2005). • Ulnar nerve injuries usually occur in four places: • (1) posterior to the medial epicondyle of the humerus,• (2) in the cubital tunnel formed by the tendinous arch

connecting the humeral and ulnar heads of the FCU, • (3) at the wrist, and • (4) in the hand.• Ulnar nerve injury occurs most commonly where the nerve

passes posterior to the medial epicondyle of the humerus

• Any lesion superior to the medial epicondyle will produce paresthesia of the median part of the dorsum of the hand.

• Ulnar nerve injury usually• produces numbness and tingling (paresthesia) of the

medial part of the palm and the medial one and a half fingers.

• Ulnar nerve injury can result in extensive motor and sensory loss to the hand.

• An injury to the nerve in the distal part of the forearm denervates most intrinsic hand muscles

• Ulnar nerve injury usually

produces numbness and tingling (paresthesia) of the medial part of the palm and the medial one and a half fingers.

Palmardigitalbranches

Palmarbranch

Injury of Radial Nerve in Forearm(Superficial or Deep Branches)

• The radial nerve is usually injured in the arm by a

• fracture of the humeral shaft. • This injury is proximal to the motor branches to

the long and short extensors of the wrist from the (common) radial nerve, and so wrist-drop is the primary clinical manifestation of an injury at this level “Injury to the Radial Nerve in Arm”

• Injury to the deep branch of the radial nerve may occur when wounds of the posterior forearm are deep (penetrating)

• Severance of the deep branch results in an inability to extend the thumb and the metacarpophalangeal (MP) joints of the other digits.

• Test:Thus the integrity of the deep branch may be tested by asking the person to extend the MP joints while the examiner provides resistance

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