W2 elbow, wrist and hand with CS

how to diagnose a posterior vs anterior radial head (what will the findings be)

*posterior radial head* forearm fully pronates, supination is restricted may occur with fall onto pronated hand (forward fall) *anterior radial head* forearm fully supinates, pronation is restricted may occur with fall onto supinated hand (backward fall)

describe the naming and findings of ulnar somatic dysfunction

*ulnar somatic dysfunctions are named for the distal ulna* ulnar abduction wrist prefers ADDuction, distal forearm prefers abduction radial head may be compressed on the capitulum ulnar adduction w lateral glide wrist prefers ABDuction, distal forearm prefers ADDuction olecranon prefers lateral glide

describe the mechanics of the forearm that occur with ulnar displacement

NEUTRAL ULNA normal carrying angle olecranon glides freely wrist is neutral ULNA ABDUCTED *wrist adducted* incr carrying angle olecranon is restricted in lateral movement ULNA ADDUCTED *wrist abducted* decr carrying angle olecranon is resisted in medial movement

flexor carpi ulnaris TP location and treatment position

distal attachment at the 5th metacarpal/pisiform F Add

flexor carpi radialis TP location and treatment position

distal attachment to the base of the 2nd and 3rd metacarpal F Abd

extensor carpi radialis TP location and treatment position

distal attachment to the base of the 2nd metacarpal E Abd/rd (rd --> radial deviation)

extensor carpi ulnaris TP location and treatment position

distal attachment to the base of the 5th metacarpal E Add

what are the steps to diagnose ulnar dysfunctions

grasp over the proximal radioulnar region introduce translation into the joint with repeated motions of flexion and extension, testing for resistance compare with other side

abductor pollicis brevis TP location and treatment position

in the mm belly in the thenar eminence F (wrist) Abd (thumb)

what are some of the common causes of elbow pain

olecranon bursitis rheumatoid nodules arthritis medial or lateral epicondylitis cubital tunnel syndrome (can be caused by prolonged elbow flexion)

soft tissue technique of the interosseus membrane

palpate the anterior forearm along the course of the interosseus membrane to assess for any tightness or tenderness place thumbs over the affected area and find the restrictive barrier, apply motion in an indirect or direct fashion to relive the tension

what are the steps to diagnose for radial dysfunction

palpate the posterior aspect of the radial head and assess the relationship with the capitulum -assess for TART changes with lateral hand, palpate the radial head at the articulation with the humerus -have pt relax arm introduce supination and pronation and assess for any restriction *restricted supination = posterior radial head, restricted pronation = anterior radial head*

carpal tunnel soft tissue technique

patients hand is facing with the palm upward physician places thumbs on the medial and lateral attachments of the transverse carpal ligament physician exerts tension on the carpal region and pushing the thumbs apart pressure is held for 20-60 seconds or until tension releases

radioulnar pronation muscle energy

performed when pt has a *posterior radial head* restrictive barrier is *toward supination* stablize elbow and hold patients hand as if in handshake physician force toward supination, pt toward pronation *can also be performed with an anterior radial head and push into pronation*

articulatory traction of the wrist

physician cups hands to form a groove in each hand place hands over the patients hand and produce traction over the intercarpal joints separate the thenar and hypothenar eminences with an articulatory force

what motions of the radial head occur with supination and pronation

pronation radius crosses over the ulna anteromedial movement of distal radius causes the *radial head to move posterior* supination distal end of the radius moves posterolaterally and the *radial head will glide anteriorly* -causes increased stretch of the interosseus membrane

pronator teres TP location and treatment position

proximal attachment point to the medial epicondyle of the humerus F PRO Add

supinator TP location and treatment position

supinator attachment point to the proximal radius E SUP Val (val --> lateral to medial force)