ELBOW AND FOREARM.pptx5tttttttgtggffffggggggg

Hematological principles

1. CLINICAL ANATOMY OF ELBOW & FOREARM

2. ELBOW JOINT

3. Synovial hinge joint between the arm and forearm Point of articulation between the trochlea and capitulum of the humerus and the trochlea notch of the ulna and head of the radius Made of a capsule that is attached above to the upper margins of the coronoid, radial fossae and to the front of the medial and lateral epicondyles and below to the margin of the coronoid process of ulna and to the anular ligament Posteriorly attached above to the margins of the olecranon fossa of the humerus and below to the upper margin and sides of the olecranon process of the ulna and anular ligament

4. RE-INFORCING LIGAMENTS

5. BURSAE Intratendinous – located within the tendon of the triceps brachii Subtendinous - between the olecranon and tendon of the triceps brachii Subcutaneous/olecranon- between olecranon and overlying connective tissue Bicipitoradial bursa; small bursa separating the biceps tendon from smooth anterior part of the radial tuberosity

6. BLOOD SUPPLY Cubital anastomosis Branches of the brachial, radial and ulnar arteries Brachial artery; superior and inferior ulnar collateral artery Deep brachial artery; middle collateral artery, radial collateral artery Radial artery; radial recurrent artery Ulna artery; anterior ulna recurrent artery, posterior ulna recurrent artery, anterior interosseous artery, posterior interosseous artery

7. CUBITAL FOSSA Area of transition between the arm and forearm Anterior to the elbow Boundaries; brachioradialis laterally and pronator teres medially, imaginary horizontal line between medial and lateral epicondyles at base Contents (lateral to medial); tendon of biceps brachii, brachial artery, median nerve

8. FOREARM Made of two bones Divided into anterior and posterior compartments

9. ANTERIOR COMPARTMENT OF FOREARM This flexor compartment is made up of 3 layers; superficial, intermediate and deep Muscles In this compartment are associated with movement of the wrist joint, flexion of fingers and pronation

10. POSTERIOR COMPARTMENT M ade up of two layers; a superficial and deep layer M uscles associated with; M ovement of the wrist joint E xtension of the fingers in the hand S upination of the forearm

11. OSSIFICATION CENTERS

12. TENNIS ELBOW common problem usually involving extensor digitorum muscle near its origin on lateral epicondyle Also Known as lateral epicondylitis

13. Golfer’s Elbow Also known as Medial Epicondylitis associated with gripping & lifting activities Somewhat less common Associated with medial wrist flexor & pronator group near their origin on medial epicondyle. Involves muscles which cross elbow but act primarily on wrist & hand

14. Nursemaid's Elbow/ Pulled Elbow most common in children from 2 to 5 years of age. Caused by longitudinal traction applied to an extended arm, thus subluxation of the radial head and interposition of the annular (orbicular) ligament into the radiocapitullar joint. Annular ligament is funnel-shaped in adults, but its sides are vertical in young children. (When child is suddenly lifted/pulled up when forearm is in pronated position, head or radius may slips out partially from annular ligament).

15. Symptoms a child with radial head subluxation tends to hold the elbow in slight flexion and the forearm pronated. Physical Exam pain and tenderness localized to the lateral aspect of the elbow.

16. TREATMENT

17. ELBOW NERVE ENTRAPMENT SYNDROMES

18. Entrapment neuropathy is caused by the direct pressure on a single nerve. Symptoms & signs depend on which nerve is affected. Earliest symptoms to occur: tingling & neuropathic pain. Followed by reduced sensation or complete numbness Muscle weakness is noticed later, followed by muscle atrophy.

19. COMPRESSION VENOUS OBSTRUCTION + ISCHEMIA ANOXIC SEGMENT NEURAL EDEMA & DILATATION OF SMALL VESSELS EXACERBATION OF ORIGINAL COMPRESSION CONT OF VICIOUS CYCLE PERSISTENT EDEMA + ANOXIA/ HYPOXIA FIBROSIS IMPAIRMENT OF SUPPLY DEFICIENCY OF VITAL NUTRIENTS FUNCTIONAL IMPAIRMENT PERMANENT IMPAIRMENT OF FUNCTION IF LEFT UNTREATED

20. Fibrous bands of the deep or superficial heads of the pronator teres. LESS COMMMON CAUSES  Anomalous muscles  Enlarged / thrombosed vessels  Tumors  Enlarged bursae CLINICAL FEATURES: Weakness of flexion in the IP joint of the thumb. Weakness of flexion in the DIP joint of index finger. No sensory loss Pain is exacerbated by exercise & relieved by rest. Number of cases occur due to a viral neuropathy.

21. TREATMENT INITIALLY: CONSERVATIVE • SURGICAL: INDICATIONS

22. . ULNAR NERVE • Ulnar nerve gets entrapped at 2 common sites:  At the elbow (cubital tunnel syndrome)  Guyon’s canal (ulnar tunnel syndrome)

23. Thus the integrity of the deep branch may be tested by asking the person to extend the MP joints while the examiner provides resistance. If the nerve is intact, the long extensor tendons should appear prominently on the dorsum of the hand, confirming that the extension is occurring at the MP joints rather than at the interphalangeal joints (movements under the control of other nerves).

24. Fractures of radius and ulna Fractures of the shafts of the radius and ulna may or may not occur together. Displacement of the fragments is usually considerable and depends on the pull of the attached muscles. The proximal fragment of the radius is supinated by the supinator and the biceps brachii muscles. The distal fragment of the radius is pronated and pulled medially by the pronator quadratus muscle. The strength of the brachioradialis and extensor carpi radialis longus and brevis shortens and angulates the forearm. In fractures of the ulna, the ulna angulates posteriorly .

25. To restore the normal movements of pronation and supination , the normal anatomic relationship of the radius, ulna, and interosseous membrane must be regained.

26. A fracture of one forearm bone may be associated with a dislocation of the other bone. In Monteggia's fracture , for example, the shaft of the ulna is fractured by a force applied from behind. There is a bowing forward of the ulnar shaft and an anterior dislocation of the radial head with rupture of the annular ligament. .

27. In Galeazzi's fracture , the proximal third of the radius is fractured and the distal end of the ulna is dislocated at the distal radioulnar joint

28. colles ’ fracture Colles ' fracture is a fracture of the distal end of the radius resulting from a fall on the outstretched hand. It commonly occurs in patients older than 50 years. The force drives the distal fragment posteriorly and superiorly, and the distal articular surface is inclined posteriorly .

29. Smith’s fracture Smith's fracture is a fracture of the distal end of the radius and occurs from a fall on the back of the hand. It is a reversed Colles ' fracture because the distal fragment is displaced anteriorly

30. Compartment syndrome of the forearm Is condition in which increased pressure in fascial compartment and compromises circulation within the space, as well as the function of tissues in that area causing ischemia. There are 4 compartments: Dorsal, volar (superficial ,deep) and mobile wad

31. It may cause fracture or traumatic injury Sensory change first 30min Irreversible nerve damage in12-24hrs Irreversible muscle change (necrosis) in 3-8hrs

32. Treatment Surgical decompression and fasciotomy is done for acute forearm compartment syndrome to avoid irreversible muscle and nerve damage.

33. Radial apalasia Is congenital defect that affects formation of radius bone in the forearm. The radius is the lateral bone which connects arm to the wrist via articulation of carpal bones. It includes defect where the bone is absent or shorter than usual. Developing early pregnancy not inherited which is unknown cause, and this is rare defect affects 1 in 30,000 babies. Radial aplasia also results in the thumb being either partly formed or completely absent from the hand, which can result in difficulties performing activities of daily living.

34. There is risk factors which can cause radial apalasia including uncontroled DM, medication taken early pregnancy. Management There is no treatment available during pregnancy. After delivery depending on severity of arm defect: After examinations including x-ray and blood tests, initially should corrected by placing cast or splints along the abnormal arm. If surgery needed, usually occur first year of life.