ELBOW

Anatomy

The elbow and forearm form a functional unit whose primary role is to accurately position the hand in space. view 

Elbow Contusion

An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains. view 

Ligament Tears and Elbow Fractures

Fractures about the elbow are the result of high energy injuries. view 

Forearm Compartment Syndrome

Compartment syndrome in all extremities is an orthopedic emergency. view

Elbow/Forearm Wounds/Amputations

Wounds occurring in the forearm and elbow must be treated as an emergency because the risk of infection if left open increases about 7 hours after an injury has occurred. view

Elbow Arthritis

Arthritis in the elbow can occur after an injury (post-traumatic arthritis), congenital lack of blood supply to the bone causing flaking off of the cartilage called Osteochondritis Dessicans. view

Cubital Tunnel Syndrome

Cubital tunnel syndrome is the compression of the ulnar nerve at the level of the elbow. view

Pronator Syndrome

Pronator syndrome is the compression of the median nerve around the elbow and palmar side of the forearm. Because it is the same nerve that causes carpal tunnel syndrome, there is overlap in the symptoms making the diagnosis difficult, at times. view

RTS & PIN Palsy

Radial tunnel syndrome and posterior Interosseous Nerve palsy are both a result of compression of the Posterior interosseous nerve with a more severe compression occurring in posterior interosseous nerve palsy. view

Lateral Epicondylitis, Medial epicondylitis, Distal Biceps Tendon Rupture

Lateral epicondyltis also called tennis elbow and medial epicondylitis called golfers elbow is a condition affecting the forearm muscles on the humeral bone at the elbow called the lateral and medial epicondylitis respectively. view

Elbow Stiffness

The cause of a stiff elbow is either at the bony level or the collagen capsule/ligament level or both. view

Elbow and Forearm Infections

The elbow, like the shoulder is well perfused with ample blood supply allowing for circulating white blood cells to offer excellent protection against infection and, consequently an elbow infection is uncommon. view

Elbow Tumors

Tumors are divided into benign and malignant types. A benign tumor is an abnormal growth of a particular cell type presenting as a mass. view

RADIAL TUNNEL SYNDROME…

Pathology

Radial Tunnel Syndrome (RTS) and Posterior Interosseous Nerve (PIN) Palsy are both a result of compression of the posterior interosseous nerve.

RTS results from more mild compression, and PIN Palsy occurs with more severe compression.

Posterior Interosseous Nerve (PIN) is the motor branch of the radial nerve. It arises at the lateral border of the elbow when it splits from the sensory part of the radial nerve, the superficial radial nerve.

Common Causes of PIN Compression

  • A tight fascia (layer of fibrous tissue) at the carpi radialis brevis muscle, forearm muscle that extends and abducts the wrist
  • Dense less elastic entry at the Arcade of Froshe, a fibrous arch over the PIN
  • Presence of fibrous bands along the course of the PIN
  • A arterial array of vessels branching off the radial artery called the leash of Henry vessels
  • A cystic mass or ganglion from the joint pressing on the nerve in patients with rheumatoid arthritis

Symptoms of Radial Tunnel Syndrome (RTS)

  • Pain
  • Weakness
  • Arm fatigue as a result of repetitive use or from a direct traumatic event

When the compression is more severe, there is severe weakness and an inability to raise the fingers, which is the hallmark of PIN palsy.

RTS can accompany tennis elbow in 5%-30% of cases. RTS must be considered when treating tennis elbow because not addressing existing RTS will result in persistent lateral elbow and dorsal forearm pain.

A PIN palsy in a patient without injury and that is severe or progressive is considered to be the result of a tumor until proven otherwise. An MRI of the forearm in this case is indicated.

If there is no tumor, the MRI can confirm atrophy of the muscles innervated by the PIN.

Treatment

Nonsurgical Treatment of RTS

Most RTS cases can be resolved with:

  • Activity modification
  • Home exercise program
  • A steroid injection
  • Properly conducted therapy program

The key in the therapy program is stretching the tight fascia elements of the muscles that trap and bind the posterior interosseous nerve (PIN).

About three months of supervised therapy is usually needed to fully resolve the problem. The exercise program is directed at stretching tight muscles and their respective fascia.

If tight bands, ganglion cysts or vascular leashes which are an anatomic static change are the cause of compression, these will usually not respond to stretching and will often require surgical release.

Surgery involves a short incision over the dorsal forearm that takes about fifteen minutes to perform. Only the arm is put to sleep and the use of the hand after surgery is allowed immediately.