10/15 Olecranon and Radial Head

Question 1

Carrying Angle

Answer 1

With arm in anatomic position, the angle formed at the elbow by the upper arm and the forearm in a valgus position

• As carrying angle increases  wrist aDduction
• As carrying angle decreases  wrist aBduction

Greater in women (10-15o) then in men (5o)

• If >15o it is called cubitus valgus
• If reversed it is called cubitus varus (AKA gunstock deformity- strait with a hitch)

Question 2

What happens when the elbow (olecranon of the ulna) abducts? and vice versa???

Answer 2

As the olecranon of the ulna (elbow) aBducts, the wrist aDducts

As the olecranon of the ulna aDducts, the wrist aBducts

somatic dysfunction of the elbow:
Adducted elbow or abducted elbow

This is a very minor motion of the elbow joint

**Dysfunction of this joint is usually the primary somatic dysfunction of the elbow with the radiohumeral joint being secondary

Question 3

What will be findings with elbow/forearm abduction with medial glide?

Answer 3

• Increased carrying angle
• Olecranon prefers medial glide
• Distal forearm prefers abduction
• Radial head may be compressed on the capitulum of the humerus
• Hand (wrist) may prefer relative adduction at radiocarpal joint

Question 4

What will be seen with elbow (forearm) adduction with lateral glide?

Answer 4

• Gunstock deformity
• Olecranon prefers lateral glide
• Distal forearm prefers adduction
• Radial head is gapped at the capitulum and drawn into the annular ligament.
• Hand (wrist) may prefer relative abduction at the radiocarpal joint

Question 5

what are the main supinators and main pronators

Answer 5

supinator = biceps

pronator = pronator teres

Question 6

Radial Head dysfunction: with pronation of hand, what happens to radial head?

Answer 6

The radius has reciprocal motion

• With pronation of the hand, the radial head glides posterior
• With supination of the hand, the radial head glides anteriorly

Question 7

What is a common posterior radial head somatic dysfunction?

Answer 7

• falling forward and bracing with hands
• Radius crosses over the ulna and creates a fulcrum.
• This fulcrum causes the distal radius to move anteriorly.
• Anterior movement of the distal radius causes the radial head to move posteriorly.

Falling forward onto your palm with an outstreched arm
The hand is in a pronated position and the forward force vector pushes the distal radius into greater anterior rotation thereby causing the radial head to move posteriorly

Question 8

what is a comon fall resulting in radial head anterior dysfunction?

Answer 8

Backward fall and bracing with the hands leads to radial head anterior somatic dysfunction.

• At the endpoint of supination, the distal radius moves posteriorly.
• Because of the actions of the interosseous ligaments, this causes the radial head to glide anteriorly.

Falling backward onto your palm with an extended arm
The hand is in a supinated position and the impacting force vector pushes the distal radius into greater posterior rotation thereby causing the radial head to move anteriorly.

Question 9

SAPP

Answer 9

Supination of forearm=Anterior radial head
Pronation of forearm=Posterior radial head

Question 10

Somatic dysfunction of the wrist

Answer 10

If the wrist hurts, look at the elbow!

• This maybe the only sign of SD elbow
• SD of the wrist generally involve the small gliding motions of the wrist
• Can have large motion loss in flexion & extension with small somatic dysfunctions of the wrist
• If caused by falls on outstretched hands, they will have a compression component
• Must rule out fracture

Question 11

Where is somatic dysfunction in the carpals usually seen?

Answer 11

Somatic dysfunction is usually seen in the anterior or posterior glide of these joints.

• anterior and posterior interosseous ligaments.

Major motions of MCPs, PIPs and DIPs:

Major Motions:

• Flexion/Extension
• ABduction/ADduction (MCPs)

Minor Motions

• Anterior/Posterior
• Medial/Lateral
• Internal/External Rotation
• Traction/Compression

Question 12

where do most compression fractures of the hand and fingers come from? i.e. soccer goalies, bball player, gymnast, boxers?

Answer 12

• CMC (carpometacarpal) joints SD almost always have a compression component to them esp if motion is restricted in both dorsal and ventral glide
• Dysfunction is usu found in dorsal/ventral glide
• 1st CMC (thumb) generally has compression SD or strain or a true sprain rather than a pure somatic dysfunction