Other Less common lateral Flashcards
PIN Pathophysiology
- entrapment of radial or PI branch of radial b=nerve between the radiohumeral joint and the supinator muscle
- radial nerve divides at the level of the capitellar joint
- PIN passes distal to the origin of the ECRB, enters the arcade of Frohse to emerge from supinator muscle distally
4 sites of compression: -fibrous bands in front of the radial head -recurrent radial vessel arcade of Frohse (supinator muscle) Tendinous margin of ECRB
PIN MOI
- compression of the nerve as it passes through the supinator muscle
- can be from hypertrophy of supinator–> overuse repetitive pronation and supination or from traumatic injuries (elbow joint fracture)
PIN Complaints
- sensation changes in hand and lateral forearm
- pain over forearm extensor mass
- wrist aching
- pain in middle or upper third of humerus
PIN Physical exam: Obs
Muscle change–> hypertrophy of supinator muscle
PIN Physical exam: palpation
- pain with sustained palpation or through static contraction of the supinator muscles
- maximal tenderness over the supinator muscles (4 fingers down from lateral epicondyle).
PIN Physical exam: movement exam
- compression leads to weakness of thumb abductors and extensors and wrist muscles
- painful to radially deviate
- pain/weakness on resisted supination of the forearm with elbow flexed at 90 degrees and the forearm fully pronated.
- pain and focal weakness also with resisted 3rd MCP (middle finger) ext with elbow ext
PIN Management
A& E
- relative rest, avoid age positions, possibly NSAIDs
- altered sensation
Cause of nerve compression
- muscle overactivity/tighness
- muscle weakness/imbalance
- RH joint mobility
Manual therapy
- soft tide over supinator
- neural mobilisations
Exercise
- target strength and endurance deficits in forearms muscles
- stretching
Posterolateral rotator instability, Pathophysiology
- tearing of the lateral ulnar collateral ligament resulting in PLRI
- whole forearm can sublet into supination
Posterolateral rotator instability, prevalence
-more common/likely than varus (LCL) instability
Posterolateral rotator instability, MOI
- traumatic (fall)
- acute or chronic (PLRI resulting from chronic lateral epiondylalgia)
- may hear a pop
Posterolateral rotator instability, Complaints
- clicking, locking with pronation and supination
- pain when pushing up from chair
- painful snapping or feeling of instability in the elbow during flex and ext with forearm supinated
Posterolateral rotator instability, Physical examination
Obs
-whole forearm may sublux into external rotation (supination)
Movement
+ posterolateral draw test (full elbow flex and supination, then distract radius back
+tabletop relocation test (pain and apprehension during elbow ext with sup
Posterolateral rotator instability, Management
- glides
- TDT push up abduction and external rotation
LCL injury
-High impact trauma
-Complains of lateral elbow pain radiating from epicondyle to radius head
-possible decreased ext ROM–> causes ligament to be taut and reproduces pain
+ Varus stress test
Management
- correcting poor technique
- soft tissue therapy (acute effleurage)
- muscle strengthening (forearm extensors)
- incomplete 3-6 wks brace
